INFLAMMATORY RHEUMATISM AND NASAL POLYPOSIS

We report five cases of seronegative inflammatory rheumatism associate d with nasal polyposis. The patients were four women and one man, mean age 49.5 years (range 42 - 59 yrs.). Two patients had polyarthralgia predominating in the hands, wrists and knees and two patients had symm etrical acromelic polyarthritis. The fifth patient, a woman, had oligo articular arthritis. In a single female patient, X-rays showed moderat e erosions of both tarsometatarsal bones. The inflammatory syndrome wa s moderate with mean ESR 23 (12 - 38) and immunological investigations were negative except for the presence of pANCA (50 - 200 U) in three patients. HLA - Al, B8, and Bw35 antigens were found in three of the f ive patients. In all cases, nasal and sinus polyposis (NSP) preceded r heumatism and the joint symptoms were accompanied by worsening of the ENT symptoms. NSP was confirmed by CT scan of the nasal fossae and sin uses. Polyps were surgically removed in four patients and the histolog y showed neither granuloma nor vasculitis. In four patients the joint symptoms, which responded poorly to nonsteroidal antiinflammatory drug s (NSAIDs), improved markedly after ENT treatment (surgery and topical steroids) and synthetic antimalarials. The concomitant course of the joint and ENT symptoms suggests there may be a link between inflammato ry rheumatism and NSP.