title: Clinical Factors Associated with the Diagnosis of Granulomatosis with Polyangiitis.
abstract: Objective To determine the predictive value of nasal endoscopic findings and symptoms in the diagnosis of granulomatosis with polyangiitis (GPA). Study Design A cross-sectional study. Setting A tertiary university hospital. Subjects and Methods A total of 116 adults were enrolled in the study: 19 patients with GPA, 29 patients with other rheumatic diseases, and 68 healthy volunteers. All patients were examined with a flexible endoscope, and nasal endoscopic images were recorded and evaluated blindly. The medical history of each patient was taken by a physician blinded to the patient's diagnosis. Results Univariate analysis indicated a statistically significant difference in rhinorrhea ( P = .002), postnasal drip ( P = .015), epistaxis ( P < .001), and saddle nose ( P = .017). However, binary logistic regression analysis demonstrated that only history of epistaxis ( P = .012; odds ratio, 5.6) was statistically significant in predicting GPA. Univariate analysis showed a statistically significant difference in nasal secretion ( P = .028), nasal septal perforation ( P < .017), nasal crusting ( P < .001), nasal adhesion ( P < .001), nasal granuloma ( P = .017), and hemorrhagic fragile nasal mucosa ( P < .001). A binary logistic regression analysis demonstrated that only hemorrhagic fragile nasal mucosa ( P < .001; odds ratio, 52.9) was a statistically significant predictor of GPA. Conclusions Given the results of this study, we believe that hemorrhagic fragile nasal mucosa and history of recurrent epistaxis may put patients at risk for GPA and should be investigated accordingly.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Izmir Ataturk Research and Education Hospital, Izmir, Turkey.
authors.forename: Erdem
authors.initials: E
authors.lastname: Eren
authors.affiliation: 2 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Izmir Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Toygar
authors.initials: T
authors.lastname: Kalkan
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Izmir Ataturk Research and Education Hospital, Izmir, Turkey.
authors.forename: Seçil
authors.initials: S
authors.lastname: Arslanoğlu
authors.affiliation: 2 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Izmir Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Özmen
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, Izmir Ataturk Research and Education Hospital, Izmir, Turkey.
authors.forename: Kazım
authors.initials: K
authors.lastname: Önal
authors.affiliation: 3 Division of Rheumatology, Department of Internal Medicine, Izmir Ataturk Research and Education Hospital, Izmir, Turkey.
authors.forename: Emine Figen
authors.initials: EF
authors.lastname: Tarhan
authors.affiliation: 2 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Izmir Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey.
authors.forename: Servet
authors.initials: S
authors.lastname: Akar
mesh_terms: D003430:Cross-Sectional Studies; D004724:Endoscopy / Q000379:methods; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose; D011237:Predictive Value of Tests
keywords: Wegener’s; diagnosis; endoscopic; hemorrhagic; nasal