The Effect of Co-Morbid Sjogren Syndrome Diagnosis on the Clinical Phenotype of Chronic Rhinosinusitis.

INTRODUCTION Sjogren's syndrome (SS) is a systemic autoimmune disease characterized by exocrine gland dysfunction and a T1/T3-skewed inflammation. Chronic rhinosinusitis (CRS) is more prevalent in SS, most likely due to the specific cytokine milieu, and the loss of secretory glands and secretion associated antimicrobials. However, the impact of SS on CRS immunopathology and symptomatology is unclear. This study evaluated whether CRS in SS patients exhibits a distinct clinical profile compared to CRS alone.

METHODS In this retrospective study, 14 patients with co-morbid SS and CRS were compared to 90 CRS patients without rheumatologic or other comorbid systemic disease. CRS severity was assessed using the Sino-Nasal Outcome Test (SNOT-22), Lund-Mackay Score (LMS), Lund-Kennedy Score (LKS), and T2 inflammatory markers (IgE, absolute eosinophil count, and nasal polyp presence).

RESULTS Demographics were similar between groups. Objective disease burden was greatest in CRS with nasal polyps, with higher LMS (p < 0.001) and LKS (p < 0.001) than the other groups. Despite this, SS patients reported the highest SNOT-22 total scores (p = 0.027). SS showed significantly higher scores in several domains, including nasal obstruction (p < 0.001), ear fullness (p < 0.001), reduced concentration (p < 0.001), frustration or irritability (p = 0.022), and fatigue (p = 0.044), with trends for need to blow the nose (p = 0.051), thick nasal discharge (p = 0.073), facial pain or pressure (p = 0.063), waking up tired (p = 0.096), and reduced productivity (p = 0.052).

CONCLUSIONS SS appears to confer a distinct CRS phenotype marked by heightened symptom burden not reflected by conventional disease metrics. This discrepancy may reflect neuroinflammatory amplification driven by SS's T1/T3 cytokine profile. These findings highlight the need for symptom-focused, multidisciplinary care in this population.