Sjögren’s patients often suffer from significant nasal dryness, which can lead to pain, crusting, epistaxis (bleeding), sinusitis (sinus infections), and even septal perforation (a hole in the cartilage and bone that separates the right from the left nasal passageway). Conservative treatment is typically effective in improving the majority of nasal symptoms and includes adequate hydration, avoidance of medications such as decongestants and antihistamines that can further dry the nasal passages and promote pain, crusting, and bleeding.
Epistaxis can occur due to significant dryness and usually originates from the front of the nose along the septum, where more than 90% of the blood vessels in the nose are located. Humidification (55% to 60%), saline irrigation (with Simply Saline, Ocean Spray, or a neti pot, among many other brands), and moisturization of the anterior septum with a nasal gel, Vaseline, or an over-the-counter antibiotic ointment such as Neosporin or triple antibiotic ointment can significantly decrease the frequency and severity of nosebleeds. Regular use of secretagogues (pilocarpine, cevimeline) at moderate to high doses may also help, although they may cause other systemic side effects. If epistaxis persists despite these measures, silver nitrate cauterization of the offending blood vessels can be performed by an otolaryngologist (ENT) in the office. While this is a simple procedure to perform, the cautery is very superficial and generally does not provide longstanding relief.
Patients with Sjögren’s are at increased risk of suffering from allergic rhinitis (itching, sneezing, and nasal congestion due to allergies) and can benefit from using a topical nasal steroid once or twice daily to decrease the inflammation.
Care must be taken not to aim the nasal steroid spray toward the septum as this can increase septal dryness and bleeding. Nasal steroids can often reduce the inflammation from rhinitis and decrease the severity and frequency of sinusitis or sinus infections, which are more common in this population because the dryness, crusting, and swelling can trap bacteria. Antibiotics can cure bouts of sinusitis; oral steroids may be needed in refractory cases when the swelling is severe or in chronic cases.
*summary courtesy of The Sjögren's Book, Fifth Edition, Daniel J. Wallace, MD
