HLA B27 Positive, Long History of Chronic Sinusitis

[Cal Hub]

Hi all:

First time poster here. 38 year old male. 6'2", 180lbs in light to moderate physical shape with long history of Chronic Sinusitis (infections ~3x/yr)

Had Iritis 3x in 2002 & 2003. Went through blood tests and HLA B27 positive. 25% of Scandinavians have it (per a few websites), and I'm Scandinavian so possible link there. All AS testing (x-ray & bone scan) came back NEGATIVE.

During my 3 episodes in 2002 & 2003, the timing was strongly correlated to a upswing in severity of my Chronic Sinusitis, and to a lesser extent Allergy. I would like to elaborate on this as it's critical to possibly diagnosis and treatment. I also acknowledge ahead of time that my situation is not nearly as severe as others on this forum, but it's surely still a nuisance to me, and I'm a pro-active problem solver.

To start, I have a 30 year history of ~3 sinus infections / year and related antibiotic treatment. Allergy diagnosis and treatment started about 15 years ago, but not successful until 7-10 years ago (note: tested as moderate allergies to grasses & trees).

Back in 2002, I had been on nasal corticosteroids for 3 to 4 years in 2002, and constantly battling sinusitis, and always racking my brain (w/ the docs) over whether the sinusitis episode had become infected. The onset of an infection was a major fear due to debilitating effects of being on antibiotics and the known long term side effects of antibiotic use. Due to this real concern, I began to “test” my body by trying to fight the sinusitis episodes longer than normal (i.e, 2-3 weeks after colored mucus, smell, and fuzzy headedness ensued). Again, this logically put higher stress on my own immune system and antibody functions. Each of these “Don’t jump to the antibiotic” experiments were correlated with those first 3 Iritis episodes in 2002/2003 (each Iritis episode ~ 6 months apart). Each Iritis was successfully treated with eye drops over a 2 week period. At that time, the Ophthalmologist, ENT, and Allergist were all skeptical of the correlation of Iritis with Sinusitis

I should interject that during the Sinusitis worsening, fatigue and endurance were becoming a fairly serious issue as well, so body was definitely struggling against something. I should also note the Sinusitis was much more frequent in the Fall and during Cold/Flu season (when immune system is stressed of course). Health/Fitness-wise, I stay in light to moderate physical shape and eat very healthy. Light exercise helped, yet my body often times rejected moderate exercise and fatigue set in, and for moderate to heavy (3 mile run or 1.5hrs of fairly intense tennis) could often immediately blow me write into a sinus infection, and also cause semi-painful muscle & joint stiffness (much more than in my early 30's and younger) for 2 or more days. Like an unusually long recovery period (even given I wasn’t in that great of shape to start with).

So in 2003, I pressed the ENT and Allergist hard. Got approved for Sinus Surgery in 2003, which helped acuteness & severity, but NOT so much the frequency. Thus, in 2004, I pressed the Allergist for immunotherapy injections for the moderate allergies to grasses & trees, thinking this could reduce Sinusitis frequency. It helped severity another notch (i.e, fuzzy headedness), and has allowed me to lower nasal corticosteroid doses (both good outcomes), yet it had NOT eliminated the frequency or susceptibleness to Sinus Infections (3, sometimes 4x/yr) and the dreaded antibiotic use (Augmentin & Cefitn rotations primarily).

Now in 2006, I'm back to ENT to problem solve the sinus infections more aggressively. Why - well I had 4 infections since November 2005, and the last one I experimented by going on Augmentin for 4.5 weeks. During this Augmentin dose, at the 2 week period, I caught a cold, and the antibiotic seemed to suppress the rest of my immune system to that the last 2 weeks it was practically useless (PROOF of the vicious cycle and other affects of antibiotics !!) So, the ENT agrees to perform another CT, YET (2.5 yrs after surgery), yet unlike the previous 3 scans, this would be done with no daily Sinus preventative maintenance routine (no sprays, no 2x/day saline flush, etc), so we could see where the Nasal area naturally fills up/gunks up/etc. So after about 10 days of “letting the sinuses slowly fill up”, I could feel myself getting a little stuffy, and smell or see (on tongue) that something was brewing up in the Sinuses. Thus, I scheduled the CT right away.

THEN (here comes the relevant punch line), the day after the CT, or about 10-14 days after "letting my Sinuses go on their own", and about 10 days after being on Augmentin (antibiot) for 4.5 weeks - I GOT IRITIS !!!!!

3 days later the ENT informs me I have 2-3 trouble spots that are hyperactively producing mucous (in maxillary/cheek & ethmoid (between the eyes), and he is going to go back in and clean them out (ie, surgery) in late May.

Any feedback on this one? (Mike?) I can't tell you how much I've looked for a Sinusitis - Irits correlation on the Internet (found only 1 testimony).

I know my body more that most, and I believe there is some correlation. The question is how can I better treat the two? Not one single Doc has given my any decent advice.

Thanks for the patience on the long-winded story and thanks in advance for any replies !

[Mike Bartolatz]

Sinusitis is often related to autoimmune disease. if granulomatus uveitis present then this should be investigated a bit furter. are your eyes 'dry'? Sarcoidosis can attack the lacrimal glands, cause sinusitis, tinnitus and joint pain in the hands before lung involvement for example. although various other sinusitis problems are usually causal with uveitis, they CAN trigger a renewed bout of uveitis. some pathogens can be present that can also cause uveitis. things like mycobacteria can get into the blood stream and then cause uveitis.
autoimmune disease processes often come in bunches. fibromyalgia which has only tender points and other diagnostic criteria without any blood tests can often appear as well. this muscle pain is almost constant.

with the HLA B27 gene present the enteropathic arthropathies as well as the seronegative spondyloarthropathies can appear years down the road OR you may never get one of these related autoimmune disease processes.

I get sinus infections, have problems with sinusitis from time to time but don't have an autoimmune related disease to this. I do have granulomatus uveitis however, along with Fibromyalgia and Osteoarthritis in many of my joints in my body from trauma and overuse.

I hope this helps,
Mike

[kristihart]

I know you originally authored this post a long time ago, but wondered if you ever found any correlation. I have been suffering with iritis for 2 years and am also HLA B27 positive. I haven't been diagnosed with any autoimmune diseases at this time, but my eye doctor feels that it's likely I could have AS because of lower back pain, the HLA B27 factor, and the uveitis. However, I too suffer horribly with allergies, and my first iritis attack correlated with a severe sinus infection. 2 years later, i have been unable to wean off of steroid drops. and now I have cataracts forming and can't have surgery for that due to the iritis. It's a vicious cycle. I have to find a new rheumatologist as mine quit seeing patients. My eye just recently flared up and low and behold, it's allergy season. I was maintaining a one drop every 2 weeks and preparing to wean down to 1 drop every 3 weeks.

[Srwalker]

I am a chronic sinusitis sufferer and have iritis. It was my progressive bilateral hearing loss treatment that brought iritis to visit me. After being on 60 mg per day oral prednisone my first time, iritis came knocking. Pred forte drops got everything under control. Each time I was put on steroids I flared within 48 hours of tapering off of them. I have tinnitis and now am completely deaf. Prednisone did not help. Nor did methotrexate. Now my allergies are very numerous and this fall I've had 2 treatments with methyl prednisone 6 day pack and 2 treartments with antibiotics. Strange isn't it that I can take methyl prednisone but not the othe drug. When my immune system is overactive my arm feel like someone has scraped them with steel wool and my joints/muscles are very sore. With in first day of treatment with methyl prred I am feeling much better. After cataract surgery my iritis flared for the first time in 25 years. Unlike prior flare ups, I could not get off prednisone forte so I am now on Imuran--150 mg/day. My irit has been in control for 6 months. I take 2 allergy shots every week, which seems to have lessened the severity of the sinus infections but has not prevented any. I've never been tested or HLA-B27. Should I ask my PCP to order this on me?