Fifty million Americans, or 20% of the population, suffer from chronic sinusitis, making it one of the most prevalent chronic (ongoing) illnesses in the country.
Chronic sinusitis is a persistent condition that is typically characterized by a combination of symptoms, such as nasal obstruction (difficulty in breathing through the nose), reduced sense of smell, facial pressure, and recurrent sinus infections. Additionally, individuals suffering from allergies or related respiratory problems, such as asthma, may also experience chronic sinusitis.
Distinguishing between allergies, an upper respiratory tract infection, or a sinus condition can be a challenging task for patients. This is because the symptoms and signs for each of these conditions are distinct, and the treatment required for each diagnosis varies.
According to a recent publication in Rheumatology Advances in Practice by Oxford University Press, Granulomatosis With Polyangiitis, a nasal condition that leads to the inflammation of blood vessels and often manifests with symptoms in the sinuses, throat, lungs, and kidneys, may be frequently misdiagnosed.
Researchers suggest that individuals diagnosed with the sinus and nasal limited form of the disease may, in fact, be experiencing nasal damage resulting from cocaine use.
In the United Kingdom, cocaine ranks as the second most widely abused drug, with an estimated 2.6% of individuals aged between 16 and 59 using it. Meanwhile, in the United States, around 4.8 million people, or 1.7% of individuals over the age of 12, reported using cocaine in the past year. The drug can cause several health problems, including cocaine-induced midline destructive lesions, and various vascular issues. Evidence also indicates that cocaine use can stimulate the production of certain antibodies, resulting in clinical symptoms that closely resemble idiopathic Granulomatosis With Polyangiitis (GPA-formerly known as Wegener’s granulomatosis).
In addition to general symptoms like arthralgia, fatigue, and skin rash, the resemblance between GPA and cocaine-induced damage makes diagnosis challenging for physicians. Although GPA is an uncommon condition, affecting roughly 3 out of every 100,000 individuals, the researchers suggest that the potential for misdiagnosis is significant since the typical treatment regimen for GPA may not be suitable for individuals who continue to use cocaine, and can even pose a risk to their health.
In this study, the researchers conducted a retrospective review of patients who had sought treatment at vasculitis clinics located at the Queen Elizabeth Hospital in Birmingham and the Royal Free Hospital in London.
In total, they examined 42 patients and discovered that a significant number of them were current cocaine users, with 86% of the provided urine samples testing positive in routine toxicology tests. Interestingly, 9 patients who denied using cocaine were found to be using it based on the results of urine toxicology analysis, while 11 individuals who had previously reported being ex-users of cocaine still tested positive for the drug.
The investigators highlighted that ten patients referred to vasculitis treatment centers had previously been diagnosed with GPA and were administered immunosuppressive medication. However, despite the treatment, these patients continued to experience persistent nasal issues.
According to the researchers, physicians should conduct tests for cocaine use in patients exhibiting destructive nasal lesions or isolated sino-nasal disease before diagnosing GPA. They note that immunosuppressive drugs may not be effective if cocaine use continues and can even increase the risk of severe adverse effects, such as infections.
Aine Burns, one of the authors of the paper, emphasized the significance of their findings and how it has transformed their medical practice. They now include tests for drugs of abuse, specifically cocaine, in the initial investigations of patients with GPA, particularly those who do not respond to treatment.
“Sadly, we have seen young people with life-changing disfigurement because of cocaine-induced granulomatosis with polyangiitis,” points out the author.
“A better understanding of this condition prevents us from potentially harming patients further by administering inappropriate, potentially toxic, and futile treatments. There needs to be heightened awareness of this complication of cocaine use amongst users, the public, and healthcare professionals.”
Source: 10.1093/rap/rkad027
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