Clinical Rheumatology

, Volume 2, Issue 1, pp 13–17 | Cite as

Spontaneous nasal septal perforation in patients with rheumatoid arthritis

  • J. L. Mathews
  • J. R. Ward
  • C. O. Samuelson
  • W. P. Knibbe


Nasal septal perforation is known to be associated with various traumatic and disease states, yet spontaneous nasal septal perforation (SNSP) is relatively rare. SNSP has been reported in three patients with seropositive rheumatoid arthritis (RA) and we report an additional seven patients with SNSP and RA, four of whom were seronegative and none of whom had Raynaud's, in contrast to those reported previously. Manifestations of overt infectious, neoplastic or granulomatous disease have not been found in our seven patients over several years of close follow-up. We have identified no obvious pathogenesis or specific etiology for SNSP. We suggest that SNSP may represent an unusual manifestation of RA previously not well recognized.

Key words

Rheumatoid Arthritis Spontaneous Nasal Septal Perforation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hajek: Intern. Klin. Rundschau. 1892, 31–35, 40–45, 49–52. Laryngorhinologische Mitteilungen. Zit. n. Passow.Google Scholar
  2. 2.
    Frey, H.H., Weinaug, P. Zur Haufigkeit und Atiologie der Nasenseptum-perforation. HNO. 1968, 16: 33–35.PubMedGoogle Scholar
  3. 3.
    Adler, Detlev, Ritz, Eberhard. Perforation of the nasal septum in patients with renal disease. Laryngoscope 1980, 90: 317–321.PubMedCrossRefGoogle Scholar
  4. 4.
    Reiter, David, Myers, Allen. Asymptomatic nasal septal perforations in systemic lupus erythematosus. Ann. Otol. 1980, 89: 78–80.Google Scholar
  5. 5.
    Snyder, G.G., McCarthy, R.F., Toomey, J.M. Rothfield, N.F. Nasal septal perforation in systemic lupus erythematosus. Arch. Otol. 1979, 99, 456–457.Google Scholar
  6. 6.
    Alcala, H., Alarcon-Segovia, D. Ulceration and perforation of the nasal septum in systemic lupus erythematosus. N. Engl. J. Med 1969, 281, 722–723.PubMedCrossRefGoogle Scholar
  7. 7.
    Rothfield, N.F. Nasal-septum perforation in systemic lupus erythematosus. N. Engl. J. Med 1974, 291, 51.Google Scholar
  8. 8.
    Simpson, J.B. Nasal-septum perforation in systemic lupus erythematosus. Letter, N. Engl. J. Med. 1974, 290, 859–860.CrossRefGoogle Scholar
  9. 9.
    Vachtenheim, J., Grossman, J. Perforation of the nasal septum in systemic lupus erythematosus. Br. Med. J. 1969, 2, 98.PubMedCrossRefGoogle Scholar
  10. 10.
    Tabata, T., Saito, T. Nishimura, A. A case of systemic lupus erythematosus with nasal involvement. Otolaryngology (Tokyo) 1969, 41, 29–35.Google Scholar
  11. 11.
    Willkens, Robert, F., Roth, Gilbert, J., Novak, Alvin, Walike, Jos., W. Perforation of nasal septum in rheumatic diseases. Arthritis Rheum. 1976, 19 (1), 119–121.PubMedCrossRefGoogle Scholar
  12. 12.
    Glass, D.N., Soter, N.A., Schur, P.H. Rheumatoid vasculitis. Arthritis Rheum. 1976, 19, 950.PubMedCrossRefGoogle Scholar
  13. 13.
    Sokoloff, L., Wilems, S.Z., Bunim, J.J. Arteritis of striated muscle in rheumatoid arthritis. Am. J. Pathol. 1951, 27, 157.PubMedGoogle Scholar
  14. 14.
    Schmid, F.R., Cooper, N.S., Ziff, M., McCwen, C. Arteritis in rheumatoid arthritis. Am. J. Med. 1961, 30, 56.CrossRefPubMedGoogle Scholar
  15. 15.
    Soter, N.A., Austen, K.F., Gigli, I. The complement system in necrotizing angiitis of the skin. Analysis of complement component activities in serum of patients with concomitant collagen-vascular diseases. J. Invest. Dermatol. 1974, 63, 219.CrossRefPubMedGoogle Scholar
  16. 16.
    Mongam, E.S., Call, R.M., Jacox, R.F., Vaugham, J.H. A study of the relation of seronegative and seropositive rheumatoid arthritis to each other and to necrotizing vasculitis. Am. J. Med. 1969, 47, 23.CrossRefPubMedGoogle Scholar
  17. 17.
    Sokoloff, L., Bunim, J.J. Vascular lesions in rheumatoid arthritis. J. Chronic Dis. 1957, 5, 668.CrossRefPubMedGoogle Scholar
  18. 18.
    Weinstein, A., Peters, K., Brown, D., Bluestone, R. Metabolism of the third component of complement (C3) in patients with rheumatoid arthritis. Arthritis Rheum. 1972, 15, 49.PubMedCrossRefGoogle Scholar
  19. 19.
    Conn, D.L. McDuffie, F.C., Dyck, P.J. Immunopathologie study of sural nerves in rheumatoid arthritis. Arthritis Rheum. 1972, 15, 135.PubMedCrossRefGoogle Scholar
  20. 20.
    Weisman, M., Zvaifler, N. Cryoimmunoglobulinemia in rheumatoid arthritis. J. Clin. Invest. 1975, 56, 725.PubMedCrossRefGoogle Scholar
  21. 21.
    Wolff, S.M., Fauci, A.S., Horn, R.G., Dale, D.C. Wegener's granulomatosis. Ann. Intern. Med. 1974, 81, 513.PubMedGoogle Scholar
  22. 22.
    Fauci, A.S., Wolff, S.M., Johnson, J.S. Effect of cyclophosphamide upon the immune response in Wegener's granulomatosis. N. Eng. J. Med. 1971, 285, 1493.CrossRefGoogle Scholar
  23. 23.
    Novack, S.N., Pearson, C.M. Cyclophosphamide therapy in Wegener's granulomatosis. N. Eng. J. Med. 1971, 284, 938.CrossRefGoogle Scholar
  24. 24.
    Collins, D.H. The subcutaneous nodule of rheumatoid arthritis. J. Pathol. Bacteriol. 1937, 45, 97.CrossRefGoogle Scholar
  25. 25.
    Bennett, G.A., Zeller, J.W., Bauer, W. Subcutaneous nodules of rheumatoid arthritis and rheumatic fever: A pathologic study. Arch. Pathol. 1940, 30, 70.Google Scholar

Copyright information

© Springer-Verlag 1983

Authors and Affiliations

  • J. L. Mathews
    • 1
  • J. R. Ward
    • 1
  • C. O. Samuelson
    • 1
  • W. P. Knibbe
    • 1
  1. 1.Department of Internal Medicine, Division of RheumatologyUniversity of Utah Medical CenterSalt Lake CityUSA

Personalised recommendations