Inner nose infection

[Cutes]

Hi, I wonder if anyone else has experienced an inner nose infection whilst taking methotrexate and Anti TNF R.arthritis meds? I first experienced this during spring '20, i.e. during lock down and eventually managed to sort it out, after sending a (horrible looking...) pic of my nose to the GP - at her request I might add!! She quickly prescribed oral antibiotics and then an anti biotic inner nose cream. I had been prescribed the latter before, but it hadn't seemed to be enough. I didn't have another occurrance of this condition until after this last Xmas, when I had a mild cold, which seemed to clear up quickly, only to then get a very severe sore throat and chronic catarrh and then the inner nose infection (probably caused by the constant blowing my nose). I have had 4 doses of oral antibiotics in total and 2 does of the antibiotc nose cream since mid January. Each time, the a-biotics seem to do the trick and the catarrh, sore throat and nasal soreness go, only to 'creep back' within about 2 weeks of finishing the antibiotic treatments. MyGP suggested I contact my local hospital's Rheumatology advice line and they told me to suspend the methotrexate, which I did. I have now received a letter from them saying my consultant says to stop methotrexate permanently and if the ENT infections continue, he will possibly consider changing me from Adalulinab Anti TNF to Etanercept, but without the methotrexate immuno suppressant. However, about 6-8 weeks on after stopping methotrexate, I still have a very sore nose again and am currently trying to get a face to face appointment with a GP, but was told it had been triaged by a GP as only being 'routine'., which I am guessing could be anytime over the next few weeks. I am v.worried re that, as the nose infection is clearly a bacterial one and I always understood it was dangerous to let bacterial infections fester. Sorry this is an incredibly long post, but I would be interested to hear if anyone else has experienced this particular symptom and if so, how it was treated . many thanks.

[hazelcats]

Hi Cutes. Am having similar problems myself. Regular nosebleeds and feeling 'stuffed up' all the time. Ended up in a&e after a very severe prolonged nosebleed.Am on methotrexate and hydroxy. I contacted rheumy nurses and was not advised to stop my meds- they did not thing meds were to blame. Prior to this they said they would put me on adalimumab - which I note can inflame the sinus!

A GP in my practice is experienced in ENT and along with antibiotic cream and nasal irrigation (thats an odd experience) he has asked to see me again to cauterise any suspected holes in the septum. He feels inflammatory arthritis may be causing this.

Its hard when there seems conflicting advise from professionals.

I hope to find out more end of next week at GPs.

I sincerely hope you get some response quickly, can you get back to rheumy nurses maybe and ask them to speak with your gp for more immediate help?

Wishing you well

[Neonkittie17]

Quite a few RA biologics list upper respiratory infections as fairly common side effects and the biologics can lower the immune more for some people than others. (I got persistent chronic bronchitis as my immunoglobulin IgG was so low on Rtx.) I have always been very sinus-y so never noticed much difference on Rtx or current med which isn’t an anti TNF.)

You make a point to not let another infection get worse by waiting a few weeks for the next routine GP appointment. I would go to the morning open access surgery if they have one, if it’s not improving and not wait for the appointment in the next few weeks. The GP who triaged you as non urgent should have had the notes from your recent previous visits and know it is a problem, and of your immune system/RA/biologic med, so I’d say that’s to be seen sooner than a few weeks. Good luck, x

[welsh12 in reply to Neonkittie17]

Yes I agree I had a cold and sinus issues that went on for a month I did try and get help just given a nasal spray was very poorly and continued with my medication when probably should have had a break. Gp didn't understand.

[Neonkittie17 in reply to welsh12]

Sadly some GPs don’t always realise how the immunosuppressant meds can make it hard to shift upper respiratory and sinus infections. 😣

[stbernhard]

Hi Cutes, I have what seems to be a permanent infection right at the back of my left nostril, by the opening to the throat. Whenever I get a cold, that's where I can feel it first and that's where the first horrible green phlegm comes from. I had this long before I was diagnosed 16 years ago. So no direct link here. I hope you find a solution for all of it!🤞🙏

[Runrig01]

I’ve suffered with sinus issues for years. Have seen ENT several times and had a scope passed each time. I was put on Mometasone nasal spray in 2021. Since February last year, I’ve had an increase in green nasal discharge, have had 2 x 2 week courses of antibiotics in that time, where for a period of 2 weeks following them, my discharge runs clear before returning to green. I had a CT of the sinuses, and was referred again to ENT, with ? Chronic sinusitis and laryngospasms. Seen in November, after waiting 31 weeks for an urgent appointment , had the scope, and was told I had chronic inflammation, but no infection. When I asked how I know when it is infected when I have constant green discharge, and being on immunosuppressants don’t show all signs of infection, like fevers etc., she couldn’t answer. My AS affects my jaw, so I have a lot of tenderness to my face, which an oral medicine consultant said was coming from the jaw inflammation.

I’ve just finished a second course of antibiotics, for a chest infection, which they feel stems from the sinus issues. Unfortunately it seems from blood tests taken on Tuesday, that I still have the infection, as my white cells and neutrophils are still very high. The GP did change my steroid nasal spray to Beclomethasone, a week ago, which actually seems to be helping, as the nasal discharge has now stopped. I’ve been on the biologic Benepali and mtx for around 8yrs, my rheumatologist has never been concerned when I mention sinus issues. At present I’m off my immunosuppressants, which is frustrating as I had foot surgery in February and missed 4 weeks then, so really need to restart to get on top of pains. However I need to have another blood test next week, to see if numbers are any better, and if not, consider another antibiotic. It’s so frustrating.

[Creakywrists]

I’m on methotrexate and adalimumab and was previously on etanercept. I’ve had a runny nose since I went on biologics but it’s much worse on adalimumab, particularly at night when it runs all the time. Around two months ago, I had a very painful nostril and and numbness and swelling between my nose and upper lip. I was seen very quickly by a locum GP (having said I was immunosuppressants!) who reckoned it was an infection in the nose. He said that oral antibiotics didn’t work particularly well on the nose and he prescribed nasal ointment to be put on four times a day for 10 days to start with. It took a while to work and before it cleared up completely, the other nostril was affected. However both cleared up just over a week of treatment and fortunately it hasn’t recurred.

[Susiebee31]

I’m on cimzia anti TNF and methotrexate and have problems with sores up my left nostril, I also have a very dry nose, I’m on steroid spray because of sinus issues and post nasal drip. I use antibiotic/steroid cream in the nostril which seems to work a treat and quickly making it manageable. I don’t take oral antibiotics for it at all, those are only used if I get infected sputum. RA and the drugs don’t make life easy and GPs are out if their depth a lot of the time. Certainly don’t understand about RA or immunosuppressant drugs, constant battles with them!

[welsh12]

One thing that seems to have helped my sinus found a good facial massage therapist not a beautician who uses techniques to drain the sinus feel better for it.