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GPA ENT Surveillance — SCE Rheumatology MCQ

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ModerateVasculitisGPA ENT SurveillanceSCE Rheumatology

A 60-year-old man with granulomatosis with polyangiitis has persistent nasal obstruction and crusting despite systemic treatment. Nasal endoscopy shows extensive crusting and turbinate destruction. His renal and pulmonary parenchymal disease are clinically quiescent, but he reports new exertional breathlessness and an intermittent harsh inspiratory noise. Which additional management plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Arrange multidisciplinary ENT and vasculitis review, start local sinonasal therapy, and assess for subglottic stenosis

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · E = shown as D · A = shown as E

E is correct. Persistent sinonasal symptoms in GPA may reflect ongoing inflammation, irreversible damage or secondary infection and therefore require multidisciplinary assessment involving ENT and clinicians experienced in AAV. Local treatment, particularly saline nasal irrigation and appropriate topical therapy, helps clear crusts and improve symptoms; systemic immunosuppression alone may be insufficient. The new exertional breathlessness and inspiratory noise require prompt specialist airway assessment for subglottic stenosis, which can progress independently of otherwise controlled systemic disease. ENT involvement is not restricted to hearing loss (A), and quiescent renal disease does not exclude significant ENT or airway disease (C). Immunosuppression should not replace local and airway-directed assessment (B). Surgery may be required for selected structural complications but is neither the sole treatment nor an automatic first step (D).

Reference: British Society for Rheumatology, The 2025 British Society for Rheumatology management recommendations for ANCA-associated vasculitis, Domain 2, Recommendations 10, 13 and 15b, 2025. https://pubmed.ncbi.nlm.nih.gov/40499922/