Rheumatoid Arthritis and Recurrent Sinus Infections: Causes, Symptoms, and Treatment

Rheumatoid Arthritis and Recurrent Sinus Infections: Causes, Symptoms, and Treatment

Recurrent sinus issues can be frustrating on their own—and even more confusing when they show up alongside autoimmune symptoms. If you’ve wondered about rheumatoid arthritis and recurrent sinus infections, you’re not alone.

Research suggests there may be a meaningful relationship between sinus inflammation and later development of certain rheumatic (autoimmune) diseases, including rheumatoid arthritis (RA), though it does not prove that one directly causes the other. Think of it more like a research “signal” observed over time—not a guarantee or a simple cause-and-effect story.

Quick Takeaways (TL;DR)

- Large studies have found a research-supported association between a history of sinusitis and a higher risk of developing rheumatic diseases later on—association is not the same as causation. The strongest association has been observed about 5–10 years before rheumatic disease symptoms begin. (1,3) This is a population-level observation, not a prediction for any individual person.

- Rheumatoid arthritis and recurrent sinus infections may co-occur for several reasons, including immune system dysregulation, dryness (including Sjögren’s overlap), allergy-driven inflammation, anatomical blockage, and the infection-risk effects of certain RA medications.

- Next steps often involve coordinated evaluation—typically primary care plus rheumatology, and when symptoms recur or persist, an ENT evaluation. Sleep and Sinus Centers of Georgia can evaluate chronic or recurrent sinus concerns and discuss personalized options.

Understanding the Conditions (Patient-Friendly Basics)

When two health issues seem to “travel together,” it helps to define each one clearly—because not every stuffy nose is an infection, and not every achy joint is RA.

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis is an autoimmune disease where the immune system mistakenly targets the lining of joints. Common symptoms include:

- Joint pain, swelling, and warmth

- Morning stiffness (often lasting longer than typical “aches”)

- Fatigue and low energy

Many people describe RA stiffness as the kind that makes everyday tasks feel oddly difficult at first—like turning a doorknob, opening jars, or getting moving after sitting.

You may also hear:

- Seropositive RA: blood tests show certain antibodies (often rheumatoid factor and/or anti-CCP).

- Seronegative rheumatoid arthritis: RA symptoms and joint findings fit, but common antibodies are negative. Seronegative RA is still real RA—just without those specific blood markers.

Clinician perspective: We diagnose RA based on the whole picture—symptoms, exam, imaging, and labs—not a single test result.

What counts as “recurrent sinus infections” (recurrent sinusitis)?

“Sinusitis” means inflammation of the sinus lining. It can be:

- Acute sinusitis: symptoms typically lasting up to about 4 weeks

- Chronic sinusitis: symptoms lasting 12 weeks or longer

- Recurrent acute sinusitis: multiple separate episodes in a year, with improvement between episodes

A helpful analogy: your sinuses function a bit like “drainage pathways.” When the lining is swollen or blocked, mucus can’t move well. That backup can cause pressure, congestion, postnasal drip, and—sometimes—infection.

If you want a deeper overview of what qualifies as chronic sinusitis and why duration matters, see: https://sleepandsinuscenters.com/chronic-sinusitis and this explainer on acute vs. chronic sinusitis: https://sleepandsinuscenters.com/blog/acute-vs-chronic-sinusitis-key-differences-and-treatment-options

Bottom line: clear definitions help you and your clinicians decide when symptoms are likely inflammatory, infectious, or both—and what to do next.

The Research Link: Can Sinusitis Be Connected to RA?

It’s important to say this clearly: association ≠ causation. Having sinusitis does not mean someone will develop RA, and having RA does not automatically mean someone will get sinus infections. Still, research suggests the sinusitis and rheumatoid arthritis link is worth understanding—especially if you’ve had frequent sinus issues and are now noticing joint symptoms (or vice versa).

Key findings patients tend to care about include:

- A history of sinusitis has been associated with about a 40% higher risk of developing rheumatic diseases (including RA) later on. (1,2)

- The association appears strongest in the 5–10 years before rheumatic disease symptoms begin. (1,3)

- Sinusitis history has also been linked with higher risk of Sjögren’s syndrome and antiphospholipid syndrome. (1,3)

- Acute sinusitis has been specifically associated with higher risk of seronegative rheumatoid arthritis in some research. (1,3)

- A higher frequency/burden of sinusitis episodes has correlated with a higher likelihood of developing rheumatic disease. (1)

One way to interpret this: sinusitis may sometimes be a marker of immune activity that shows up years before a diagnosable rheumatic condition. That does not mean sinusitis “turns into” RA—only that the two may share underlying patterns in some people. At the individual level, most people with sinusitis will not develop RA.

Why researchers think this association may exist (possible mechanisms)

- Chronic mucosal inflammation: The sinus lining is part of the immune system’s frontline. Repeated inflammation may reflect a more activated immune state.

- Shared inflammatory pathways: Some immune signaling patterns involved in chronic sinus inflammation overlap with pathways implicated in autoimmune disease.

- Barrier and microbiome changes: Disruptions in the nasal/sinus lining and microbial balance may influence immune regulation.

- Big caveat: These are hypotheses under study, not settled facts.

Takeaway: research shows a population-level association—not a personal prediction—and ongoing studies are exploring why these conditions sometimes cluster.

Why People with RA May Get Sinus Infections More Often (Common Causes)

If you’re dealing with rheumatoid arthritis and recurrent sinus infections, the practical question is often: “Why does this keep happening?” In real life, it’s usually not one single reason—it’s a combination (for example: allergies + anatomy + medication effects).

Immune system dysregulation from autoimmune disease

Autoimmune disease can involve chronic, body-wide immune activation. That can be associated with changes in mucosal defenses (like the lining of the nose and sinuses). Some people also have more than one autoimmune condition, which may further affect dryness, inflammation, or infection susceptibility.

If you notice sinus symptoms alongside other systemic patterns—like persistent fatigue, dry eyes/mouth, or ongoing joint stiffness—it’s worth mentioning the full picture to your care team.

RA medications that can increase infection susceptibility

Many RA treatment plans include medications that calm an overactive immune response. These may include:

- Conventional DMARDs

- Biologics

- JAK inhibitors

- Corticosteroids (steroids)

Because some of these therapies can reduce immune responsiveness, infections may occur more easily or be harder to clear. Importantly, the degree of risk varies by medication and by person, and monitoring is individualized. Do not stop or change RA medications without guidance from your prescribing clinician; frequent infections are typically a reason for coordinated discussion, not abrupt changes.

Sjögren’s overlap: dryness and thick mucus

Sjögren’s syndrome can overlap with RA and is known for dryness (eyes, mouth, and sometimes nasal passages). Dryness can lead to thicker mucus and reduced clearance, which may contribute to infections or persistent symptoms. Research linking sinusitis with Sjögren’s risk reinforces that these conditions can cluster. (1,3)

Many patients describe this as feeling “stuffy but dry,” or like mucus is present but doesn’t move well—especially overnight or in low-humidity environments.

Allergies and chronic inflammation

Allergic rhinitis can cause swelling and blockage, trapping mucus and creating conditions where infections are more likely. Identifying triggers can be a key step; Sleep and Sinus Centers of Georgia offers allergy testing as part of a comprehensive evaluation to help clarify whether allergies are contributing: https://sleepandsinuscenters.com/allergy-testing

Even when allergies don’t directly cause an infection, they can set the stage by narrowing drainage pathways and keeping tissues inflamed.

Structural/anatomic contributors (ENT causes)

Sometimes recurrent symptoms are less about “catching” infections and more about airflow/drainage problems, such as:

- Deviated septum

- Narrow sinus drainage pathways

- Nasal polyps

When drainage is impaired, inflammation can be more persistent and infections can recur. In these cases, treating only the infection (for example, repeated antibiotics) may provide temporary relief without addressing the underlying blockage. For chronic cases related to narrowed drainage pathways, minimally invasive options like balloon sinuplasty may be considered: https://sleepandsinuscenters.com/balloon-sinuplasty

Environmental/behavioral contributors

Common contributors include smoke exposure, indoor irritants, low humidity, dehydration, and poor sleep—factors that can worsen nasal irritation and congestion.

If symptoms flare after travel, seasonal changes, or indoor heating cycles, those patterns can be valuable clues.

In practice, recurrent sinus problems in RA usually reflect multiple overlapping factors—understanding your drivers helps target the right mix of prevention and treatment.

Symptoms to Watch For (Sinus Infection vs RA Flare)

Common sinus infection symptoms

Sinus infections (or significant sinus inflammation) often include:

- Facial pressure/pain

- Nasal congestion

- Thick nasal drainage (or postnasal drip)

- Reduced sense of smell

- Cough, especially at night

- Tooth or upper jaw pressure

Fever can happen, but it’s not always present. Some people mainly notice “head pressure,” ear fullness, or a cough from postnasal drip that disrupts sleep.

Signs it may be more than a typical cold

Clues that can suggest acute bacterial sinusitis (rather than a short viral illness) include:

- “Double worsening” (you start to improve, then symptoms get worse again)

- Symptoms lasting more than about 10 days

- Severe symptoms early on (notably significant facial pain/pressure with high fever)

These patterns help clinicians decide when antibiotics are more likely to help versus when supportive care and time may be the better course. Not all sinus symptoms are due to bacterial infection.

RA symptoms that can overlap or worsen during infection

Infections can increase fatigue and body aches, and they may temporarily raise overall inflammation—sometimes making it hard to tell infection from flare. For people managing rheumatoid arthritis and recurrent sinus infections, it can be helpful to track the pattern: congestion/drainage and facial pressure tend to point more toward sinus involvement.

A practical tip: jot down timing (start date), peak symptoms, temperature, and whether nasal symptoms improved with irrigation or nasal spray—these details often make visits more productive.

Red flags—seek urgent care

Urgent evaluation is typically appropriate for:

- Eye swelling, vision changes

- Severe headache, confusion, stiff neck

- Shortness of breath

- High fever in the setting of significant immunosuppression

- Concern for spreading infection

If your symptoms don’t fit a simple “cold” pattern—or if red flags arise—timely evaluation helps protect both sinus health and overall wellbeing.

How Doctors Diagnose Recurrent Sinus Infections in RA Patients

What an ENT evaluation may include

An ENT visit often starts with a focused nasal exam and may include nasal endoscopy (a small camera to look deeper into the nasal passages).

CT imaging can be useful when symptoms are recurrent or chronic, when complications are suspected, or when planning procedures. The goal is to understand whether symptoms are driven by ongoing inflammation, structural narrowing, polyps, or other issues affecting drainage.

Lab work and cultures—when they matter

For frequent infections, infections not responding as expected, or unusual presentations, clinicians may consider additional workup, including cultures to guide antibiotic selection when appropriate. This can be especially relevant when symptoms keep returning quickly after treatment, or when the usual “first-line” approach hasn’t worked.

When to involve rheumatology (and what they may assess)

Rheumatology may review:

- Medication regimen and infection history

- Whether symptoms suggest overlapping conditions (like Sjögren’s)

- The balance between autoimmune control and infection risk

In many cases, the best outcomes come from treating both sides of the equation: controlling inflammation and supporting healthy sinus function.

Coordinated care—primary care, ENT, and rheumatology—helps align sinus management with autoimmune treatment and safety.

Treatment Options (Relief Now + Preventing the Next Episode)

At-home and OTC supportive care (often first-line)

- Saline irrigation (with sterile/distilled water and cleaned devices)

- Humidification and hydration

- Warm compresses

- Over-the-counter pain relief options (considering medication interactions and individual health history)

For many people, consistent basics—especially proper saline rinsing technique—make a noticeable difference over time. If you’re immunosuppressed, it’s particularly important to use sterile/distilled water for rinses.

Prescription treatments your clinician may recommend

Depending on symptoms and exam findings, treatment may include:

- Intranasal corticosteroid sprays (technique and consistency can matter)

- A short course of oral steroids in selected situations

- Antibiotics only when bacterial infection is likely

- Allergy-directed therapy (antihistamines, leukotriene modifiers, or immunotherapy in appropriate cases)

If you’re on RA medications, make sure every clinician involved knows your full medication list—this helps tailor choices and safety monitoring. Risk from RA therapies varies, and plans are individualized.

Treating underlying triggers to reduce recurrence

When evaluating recurrent sinus infections causes, clinicians often look for drivers like allergic rhinitis or chronic nonallergic rhinitis. Identifying triggers with allergy testing—as part of a complete clinical assessment—may help guide a prevention plan: https://sleepandsinuscenters.com/allergy-testing

When prevention is working, patients often notice fewer “cycles” of congestion → pressure → infection-like flares, even if they still get occasional colds.

When procedures help (for chronic or recurrent cases)

For eligible patients, procedures may improve sinus drainage and reduce recurrence risk. One common option is balloon sinuplasty (balloon sinus dilation), which aims to widen narrowed drainage pathways. Learn more here: https://sleepandsinuscenters.com/balloon-sinuplasty

RA-specific considerations during infections

Because RA medications can affect infection risk, it’s especially important that infection treatment plans and RA treatment plans are aligned. Vaccine planning and prevention strategies are often part of shared decision-making with your prescribing team.

An effective plan usually mixes symptom relief, trigger control, and—when needed—procedures that improve drainage, all coordinated with your RA care.

Lifestyle Tips to Reduce Recurrence (Patient Checklist)

Daily habits that support sinus health

- Saline rinses during high-risk seasons (when recommended by your clinician)

- Hand hygiene and avoiding sick contacts when possible—particularly for those on immunosuppressive therapy

If sinus problems are disrupting your sleep, consider tracking how often congestion wakes you up—sleep disruption is a common “hidden” burden of chronic sinus inflammation.

Home environment tweaks

- Maintain comfortable indoor humidity

- Consider air filtration

- Reduce irritants like smoke and strong fragrances

- Address dust exposure (especially if allergies are suspected)

Small changes—like improving bedroom air quality—can be surprisingly meaningful when symptoms are frequent.

Sleep and inflammation

Congestion can disrupt sleep, and poor sleep can worsen how the body feels overall. Some people find that sleep positioning helps drainage during symptomatic periods.

Simple, consistent habits can reduce flares and make treatments work better over time.

FAQs (SEO-Friendly)

1) Can sinus infections cause rheumatoid arthritis?

Current evidence shows an association, not proof of causation. Studies suggest sinusitis may be a marker or risk factor that shows up years before some rheumatic diseases begin, particularly in the 5–10 year window before symptoms. (1,3) This does not mean sinusitis predicts RA for an individual person.

2) What is seronegative rheumatoid arthritis, and how is it different?

Seronegative rheumatoid arthritis means RA features are present, but common antibody tests are negative. Diagnosis still relies on the overall clinical picture (symptoms, exam, imaging/labs over time).

3) How many sinus infections are “too many”?

Recurrent acute rhinosinusitis is often defined as about four or more distinct episodes per year with complete resolution between episodes. Chronic rhinosinusitis means symptoms persist for 12 weeks or longer. Because definitions and circumstances vary, an ENT evaluation is helpful when symptoms are frequent or prolonged. For more on acute vs chronic patterns: https://sleepandsinuscenters.com/blog/acute-vs-chronic-sinusitis-key-differences-and-treatment-options

4) Do RA biologics or steroids make sinus infections more common?

Some RA treatments can increase susceptibility to infections in general. The degree of risk varies widely by medication and by person, so coordination with the prescribing team is important.

5) How can I tell allergies from a sinus infection?

Allergies often cause sneezing, itching, and clear drainage, while infection is more associated with facial pressure, thicker drainage, and “double worsening.” Overlap is common.

6) When should I see an ENT vs my primary care doctor vs my rheumatologist?

Primary care often handles initial episodes; ENT is commonly involved for recurrent/chronic symptoms or anatomical concerns; rheumatology helps when RA treatment and infection patterns intersect.

7) Will balloon sinuplasty help recurrent sinus infections?

It may help selected patients whose symptoms are driven by drainage pathway narrowing. Evaluation determines whether anatomy and symptom pattern fit. https://sleepandsinuscenters.com/balloon-sinuplasty

8) Should I stop my RA medication when I have a sinus infection?

Medication changes are individualized. It’s generally safest to confirm a plan with the clinician who prescribes your RA therapy rather than making changes independently.

When to Book an Appointment

Consider scheduling an evaluation if:

- Symptoms recur multiple times per year

- Symptoms persist longer than 12 weeks

- Episodes aren’t improving as expected

- You’re immunosuppressed and infections are becoming frequent

Sleep and Sinus Centers of Georgia can help assess what’s driving your symptoms—whether it’s chronic inflammation, allergies, anatomy, or a combination—and discuss options for chronic sinusitis care and prevention planning. To schedule, visit https://www.sleepandsinuscenters.com/

Sources

1) RMD Open (BMJ). Sinusitis linked to increased risk of rheumatic disease. https://rmdopen.bmj.com/content/10/1/e003622

2) BMJ Group news release (summary). https://bmjgroup.com/sinusitis-linked-to-40-heightened-risk-of-rheumatic-disease/

3) The Journal of Rheumatology. https://www.jrheum.org/content/49/4/358

4) Rheumatology Advisor (summary). https://www.rheumatologyadvisor.com/news/past-sinusitis-associated-with-rheumatic-disease-incidence/

5) Medical News Today (summary). https://www.medicalnewstoday.com/articles/sinusitis-linked-to-40-heightened-risk-of-rheumatic-diseases

6) Frontiers in Immunology (review). https://pmc.ncbi.nlm.nih.gov/articles/PMC10570781/

7) ScienceDirect (review abstract). https://www.sciencedirect.com/science/article/abs/pii/S0049017221002298

This article is for educational purposes only and is not medical advice. Please consult a qualified healthcare provider for diagnosis and treatment.