Rheumatology deals with auto-immune inflammatory diseases that usually cause arthritis. But some rare ones affect the nose, not the joints. One is called “Granulomatosis With Polyangiitis,” which used to be called Wegener’s Granulomatosis, but Wegener was one of Hitler’s Nazis, so his name got nixed.
In addition to chronic nasal congestion, patients may have bleeding sores, nose deformities, hearing loss, and other serious destruction of the eye and face. An Ear-Nose-Throat (ENT) specialist (Otorhinolaryngologists) can help make the diagnosis, but Rheumatologists are usually more experienced in treatment, which involves anti-inflammatory medications that carry certain risks.
Primary clinicians might suspect the disease if a patient has lots of problems of the nose, ear, and throat, and especially if general inflammatory lab tests like the Sed Rate or CRP are abnormal, or there’s an anemia of chronic disease (that’s not due to iron deficiency). Then, a positive blood test for “ANCA” antibodies is key. Biopsy should be done to be sure, but may be obtained from kidney or skin (the disease may involve many organs).
Some rare tumors can affect the nose. Some are cancerous, others may be “benign” meaning not cancer, but still cause major destruction. They can usually be found by CT scan. ENT specialists can perform biopsies to make the diagnosis and perform surgery as necessary.