Hello Everyone!

First, I want to thank everyone who participates in this forum. I've read a bunch of these posts over the last couple months while learning about GPA, and it's been valuable to read about so many of your experiences.

I've recently started seeing a rheumatologist over, what they suspect, could be possible GPA.

In February of 2022, I started experiencing pretty severe nasal congestion. This congestion was pretty abnormal for me, since I've never been one to get sinus infections, have allergies, etc. I couldn't breathe through my nose at all without using Afrin (OTC Sudafed didn't work either ). I went to my primary doctor who said it was most likely allergies, and placed me on Claritin and Flonase and told me to come back in 1 month. I follow up a month later, without improvement, and she refers me to an ENT.

I start seeing the ENT off/on for the next 6 months or so. At first, they treated me w/ two 10-day courses of Augmentin. They also ordered a CT of my sinuses. The CT was normal except for a slight deviation in my septum. The ENT prescribed some sinus rinses + budesonide and performed a scope of my nose. He noticed that the inferior turbinates on both sides were really swollen, and said that my septum was pretty inflamed. He also noticed that I had some crusting and evidence of nosebleeds. There was also an ulcer on the right side that they were worried might perforate, but it's since healed. He said that I would benefit from sinus surgery, but because of the inflammation/crusting that they wanted to run a couple blood tests to check for vasculitis.

The ENT ordered blood tests to check my SED rate, CRP, and ANCA. The SED rate and CRP were normal, but the ANCA screen came back positive for C-ANCA and I had a slightly elevated PR-3 value as well. Since those two tests came back positive, the ENT said no surgery for now and referred me to my rheumatologist.

I started seeing the rheumatologist on 12-22-2022. We talked for probably an hour about symptoms that I have experienced for the last year or so. We came up with the following...


  • Sinus Congestion (awful)
  • Nasal Crusting (pretty annoying when not doing the rinses)
  • Nose bleeds (regularly?)
  • Fatigue (I nap every single day now after work, which I never did prior to all this starting)
  • Slightly elevated temperature (it's almost always 99.7 - 100)
  • Joint pains (mostly in my knees, but definitely towards the bottom of things bothering me)


The rheumatologist said that they wanted to order a bunch of extra blood work + a urinalysis to make sure that there wasn't anything else going on behind the scenes. Assuming these come back negative (which they have), they are going to treat it as sinus limited GPA, but she informed me that it doesn't have to stay that way and it's important that I'm aware of any changes in my body/habits/etc. She put me on methotrexate + a taper of prednisone (30/20/10/5/2.5) and is set to see me again at the end of march.

All that said, I wanted to ask a few questions of you all, since you've all had experiences with this stuff.


  • Have you had success w/ methotrexate and prednisone?
  • Do the nose issues ever go away?
  • Should I keep pushing back on my rheum and looking for alternatives?


I've felt better(ish) since I've started the prednisone. My nose has felt better than it has anytime in the last year. It's still congested, but at least I'm able to breathe through it most of the time

My wife also says that my energy levels have gone back up and I look better (how rude ). I've also stopped napping as much.

Thanks everyone, and I look forward to talking to everyone and being a part of the community.