You should ask the ENT if you might be a candidate for surgical repair of the nasal septum perforation. The tissue used is an acellular human dermal allograft and now days it is applied with fibrin glue, rather than with sutures. If not, why not?
If not, nasal irrigation or washing with normal saline might prevent the “crusty stuff” from building up. To learn more about this technique please read our nasal wash treatment information by copying and pasting this address
into the address window of your internet browser. Share this information with your doctor to see if you would benefit from this daily treatment, possibly in association with a mild inhaled nasal steroid.
The “thick gooey phlegm” could also be originating in your nose but equally likely from your lungs, as rheumatoid arthritis is frequently compounded by a number of different diseases that all fall into the category of rheumatoid lung, usually but not always associated with chest x-ray abnormalities. Also, some of the material that is bothering you could be caused by recurrence of the nasal polyps, not immediately visible near the nostrils.
If your ENT is not open to any of the above, you might want to request a second opinion.