Ocular inflammation associated with relapsing polychondritis in Japanese patients: a review of 11 patients

Sclerokeratitis and Secondary Glaucoma in Relapsing Polychondritis in a 30-Year-Old Asian Male Patient: A Case Report

Relapsing polychondritis (RPC) is an immune-mediated systemic disease characterized by recurring inflammatory episodes in cartilage structures, mainly in the ears, nose, and respiratory tract. It is associated with various systemic and ocular manifestations, such as scleritis, the most common ocular feature of RPC. Scleromalacia perforans (SP) is a rare and severe form of anterior scleritis that appears as a dark bluish discoloration and bulging of a thinned-out sclera in the absence of pain or redness. This case report describes a 30-year-old Asian male who presented a seven-year history of blurred vision and recurrent eye redness. Visual acuity (VA) was 15/200 and 20/63+2 on OD and OS, respectively. An eye exam showed diffusely hazy cornea, thinned-out sclera, and elevated intraocular pressure (IOP) in both eyes. A systems review revealed bilateral auriculitis and mixed hearing loss. He was clinically diagnosed with RP and started on systemic corticosteroids at 1 mg/kg/day. On follow-up, the patient showed resolution of conjunctival hyperemia; however, IOP remains elevated despite maximal therapy. Ocular manifestations in RPC are protean and may be the presenting symptoms of RPC, resulting in the possibility of delayed or missed diagnosis in the absence of chondritis. SP, corneal scarring, and secondary glaucoma are late sequelae and vision-threatening conditions that may pose significant therapeutic challenges to ophthalmologists. Multispecialty collaboration is warranted in the management of systemic complications of RPC.

Relapsing polychondritis - A single Centre study in the United Kingdom

INTRODUCTION AND OBJECTIVES

Relapsing Polychondritis (RP) is a rare immune mediated inflammatory disorder that may result in damage and destruction of cartilaginous tissues.

PATIENTS AND METHODS

We retrospectively analysed patients with a clinical diagnosis of RP. Patients were investigated using pulmonary function tests, dynamic high-resolution CT scans, bronchoscopy, laryngoscopy and/or PET-CT scans along with autoimmune serology. Patients had other specialist reviews when indicated.

RESULTS

We identified 68 patients with a diagnosis of RP, 55 (81%) were Caucasian, 8 (12%) Afro Caribbean, 4 (6%) Asian and 1 patient had Mixed Ethnicity. Twenty-nine (43%) had pulmonary involvement and in 16, pulmonary involvement was the initial presentation. The mean age at onset was 44 years (range 17-74). There was a mean diagnostic delay of 55 weeks. 66 (97%) patients received a combination of oral Prednisolone and disease modifying anti-rheumatic drugs. Twelve of 19 (63%) received biologics, with an initial good response, and 10 remain on treatment. 11 patients with respiratory collapse required CPAP to maintain airway patency. Twelve (18%) patients died due to RP and 9 had respiratory complications. Two patients developed myelodysplasia and one had lung carcinoma. In a multivariate regression analysis, the prognostic variables were ethnicity, nasal chondritis, laryngotracheal stricture and elevated serum creatinine.

CONCLUSION

RP is a rare autoimmune condition often associated with significant delays in diagnosis and initiation of treatment. Pulmonary involvement in RP may cause significant morbidity and mortality due to organ damage. Disease modifying anti rheumatic drugs and biologics should be considered early in the disease course to minimise adverse effects of long-term corticosteroid therapy and organ damage.

Ocular Involvement in Relapsing Polychondritis

Relapsing polychondritis (RPC) is a rare systemic immune-mediated disease characterized by recurrent inflammation of cartilaginous and proteoglycan-rich tissues throughout the body. Auricular, nasal, tracheal, and articular chondritis and arthritis are common systemic symptoms in patients with RPC. Ocular tissues are also targets of inflammation in RPC, and a variety of ocular symptoms are observed in approximately half of the patients with RPC. Scleritis/episcleritis, uveitis, and conjunctivitis are common symptoms associated with RPC. Less frequently, keratitis, retinopathy, optic neuropathy, muscle palsy, and orbital inflammation are also observed. Ocular inflammation could also be the first manifestation of RPC. Although RPC is a potentially fatal and sight-threatening disease, the rarity of the disease and its protean clinical presentation may lead to delayed diagnosis or misdiagnosis. Given the high prevalence of ocular involvement in RPC, to avoid misdiagnosis, physicians should be suspicious of RPC when they see patients with recurrent ocular inflammatory conditions and various systemic symptoms. In this article, we provide a comprehensive review of ocular manifestations associated with RPC.

Sustained Remission with Tocilizumab in Refractory Relapsing Polychondritis with Ocular Involvement: A Case Series

Objective: Describe our experience with tocilizumab in the treatment of refractory relapsing polychondritis with ocular involvement.Methods: Retrospective consecutive interventional case series that included all patients that received tocilizumab for the treatment of relapsing polychondritis with ocular manifestations.Results: Three cases were selected and the duration of tocilizumab treatment ranged from 1 to 2 years. One of our patients received tocilizumab as a first-line immunosuppressive treatment directly after prednisone. All achieved complete response to tocilizumab 1 month after treatment initiation. No advert events were reported during the follow-up period except for transient neutropenia without any associated infection.Conclusion: Our three cases suggest that tocilizumab may be an effective and safe treatment for ocular manifestation associated with relapsing polychondritis.