Relapsing polychondritis: Best Practice & Clinical Rheumatology

Laryngeal involvement in relapsing polychondritis: clinical and CT findings in 173 patients

INTRODUCTION/OBJECTIVES

Relapsing polychondritis (RP) is a rare autoimmune disorder primarily affecting cartilaginous structures. We aimed to characterise the clinical features and CT findings of laryngeal involvement in RP, hypothesising that specific CT patterns correlate with clinical manifestations.

METHODS

We retrospectively analysed 173 patients with confirmed RP. Demographic and clinical data were collected, and laryngeal, tracheal, and bronchial CT findings were reviewed. Statistical analyses identified factors associated with laryngeal involvement and airway stenosis.

RESULTS

Notably, 66% of asymptomatic patients displayed CT evidence of airway damage, with laryngeal involvement in 41.1% (44/107), tracheal involvement in 80.9% (140/173), and bronchial involvement in 36.4% (63/107). Cricoid erosion and broadening with mucosal hyperplasia were the predominant laryngeal findings. Significant associations with laryngeal involvement included younger age at disease onset (p<0.05), longer disease duration (p<0.01) and multiorgan manifestations (p<0.01).

CONCLUSIONS

Laryngeal involvement is common in RP patients with airway manifestations, second only to tracheal involvement. CT findings of cricoid erosion and broadening are characteristic. Vigilant clinical monitoring is recommended for RP patients with identified risk factors to facilitate early detection and management. Future research should focus on developing targeted interventions for this high-risk subgroup of RP patients.

Clinical Manifestations and Treatment in Patients With Relapsing Polychondritis: A Multicenter Observational Cohort Study

OBJECTIVE

Relapsing polychondritis (RP) is a rare, heterogeneous, multisystem disease lacking standard treatment guidelines. This study describes clinical manifestations in association with approaches to treatment.

METHODS

Adults with physician-diagnosed RP were recruited into a multicenter observational cohort study. Clinical manifestations, organ damage, and medication history were recorded at the baseline study visit. Treatments received for RP at any time point before the initial visit were categorized into three groups: group 1 was treated with glucocorticoids (GCs) or no drugs, group 2 was treated with nonbiologic immunosuppressive (IS) drugs excluding JAK inhibitors (JAKis) with or without GCs, and group 3 was treated with JAKis or biologic IS drugs with or without nonbiologic IS drugs or GCs.

RESULTS

Included in the study were 195 patients with RP who were predominantly female (167, 86%) and White (174, 89%), with a mean age of 49 ± 13years. All patients had ear, nose, or airway involvement, and 163 (83%) had musculoskeletal manifestations of RP. All patients had at least three clinical manifestations with median of 11 (range 3-19). GC treatment was given to 186 (95%) patients. Organ damage was seen in 80 (41%) patients. Treatment groups 1, 2, and 3 had 37 (19%), 55 (28%), and 103 (53%) patients, respectively. Patients in group 3 were more likely to have organ damage, arthritis, and subglottic stenosis.

CONCLUSION

Patients with RP have a high burden of clinical manifestations with resultant damage. Physicians typically treat RP with GCs, and the use of other immunosuppressive medications is variable. Absence of a consensus approach to treatment underscores the need for clinical trials and treatment guidelines for RP.

Early Diagnosis of Relapsing Polychondritis With Airway Involvement: A Case Report

Relapsing polychondritis (RP) is a rare systemic immune-mediated disease that causes recurrent inflammation of cartilaginous tissues. Airway involvement is a significant prognostic factor; however, diagnosis is often delayed because of nonspecific symptoms. We report the case of a 38-year-old woman who presented with pharyngeal discomfort, cough, and chest pain. Initial tests revealed elevated inflammatory markers and anemia. A chest CT scan showed soft tissue enhancement around the costal cartilage and thickening of the tracheal and bronchial walls. Bronchoscopy demonstrated extensive inflammation from the larynx to the main bronchi, with approximately 90% narrowing of the left bronchus during exhalation, suggestive of tracheomalacia. Based on clinical findings, imaging, bronchoscopy, and serological tests, a diagnosis of RP was made, fulfilling McAdam's and Damiani's criteria. Although pulmonary function tests continued to show obstructive ventilatory impairment, treatment withcorticosteroids (0.6 mg/kg prednisolone) and methotrexate resulted in rapid improvement in inflammatory markers and imaging findings. This case highlights the importance of early bronchoscopy in assessing airway involvement in RP, even when respiratory symptoms are mild, and emphasizes the need to balance the diagnostic benefits against potential risks, particularly in those with reduced forced vital capacity. Early diagnosis and timely intervention, including consideration of biologics, may prevent progression to severe airway compromise.

Hiding in Plain Sight-Relapsing Polychondritis Disguised as Hip Arthritis: A Case Report and Literature Review

BACKGROUND

Relapsing polychondritis (RP) is a rare autoimmune disorder characterized by episodic inflammation of cartilaginous tissues. Its diverse clinical manifestations frequently pose diagnostic challenges and lead to misdiagnosis.

METHODS

We present a 59-year-old female initially diagnosed with refractory hip osteoarthritis based on persistent left hip pain unresponsive to conventional anti-inflammatory therapy. Subsequent development of stridor and dyspnea prompted comprehensive evaluation, including laryngotracheal imaging, autoimmune serology, and multidisciplinary consultation. Diagnostic criteria for RP were applied in accordance with revised Michet criteria.

RESULTS

Tracheal stenosis secondary to tracheal chondritis and iritis were identified, confirming the diagnosis of RP. Following initiation of corticosteroid therapy, the patient exhibited marked clinical improvement.

CONCLUSION

This case underscores the importance of enhanced clinical awareness regarding atypical presentations of RP, particularly when accompanied by evolving systemic symptoms. A multidisciplinary diagnostic approach is advocated to facilitate early detection and improve patient outcomes.

Comprehensive Interventional treatment for severe central airway collapse caused by Relapsing Polychondritis: A case report

Relapsing Polychondritis (RP) is a rare systemic inflammatory disease. One major cause of death for patients with RP is severe tracheobronchial tree collapse. Treatment guidelines for RP are mainly based on case reports. We report a rare and challenging case of RP in a patient who experienced asphyxia due to severe central airway collapse. The patient had previously been misdiagnosed with refractory asthma due to recurrent wheezing. Following interventions including bronchoscopic laser tracheobronchoplasty, stent placement, corticosteroid therapy, and both invasive and non-invasive mechanical ventilation, the patient was successfully stabilized and subsequently discharged from the hospital. Notably, after discharge, the patient did not require rehospitalisation for worsening respiratory symptoms and was managed with only a gradually tapering glucocorticoid regimen. In our case report, stent placement rapidly relieved asphyxia due to severe tracheobronchial stenosis, and laser tracheobronchoplasty may be a potential cure for diffuse airway collapse due to RP.

Clonal hematopoiesis and autoimmunity

Clonal hematopoiesis (CH) has been associated with aging, occurring in about 10% of individuals aged >70 years, and immune dysfunction. Aged hematopoietic stem and progenitor cells exhibit pathological changes in immune function and activation of inflammatory pathways. CH clones commonly harbor a loss of function mutation in DNMT3A or TET2, which causes increased expression of inflammatory signaling genes, a proposed mechanism connected to CH and the development of age-related diseases. Additionally, inflammation may stress the hematopoietic compartment, driving the expansion of mutant clones. While the epidemiologic overlap between CH, hematologic malignancies, and atherosclerotic cardiovascular diseases has been reported, the mechanisms linking these concepts are largely unknown and merit much further investigation. Here, we review studies highlighting the interplay between CH, inflamm-aging, the immune system, and the prevalence of CH in autoimmune diseases.