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Fukuda K, Mizobuchi T, Nakajima I, Kishimoto T, Miura Y, Taniguchi Y. Ocular Involvement in Relapsing Polychondritis. J Clin Med 2021; 10:jcm10214970. [PMID: 34768492 PMCID: PMC8584789 DOI: 10.3390/jcm10214970] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 01/17/2023] Open
Abstract
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.
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Affiliation(s)
- Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
- Correspondence: ; Tel.: +81-88880-2391
| | - Tomoka Mizobuchi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
| | - Isana Nakajima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
| | - Tatsuma Kishimoto
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
| | - Yusaku Miura
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi 783-8505, Japan;
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Alfraji N, Alpert DR. Unusual Presentation of Relapsing Polychondritis in a Patient with Human Immunodeficiency Virus and Reactive Arthritis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933327. [PMID: 34580270 PMCID: PMC8488188 DOI: 10.12659/ajcr.933327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patient: Female, 58-year-old
Final Diagnosis: Relapsing polychondritis
Symptoms: Ear pain • eye pain
Medication: —
Clinical Procedure: —
Specialty: Rheumatology
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Affiliation(s)
- Nasam Alfraji
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Deborah R Alpert
- Department of Rheumatology, Jersey Shore University Medical Center, Neptune, NJ, USA
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Sheikh A, Rodgers R. Fulminant orbital inflammatory syndrome in a patient with relapsing polychondritis: case report and review of the literature. Orbit 2020; 40:252-254. [PMID: 32363978 DOI: 10.1080/01676830.2020.1762230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We describe a 75-year-old woman with rapid onset orbital inflammatory syndrome as her initial manifestation of relapsing polychondritis. Patient presented after the development of right eyelid swelling, erythema, and proptosis over a 48-hour period. Visual acuity was 20/30 in both eyes. Intraocular pressure was elevated in her right eye along with severe restriction of extraocular motility. Magnetic resonance imaging of the orbits revealed thickened right medial and inferior recti muscles. Serologic laboratory data was unrevealing. Patient demonstrated marked improvement within 12 hours of administration of intravenous corticosteroids. She was symptom-free after 1 week. A diagnosis of relapsing polychondritis was confirmed 3 weeks later after new onset complaints of right ear pain and a rash.
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Affiliation(s)
- Ahmed Sheikh
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | - Rand Rodgers
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
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Haldar S, Jackson D, Magliano M, Scawn R. Relapsing periorbital polychondritis: a great ophthalmic masquerader. Can J Ophthalmol 2019; 54:e16-e18. [PMID: 30851788 DOI: 10.1016/j.jcjo.2018.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 10/28/2022]
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Relapsing Polychondritis: An Updated Review. Biomedicines 2018; 6:biomedicines6030084. [PMID: 30072598 PMCID: PMC6164217 DOI: 10.3390/biomedicines6030084] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022] Open
Abstract
Relapsing polychondritis is an immune-mediated systemic disease characterized by recurrent episodes of inflammation of cartilaginous and proteoglycan-rich tissues, resulting in progressive anatomical deformation and functional impairment of the involved structures. Auricular and nasal chondritis and/or polyarthritis represent the most common clinical features, but potentially all types of cartilage may be involved. Because of the pleomorphic nature of the disease, with non-specific symptoms at the onset, the diagnosis of relapsing polychondritis is often delayed. In this review article we provide a comprehensive look into clinical presentation, laboratory and instrumental investigations, diagnostic criteria, and therapeutic options.
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Eun YH, Seok H, Shin IS, Lee SE, Lee YB, Lee J. Relapsing polychondritis presenting with inflammatory pseudotumor. Korean J Intern Med 2016; 31:1003-5. [PMID: 26968191 PMCID: PMC5016277 DOI: 10.3904/kjim.2015.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/03/2015] [Accepted: 06/15/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | | | | | | | - Jaejoon Lee
- Correspondence to Jaejoon Lee, M.D. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3439 Fax: +82-2-3410-3849 E-mail:
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Idiopathic Orbital Inflammation Associated With Relapsing Polychondritis. Ophthalmic Plast Reconstr Surg 2016; 33:S167-S168. [PMID: 26974421 DOI: 10.1097/iop.0000000000000667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The authors describe a patient with recurrent idiopathic orbital inflammatory disease as an unusual presentation of relapsing polychondritis. There are very few reported cases in the literature of relapsing polychondritis associated with idiopathic orbital inflammation. Clinicians should be aware of the orbital and ophthalmic presentations of relapsing polychondritis.
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Longo L, Greco A, Rea A, Lo Vasco VR, De Virgilio A, De Vincentiis M. Relapsing polychondritis: A clinical update. Autoimmun Rev 2016; 15:539-43. [PMID: 26876384 DOI: 10.1016/j.autrev.2016.02.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/08/2016] [Indexed: 02/07/2023]
Abstract
Relapsing polychondritis (RP) is a rare connective tissue disease in which recurrent bouts of inflammation, involve the cartilage of the ears, nose, larynx, tracheobronchial tree and cardiovascular system. RP is generally observed in the fourth and fifth decades of life and occurs with equal frequency in both sexes. The cause of RP is still unknown. It is considered an immune-mediated disease, as there is an overlap between well documented RP with other rheumatic and autoimmune diseases. There is a significant association of RP with the antigen HLA-DR4. RP includes loss of basophilic staining of cartilage matrix perichondral accompanied by inflammation of the cartilage. Cells are present perivascular mononuclear and polymorphonuclear cells infiltrated. The chondrocytes become vacuolated and necrotic and are replaced by fibrous tissue. Common symptoms are often absent in the early stages of the disease in almost half the cases, resulting in delay in diagnosis. The development of chondrite allows the diagnosis of RP in patients initially evaluated for joint abnormalities, ocular, cutaneous, or audio-vestibular. Diagnostic criteria for RP are based on characteristic clinical manifestations. According to Damiani and Levine, the diagnosis can be considered final when one or more of the clinical features are present in conjunction with biopsy confirmation. The course of symptoms for patients with relapsing polychondritis is often unpredictable. Patients with mild signs of acute inflammation are usually treated with non-steroidal anti-inflammatory drugs and small doses of prednisone. Patients with severe manifestations, such as airway compromise may require high doses of prednisone or even intravenous pulse methyl-prednisone.
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Affiliation(s)
- Lucia Longo
- Department Organs of Sense, Phoniatrics Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
| | - Antonio Greco
- Department Organs of Sense, ENT Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
| | - Andrea Rea
- Department Organs of Sense, Phoniatrics Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
| | - Vincenza Rita Lo Vasco
- Department Organs of Sense, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
| | - Armando De Virgilio
- Department Organs of Sense, ENT Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy.
| | - Marco De Vincentiis
- Department Organs of Sense, ENT Section, 'Sapienza' University of Rome, Viale del Policlinico 155, 00100 Roma, Italy
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Furuya N, Oshitari T, Yotsukura J, Baba T, Yamamoto S. Relapsing polychondritis with different types of ocular inflammations. Int Med Case Rep J 2015; 8:193-7. [PMID: 26425107 PMCID: PMC4581778 DOI: 10.2147/imcrj.s89507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We were presented with two cases of relapsing polychondritis (RP) associated with different types of ocular inflammation. The first case was a 35-year-old man who had bilateral hyperemic conjunctiva and ocular pain, and was referred to Chiba University Hospital with a diagnosis of episcleritis refractory. He was treated with dexamethasone eye drops. He developed tinnitus, deafness in both ears, and left auriculitis. A left auricular biopsy showed an infiltration of lymphocytes surrounding the cartilage. He was diagnosed with RP and treated with 30 mg/day oral prednisolone. After tapering the prednisolone, the scleritis in both eyes improved. The second case was a 71-year-old man who was deaf in both ears and had bilateral scleritis. At the first visit to our hospital, his left eyelid and right auricula were reddish and swollen, and he reported some pain. He was treated with intravenous antibiotics, and the left orbital cellulitis quickly improved. However, he developed right scleritis and left gonitis. Magnetic resonance imaging showed bilateral posterior scleritis and right auricular perichondritis. Auricular biopsy showed an infiltration of lymphocytes into the periauricular tissue. He was diagnosed with RP, and 40 mg/day oral prednisolone was given and his symptoms improved. Although RP is rare, it is a life-threatening disease. Thus, ophthalmologists should consider RP in patients with both ocular and auricular inflammation.
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Affiliation(s)
- Nana Furuya
- Department of Ophthalmology and Visual Science, Chiba University, Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Toshiyuki Oshitari
- Department of Ophthalmology and Visual Science, Chiba University, Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Jiro Yotsukura
- Department of Ophthalmology and Visual Science, Chiba University, Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University, Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University, Graduate School of Medicine, Chuo-ku, Chiba, Japan
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