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PURCELLI FM, NAHUM A, MONELL C. XCII Relapsing Polychondritis with Tracheal Collapse. Ann Otol Rhinol Laryngol 2016; 71:1120-9. [PMID: 13972564 DOI: 10.1177/000348946207100426] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Belot A, Duquesne A, Job-Deslandre C, Costedoat-Chalumeau N, Boudjemaa S, Wechsler B, Cochat P, Piette JC, Cimaz R. Pediatric-onset relapsing polychondritis: case series and systematic review. J Pediatr 2010; 156:484-9. [PMID: 19880136 DOI: 10.1016/j.jpeds.2009.09.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 07/22/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To study the pediatric presentation and evolution of relapsing polychondritis (RP), a rare inflammatory disease characterized by recurrent inflammation of cartilage. STUDY DESIGN We retrospectively collected data from 10 patients observed in 3 French hospitals for relapsing polychondritis, with an age at onset <18 years. We also analyzed 37 cases of pediatric-onset RP from a systematic review. RESULTS The mean age at first symptoms was 8.6 years, and the sex ratio was 6 male patients and 4 female patients. Children came to medical attention with joint pain, ocular inflammation, and chondritis. Outcomes included severe visual impairment, chronic destructive chondritis, and 1 death caused by aortic dilatation. Treatment mainly consisted of non-steroidal-anti-inflammatory drugs, corticosteroids, and immunosuppressants. Growth was normal in 7 examined patients. Systematic literature review also suggested a high number of tracheostomy in pediatric cases, but this was not confirmed in our series. CONCLUSION RP in childhood shares the main clinical features of its adult counterpart, including destructive chondritis and systemic symptoms, but unlike adults, children frequently have a family history of autoimmunity and infrequently have other associated autoimmune diseases. RP can be fatal; close screening for complications is mandatory. Growth does not appear to be impaired by cartilage inflammation.
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Affiliation(s)
- Alexandre Belot
- Service de néphrologie et rhumatologie pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon et Université de Lyon, Lyon, France.
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Tomashefski JF, Cagle PT, Farver CF, Fraire AE. Collagen Vascular Diseases and Disorders of Connective Tissue. DAIL AND HAMMAR’S PULMONARY PATHOLOGY 2008. [PMCID: PMC7120184 DOI: 10.1007/978-0-387-68792-6_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The collagen vascular diseases, also referred to as connective tissue diseases, are a diverse group of systemic inflammatory disorders thought to be immunologically mediated. The concept of collagen vascular disease began to take shape in the 1930s, when it was recognized that rheumatic fever and rheumatoid arthritis can affect connective tissues throughout the body.1,2 During the following decade, as conditions such as systemic lupus erythematosus (SLE) and scleroderma came to be viewed as systemic diseases of connective tissue, the terms diffuse connective disease and diffuse collagen disease were proposed.3,4 During the same period, the designation of diffuse vascular disease was proposed for diseases such as scleroderma, polymyositis, SLE, and polyarteritis nodosa, which featured widespread vascular involvement.5 With the realization that many of these entities can exhibit both systemic connective tissue manifestations and vascular abnormalities, the unifying designation of collagen vascular disease was introduced.6
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Affiliation(s)
- Joseph F. Tomashefski
- grid.67105.350000000121643847Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH USA ,grid.411931.f0000000100354528Department of Pathology, MetroHealth Medical Center, Cleveland, OH USA
| | - Philip T. Cagle
- grid.5386.8000000041936877XDepartment of Pathology, Weill Medical College of Cornell University, New York, NY ,grid.63368.380000000404450041Pulmonary Pathology, Department of Pathology, The Methodist Hospital, Houston, TX USA
| | - Carol F. Farver
- grid.239578.20000000106754725Pulmonary Pathology, Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, OH USA
| | - Armando E. Fraire
- grid.168645.80000000107420364Department of Pathology, University of Massachusetts Medical School, Worcester, MA USA
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Bachor E, Blevins NH, Karmody C, Kühnel T. Otologic manifestations of relapsing polychondritis. Auris Nasus Larynx 2006; 33:135-41. [PMID: 16427754 DOI: 10.1016/j.anl.2005.11.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Revised: 09/26/2005] [Accepted: 11/11/2005] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Relapsing polychondritis (RP) is an episodic disease most likely of autoimmune etiology, characterized by recurrent inflammation of cartilaginous structures. METHODS Retrospective case study at two tertiary referral centers with presentation of nine patients with otologic involvement of RP, review of the spectrum of otologic disorders seen, and treatment. RESULTS The clinical course of otologic manifestations of RP was highly variable and ranged from mild to moderate. In 6/9 patients there was an association with other autoimmune disorders. In addition to recurrent auricular chondritis, which was present in 8/9 patients, our patients had otitis externa, chronic myringitis, Eustachian tube dysfunction, conductive hearing loss, sensorineural hearing loss, and tinnitus. All patients had their diagnosis of RP made on the basis of their otologic involvement and the response to systemic corticosteroids. CONCLUSION The diagnosis of RP is primarily clinical, but laboratory studies and biopsy may contribute as well. Once the diagnosis is suspected, the otolaryngologist should consider consultation with a rheumatologist to assist in the management of additional systemic manifestations.
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Affiliation(s)
- Edgar Bachor
- Universitäts-HNO Klinik, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany.
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Letko E, Zafirakis P, Baltatzis S, Voudouri A, Livir-Rallatos C, Foster CS. Relapsing polychondritis: a clinical review. Semin Arthritis Rheum 2002; 31:384-95. [PMID: 12077711 DOI: 10.1053/sarh.2002.32586] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study comprehensively reviews the literature related to relapsing polychondritis (RP). METHODS A detailed search via MEDLINE (PubMed) was performed using relapsing polychondritis as the key term. Relevant articles were analyzed with a focus on history, epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of RP. RESULTS RP is a rare episodic and progressive inflammatory disease of presumed autoimmune etiology first described in 1923. RP affects cartilage in multiple organs, such as the ear, nose, larynx, trachea, bronchi, and joints. In addition, it can affect proteoglycan-rich tissues, such as the eyes, aorta, heart, and skin. The diagnosis of RP is based on the presence of clinical criteria. A standardized therapeutic protocol for RP has not been established. Nonsteroidal anti-inflammatory drugs, dapsone and/or colchicine, may control disease activity in some patients. In other patients, immunosuppressive drugs and prednisone have been effective. RP is a potentially lethal disease; pulmonary infection, systemic vasculitis, airway collapse, and renal failure are the most common causes of death. Earlier studies indicate survival rates between 70% at 4 years and 55% at 10 years. In a recent study, a survival rate of 94% at 8 years may be due to improved medical and surgical management. CONCLUSIONS RP is a rare, multisystemic, and potentially fatal disease. The pathogenesis and optimal therapeutic approach to patients with RP is poorly understood.
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Affiliation(s)
- Erik Letko
- Uveitis and Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Lee-Chiong TL. Pulmonary manifestations of ankylosing spondylitis and relapsing polychondritis. Clin Chest Med 1998; 19:747-57, ix. [PMID: 9917964 DOI: 10.1016/s0272-5231(05)70114-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ankylosing spondylitis is a chronic inflammatory disease that affects chiefly the joints of the axial skeleton. It is a multisystem disease. Several extra-auricular manifestations of ankylosing spondylitis have been described including ocular, cardiovascular, renal, and neurologic complications. Pulmonary involvement consists principally of upper lobe fibrocystic changes and chest wall restriction. Relapsing polychondritis, on the other hand, is a rare disorder characterized by progressive inflammation and degeneration of the cartilaginous structures and other connective tissues throughout the body. Involvement of the respiratory tract is identified in more than one-half of patients with relapsing polychondritis.
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Affiliation(s)
- T L Lee-Chiong
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
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Abstract
Relapsing polychondritis is a rare multisystem disease. We describe the presentation and treatment of a patient with relapsing polychondritis and review the literature. This patient had involvement of the tracheobronchial tree requiring insertion of metallic stents.
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Affiliation(s)
- J A Dunne
- Bradford Royal Infirmary, Yorkshire, England
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Abstract
To analyze the importance of airway involvement in relapsing polychondritis, an illustrative case report is presented and 62 patients reported in the literature with serious airway complications are reviewed. There were 47 female and 17 male patients, with an average age of 40.3 years (range, 2 to 73 years). Patients were seen with hoarseness, breathlessness, cough, stridor, wheezes, and tenderness over laryngotracheal cartilages. Respiratory tract involvement was confirmed by conventional radiography, tomography, computed tomography, dynamic pulmonary function tests, and bronchoscopy. Corticosteroids and antiinflammatory and immunosuppressive agents were used in these patients. Tracheostomy was performed in 18 patients. Death occurred in 13 patients despite tracheostomy or corticosteroid therapy, or both. A detailed analysis of the clinical, radiological, and pulmonary function studies is presented, with emphasis on upper airway mechanics. The medical and surgical management options are reviewed, including the use of endotracheal prosthesis and extraluminal splinting in dynamic airway collapse.
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Affiliation(s)
- J Eng
- Department of Thoracic Surgery, Bradford Royal Infirmary, England
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Braun-Falco O, Plewig G, Wolff HH, Winkelmann RK. Inflammatory Disease of Cartilage. Dermatology 1991. [DOI: 10.1007/978-3-662-00181-3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
The anaesthetic management of a patient with upper airway obstruction secondary to relapsing polychondritis is described. The relevance of this condition to the anaesthetist is discussed.
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Affiliation(s)
- A W Hayward
- Anaesthetic Department, Royal National Throat, Nose and Ear Hospital, London
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Abstract
The ocular and systemic findings in 112 Mayo Clinic patients with relapsing polychondritis were reviewed. The incidence of males and females was equal, with median age at diagnosis of 51 years and the median follow-up of 6 years. Most patients had several organ systems involved at the time of the diagnosis. Twenty-one patients had ocular symptoms at the onset, and 57 developed ocular symptoms during their course. Major ocular complications included proptosis, lid edema, episcleritis/scleritis, corneal infiltrates/thinning, iridocyclitis, retinopathy, and optic neuritis. The major system involvement included otorhinolaryngeal, respiratory, arthritic, renal, cardiovascular, dermatologic, and neurologic diseases. Generally, laboratory studies were not helpful in making the diagnosis but were valuable in monitoring the disease. Based on the experience in these cases, the indications for the various therapeutic modalities are offered.
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Giroux L, Paquin F, Guérard-Desjardins MJ, Lefaivre A. Relapsing polychondritis: an autoimmune disease. Semin Arthritis Rheum 1983; 13:182-7. [PMID: 6673114 DOI: 10.1016/0049-0172(83)90005-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
This communication has attempted to review the present state of published knowledge on the syndrome of relapsing polychondritis. Basic anatomic, physiologic, and biochemical changes in this disorder are summarized and the role of metabolic and immunologic alterations in the pathogenesis discussed. An additional case of relapsing polychondritis is reported, and the clinical features of this case, plus those of 131 previously reported, are reviewed with discussion of present day therapeutic experience and prognosis.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Autoimmune Diseases/complications
- Biopsy
- Cartilage, Articular/pathology
- Diagnosis, Differential
- Disease Models, Animal
- Female
- Glycosaminoglycans/biosynthesis
- Glycosaminoglycans/deficiency
- Humans
- Immunity
- Immunosuppressive Agents
- Male
- Middle Aged
- Peptide Hydrolases/metabolism
- Polychondritis, Relapsing/complications
- Polychondritis, Relapsing/diagnosis
- Polychondritis, Relapsing/drug therapy
- Polychondritis, Relapsing/etiology
- Polychondritis, Relapsing/genetics
- Polychondritis, Relapsing/immunology
- Polychondritis, Relapsing/pathology
- Polychondritis, Relapsing/physiopathology
- Polychondritis, Relapsing/surgery
- Prognosis
- Recurrence
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Jentzsch K. Eine besondere morphologische Verlaufsform der prim�r chronischen Polyarthritis (p.c.P.). Virchows Arch 1970. [DOI: 10.1007/bf00544576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shinoda Y, Kitamura S, Okazaki E. An autopsy case of relapsing polychondritis. ACTA PATHOLOGICA JAPONICA 1968; 18:185-95. [PMID: 5755101 DOI: 10.1111/j.1440-1827.1968.tb00047.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Dolan DL, Lemmon GB, Teitelbaum SL. Relapsing polychondritis. Analytical literature review and studies on pathogenesis. Am J Med 1966; 41:285-99. [PMID: 4223687 DOI: 10.1016/0002-9343(66)90023-4] [Citation(s) in RCA: 150] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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WAGEMANN W. Die Panchondritis. Eur Arch Otorhinolaryngol 1960; 176:786-92. [PMID: 13782439 DOI: 10.1007/bf02135191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Harders H. Laryngotrachealer Stridor durch eine generalisierte Knorpelerkrankung. Eur Arch Otorhinolaryngol 1954. [DOI: 10.1007/bf02105850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Linzbach AJ. Über generalisierte Gefäßverkalkungen bei einem Fall von gleichzeitiger knöcherner Stenose der Trachea und der Bronchien und ihre Beziehungen zur Dystrophie der Intercellularsubstanzen. Virchows Arch 1942. [DOI: 10.1007/bf02593433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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