1
|
Abstract
Relapsing polychondritis (RP) is a rare auto-immune disease that causes progressive destruction of cartilaginous structures. Most cases of pediatric-onset RP were published as a single case report or hand-full case series although the prevalence of RP is unknown. This review aimed to describe the characteristics of pediatric-onset RP in order to provide a comparison between childhood and adulthood features of the disease and to review the experiences of biological agents used in children with RP. In children, the diagnosis of RP is either delayed or overlooked due to low incidence and variability in clinical features. Treatment of RP is challenging due to the recurrent episodic nature of the disease. Different immunosuppressive medications, including steroid and steroid-sparing disease-modifying antirheumatic drugs (DMARDs), such as methotrexate or azathioprine, are used to treat RP. There is no rigorous clinical research to support the use of new therapeutic modalities, including biological agents. It is challenging to protocolize the treatment of pediatric-onset RP due to the rarity of the disease. Corticosteroids are the primary form of therapy. However, DMARDs and biological agents may have a role in treating patients with sustained or refractory disease.
Collapse
Affiliation(s)
- Jubran T Alqanatish
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | | |
Collapse
|
2
|
Ellis RJB, Doran M, Jacob A, Ismail A, Davenport R. Clinicopathological case: rapid cognitive decline and myoclonus associated with fever, arthropathy and scleritis. Pract Neurol 2018; 19:147-155. [PMID: 30425126 DOI: 10.1136/practneurol-2018-002013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/16/2018] [Accepted: 08/05/2018] [Indexed: 11/04/2022]
Abstract
A 65-year-old man presented with transient neurological symptoms, followed by rapid cognitive decline, myoclonus and fevers. He had evidence of scleritis and an arthropathy. This paper reports the clinicopathological conference discussed at the Association of British Neurologists Annual Meeting 2017.
Collapse
Affiliation(s)
| | - Mark Doran
- Neurology Department, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anu Jacob
- Neurology Department, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Azzam Ismail
- Histopathology Department, St James' Hospital, Leeds, UK
| | - Richard Davenport
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| |
Collapse
|
3
|
Abstract
Relapsing polychondritis, or RP, is a rare connective tissue disease characterized by relapsing-remitting destructive inflammation of the cartilaginous and other proteoglycan-rich structures in the body. Given the relatively low incidence of RP, a concise clinically relevant guide, focusing on the cutaneous manifestations of this serious disease, is lacking. In this review, we provide the dermatologist with an approach to diagnosing RP and a guide to its initial work-up, and management. We close with an overview of the currently available treatment modalities for RP.
Collapse
|
4
|
Ellis RJB, Mbizvo GK, Jacob A, Doran M, Larner AJ. Relapsing polychondritis complicated by cognitive dysfunction: two distinct clinical phenotypes? Int J Neurosci 2016; 127:124-134. [DOI: 10.3109/00207454.2016.1151880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- R. J. B. Ellis
- Neurology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - G. K. Mbizvo
- Neurology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - A. Jacob
- Neurology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - M. Doran
- Neurology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - A. J. Larner
- Neurology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| |
Collapse
|
5
|
Obusez EC, Jamjoom L, Kirsch J, Gildea T, Mohammed TL. Computed tomography correlation of airway disease with bronchoscopy: part I--nonneoplastic large airway diseases. Curr Probl Diagn Radiol 2014; 43:268-77. [PMID: 24947529 DOI: 10.1067/j.cpradiol.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To illustrate and describe computed tomographic large airway pathology and correlate with fiberoptic bronchoscopy findings. Commonly encountered diseases of the large airway include tracheobronchial amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, relapsing polychondritis, Wegener granulomatosis, sarcoidosis, and tracheal stenosis. Computed tomography manifestations and bronchoscopic findings of these selected large airway diseases are discussed.
Collapse
Affiliation(s)
| | - Lamia Jamjoom
- Department of Radiology, King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Jacobo Kirsch
- Division of Radiology, Cleveland Clinic Florida, Weston, FL
| | - Thomas Gildea
- Department of Pulmonary, Allergy and Critical Care, Cleveland Clinic, Cleveland, OH
| | | |
Collapse
|
6
|
Aggravation of Relapsing Polychondritis due to the Infection and Its Manifestation on a Nasal Tip Graft. Clin Exp Otorhinolaryngol 2014; 7:63-5. [PMID: 24587884 PMCID: PMC3932352 DOI: 10.3342/ceo.2014.7.1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 04/19/2011] [Accepted: 04/21/2011] [Indexed: 11/28/2022] Open
Abstract
Relapsing polychondritis (RP) is an uncommon systemic disease that is characterized by episodic and progressive inflammation of the cartilaginous structures, which can be very debilitating and in some instances life-threatening. The pathogenic pathways of RP are largely unknown. However, several hypothesis have been suggested. We had an interesting case of aggravation of RP due to the infection. Graft cartilage on the nasal tip was affected by RP also. This case can give a clue of revealing the pathogenesis of RP. We introduce a case with a review of the literature.
Collapse
|
7
|
Cantarini L, Vitale A, Brizi MG, Caso F, Frediani B, Punzi L, Galeazzi M, Rigante D. Diagnosis and classification of relapsing polychondritis. J Autoimmun 2014; 48-49:53-9. [PMID: 24461536 DOI: 10.1016/j.jaut.2014.01.026] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 12/17/2022]
Abstract
Relapsing polychondritis is a rare and potentially fatal autoimmune disease of unknown etiology, characterized by inflammation and destruction of different cartilaginous structures, including the ear, nose, larynx, trachea, bronchi, peripheral joints, eye, heart and skin, with high risk of misdiagnosis. The spectrum of clinical presentations is protean and may vary from intermittent episodes of painful and disfiguring auricular and nasal chondritis or polyarthritis to severe progressive multi-organ damage. A laryngotracheobronchial involvement appears in nearly half of patients and is complicated by local obstructions, which may be life-threatening. A highly medical specialized approach is required for diagnosis of relapsing polychondritis. This review comprehensively examines the literature related to the clinical sceneries of the disease and focuses on both diagnostic tools used in clinical studies and recent findings related to its etiopathogenesis.
Collapse
Affiliation(s)
- Luca Cantarini
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Siena, Italy.
| | - Antonio Vitale
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Maria Giuseppina Brizi
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Francesco Caso
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Siena, Italy; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
| | - Bruno Frediani
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
| | - Mauro Galeazzi
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy
| |
Collapse
|
8
|
Oka H, Yamano Y, Shimizu J, Yudoh K, Suzuki N. A large-scale survey of patients with relapsing polychondritis in Japan. Inflamm Regen 2014. [DOI: 10.2492/inflammregen.34.149] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
9
|
Arnaud L, Mathian A, Haroche J, Gorochov G, Amoura Z. Pathogenesis of relapsing polychondritis: a 2013 update. Autoimmun Rev 2013; 13:90-5. [PMID: 24051104 DOI: 10.1016/j.autrev.2013.07.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 07/27/2013] [Indexed: 02/08/2023]
Abstract
Relapsing polychondritis (RP) is a systemic inflammatory disease primarily affecting not only the cartilaginous structures of the ears, nose and tracheobronchial tree but also the joints, the inner ear, the eyes, and the cardiovascular system. RP is an immune-mediated disease during which target antigens are still unknown, but data from human studies and murine models strongly support a role of both Collagen Type II (CII) and matrilin-1 as potential candidates. RP is likely a Th1-mediated disease as serum levels of interferon (IFN)-γ, interleukin [IL]-12, and IL-2 parallel changes in disease activity, while the levels of Th2 cytokines do not. Serum levels of sTREM-1, interferon-γ, CCL4, vascular endothelial growth factor, and matrix metalloproteinases-3 are significantly higher in RP patients than in healthy donors, with sTREM-1 correlating with disease activity. Patients with active RP also have significantly higher levels of MCP-1, MIP-1β, MIF, and IL-8 than controls. These pro-inflammatory chemokines are involved in the modulation and recruitment of monocytes and neutrophils. Altogether, these data suggest that a complex cytokine network orchestrates the recruitment of infiltrating cells in RP lesions. Cytokine modulation using TNFα blockers, rituximab, anakinra, tocilizumab, and abatacept has recently been shown effective in some RP cases but further data are needed. Better understanding of the repertoire of infiltrating cells may provide interesting clues to further define the putative RP auto-antigens. Study of circulating mononuclear cells during RP flares may also provide crucial information about the ongoing cellular trafficking and recruitment processes involved in this rare disease.
Collapse
Affiliation(s)
- Laurent Arnaud
- Service de Médecine Interne 2, French National Reference Center for Systemic Lupus Erythematosus and the Antiphospholipid Syndrome, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, F-75013 Paris, France; Université Pierre et Marie Curie, UPMC Univ Paris 06, F-75013 Paris, France; Institut National de la Recherche Médicale et de la Santé, INSERM UMR-S 945, Paris, France.
| | | | | | | | | |
Collapse
|
10
|
Relapsing polychondritis: a review. Clin Rheumatol 2013; 32:1575-83. [DOI: 10.1007/s10067-013-2328-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 06/26/2013] [Indexed: 12/18/2022]
|
11
|
Watanabe M, Suzuki H, Ara T, Nishizuka M, Morita M, Sato C, Tsuchida F, Takeda H, Kato T. Relapsing polychondritis complicated by giant cell myocarditis and myositis. Intern Med 2013; 52:1397-402. [PMID: 23774555 DOI: 10.2169/internalmedicine.52.9080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 83-year-old man presented with a three-week history of dyspnea. The clinical features suggested a diagnosis of relapsing polychondritis (RP); however, the patient died of heart failure. An autopsy revealed active chondritis of the tracheal and bronchial cartilage. Furthermore, giant cell myocarditis (GCM) and myositis were detected. To the best of our knowledge, this represents the first report of RP complicated by GCM and myositis. In patients with RP, GCM and myositis, CD163-positive macrophages and T-cells are most common, and the T-cell subset exhibits CD8 predominance. Common mechanisms of tissue damage caused by cytotoxic T-cells are likely to contribute to RP, GCM and myositis.
Collapse
Affiliation(s)
- Mari Watanabe
- Department of Respiratory Medicine, Saiseikai Yamagata Saisei Hospital, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Kemta Lekpa F, Kraus VB, Chevalier X. Biologics in Relapsing Polychondritis: A Literature Review. Semin Arthritis Rheum 2012; 41:712-9. [DOI: 10.1016/j.semarthrit.2011.08.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 08/29/2011] [Indexed: 12/27/2022]
|
13
|
Relapsing polychondritis: a description of a case and review article. Rheumatol Int 2011; 31:707-13. [PMID: 21246361 DOI: 10.1007/s00296-010-1775-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 12/30/2010] [Indexed: 01/02/2023]
Abstract
Relapsing polychondritis (RPC) is a rare autoimmune disease in which the cartilaginous tissues are the target for inflammation and destruction, the associated immune reaction causes inflammation in non-cartilaginous tissues like kidney and blood vessels. This article provides a description of a case of RPC and a review article about the disease.
Collapse
|
14
|
Abstract
Relapsing polychondritis (RP) is a chronic multisystemic disease characterized by recurrent episodes of cartilage inflammation throughout the body. The lower respiratory tract is involved in 20% to 50% of patients and results in significant morbidity. Effective medical therapies and airway interventions are available in experienced centers; however, no single treatment is curative, and the prognosis of RP with airway disease remains overall guarded.
Collapse
|
15
|
|
16
|
Coexisting relapsing polychondritis and sarcoidosis: an unusual association. Rheumatol Int 2009; 30:1507-9. [DOI: 10.1007/s00296-009-1102-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 08/07/2009] [Indexed: 11/26/2022]
|
17
|
Bergaust B, Abrahamsen AM. Relapsing polychondritis. Report of a case presenting multiple ocular complications. Acta Ophthalmol 2009; 47:174-81. [PMID: 5819823 DOI: 10.1111/j.1755-3768.1969.tb05620.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
18
|
Luthra HS, McKenna CH, Terasaki PI. Lack of association of HLA-A and B locus antigens with relapsing polychondritis. TISSUE ANTIGENS 2008; 17:442-3. [PMID: 6949338 DOI: 10.1111/j.1399-0039.1981.tb00726.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
19
|
Ananthakrishna R, Goel R, Padhan P, Mathew J, Danda D. Relapsing polychondritis—case series from South India. Clin Rheumatol 2008; 28 Suppl 1:S7-10. [DOI: 10.1007/s10067-008-1016-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 09/10/2008] [Indexed: 01/24/2023]
|
20
|
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
Collapse
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
| |
Collapse
|
21
|
Kwok SK, Seo SH, Kim HS, Ju JH, Yoon CH, Park SH, Kim HY. Pneumatosis cystoides intestinalis in relapsing polychondritis. Clin Rheumatol 2006; 26:1565-7. [PMID: 17047889 DOI: 10.1007/s10067-006-0458-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Revised: 09/26/2006] [Accepted: 09/27/2006] [Indexed: 10/24/2022]
Abstract
Relapsing polychondritis (RP) is a rare systemic disease characterized by an inflammatory process involving predominantly cartilaginous structures. Pneumatosis cystoides intestinalis (PCI) in RP has not been reported previously. We report a case of PCI in RP that was successfully treated with high oxygen and antibiotics.
Collapse
Affiliation(s)
- Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Kang-Nam St. Mary's Hospital, 505 Banpo-Dong, Seocho-Gu, Seoul 137-040, South Korea
| | | | | | | | | | | | | |
Collapse
|
22
|
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.
Collapse
Affiliation(s)
- Edgar Bachor
- Universitäts-HNO Klinik, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany.
| | | | | | | |
Collapse
|
23
|
Dib C, Moustafa SE, Mookadam M, Zehr KJ, Michet CJ, Mookadam F. Surgical treatment of the cardiac manifestations of relapsing polychondritis: overview of 33 patients identified through literature review and the Mayo Clinic records. Mayo Clin Proc 2006; 81:772-6. [PMID: 16770977 DOI: 10.4065/81.6.772] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To analyze the cardiac findings that necessitate surgery in patients with relapsing polychondritis (RP) and to compare our results to cases in the literature. MATERIAL AND METHODS A systematic overview of the literature was completed with the addition of cases of RP from the Mayo patient population that necessitated cardiac surgery. RESULTS Thirty-three patients were identified (25 from the literature and 8 from the Mayo patient population). Nine patients (27%) were female, 22 (67%) were male, and sex was not stated for 2 patients (6%). The patient age ranged from 17 to 69 years (mean +/- SD, 42.5 +/- 15.7 years). At operation, 30 patients (91%) had aortic regurgitation, 21 (64%) had aortic root disease, and 13 (39%) had mitral regurgitation. The most common surgical procedure performed was aortic valve replacement in 12 patients (36%). The most common complications were death in 12 patients (36%) and prosthetic valve dehiscence in 4 patients (12%). CONCLUSIONS Cardiac involvement is more prominent in the male population and requires more invasive procedures. Aortic valve replacement with composite graft replacement of the ascending aorta along with coronary artery ostial reimplantation should be considered in these patients. Postsurgical valvular complications include prosthetic dehiscence, paravalvular leakage, mediastinitis, and heart failure, and these complications are associated with postoperative corticosteroid therapy. Initiation of second-line immunosuppressive therapy should be substituted for corticosteroids after cardiac surgery.
Collapse
Affiliation(s)
- Chadi Dib
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
| | | | | | | | | | | |
Collapse
|
24
|
Chang SJ, Lu CC, Chung YM, Lee SS, Chou CT, Huang DF. Laryngotracheal involvement as the initial manifestation of relapsing polychondritis. J Chin Med Assoc 2005; 68:279-82. [PMID: 15984823 DOI: 10.1016/s1726-4901(09)70151-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare multisystemic disease characterized by recurrent inflammation of cartilaginous and noncartilaginous tissues. When laryngotracheal or bronchial cartilages are involved, the disease can be life-threatening and needs aggressive treatment. Upper airway complaints are rare as initial presentations of RP. Here, however, we present a case of RP, with initial manifestations of cough and dyspnea that were treated as bronchial asthma for 6 months. Subglottic stenosis was found in April 2003, during a bronchoscopic examination, and emergency tracheostomy was performed. Auricular and nasal chondritis and bilateral scleritis developed 3 months after tracheostomy. High doses of methylprednisolone and immunosuppressive agents were used, and active inflammation in the eyes and ears was controlled, but the patient's upper airway was completely collapsed. This case is reported with the hope of increasing awareness about the potential for early upper airway involvement in RP.
Collapse
Affiliation(s)
- Shu-Jen Chang
- Section of Allergy, Immunology, and Rheumatology, Department of Medicine, Cheng Hsin Rehabilitation Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | | | | | | | | | | |
Collapse
|
25
|
Kumakiri K, Sakamoto T, Karahashi T, Mineta H, Takebayashi S. A case of relapsing polychondritis preceded by inner ear involvement. Auris Nasus Larynx 2005; 32:71-6. [PMID: 15882830 DOI: 10.1016/j.anl.2004.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 07/16/2004] [Accepted: 09/24/2004] [Indexed: 11/17/2022]
Abstract
Relapsing polychondritis is a rare disease of unknown etiology causing systematic inflammation of the whole cartilaginous tissues. We report a patient with relapsing polychondritis preceded by inner ear involvement. A 68-year-old female visited our hospital for a chief complaint of sudden bilateral hearing loss. On pure-tone audiometry, sensorineural hearing loss, 47dB on the right and 51dB on the left, was observed. Later, bilateral auricular chondritis and uveitis developed. On biopsy of the auricular cartilage, perichondritis was observed. The patient was diagnosed with relapsing polychondritis in the early stage, 2 weeks after the onset. Oral predonine administration was initiated, and the auricular inflammation was improved within 10 days. The hearing loss disorder was gradually improved. The steroid dose was reduced, and no decrease in hearing has been observed so far.
Collapse
Affiliation(s)
- Kenichi Kumakiri
- Department of Otorhinolaryngology, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda, Shizuoka 426-8677, Japan.
| | | | | | | | | |
Collapse
|
26
|
Herrera I, Concha R, Molina EG, Schiff ER, Altman RD. Relapsing polychondritis, chronic hepatitis C virus infection, and mixed cryoglobulemia. Semin Arthritis Rheum 2004; 33:388-403. [PMID: 15190524 DOI: 10.1016/j.semarthrit.2003.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Review of relapsing polychondritis (RP) and its association to chronic hepatitis C virus (HCV) infection and mixed cryoglobulinemia. METHODS A case of RP associated with HCV infection is reported. The English language medical and scientific literature was reviewed for RP, hepatitis C, and its relation to other connective tissue diseases from February 1966 to January 2003 using MEDLINE. RESULTS RP is an uncommon, multisystem disease of unknown etiology characterized by recurrent inflammation of cartilaginous and related tissues, being associated with other diseases in 30% to 35% of cases. HCV infection is a systemic illness with a propensity to trigger or exacerbate autoimmune disorders: eg, essential mixed cryoglobulinemia, membranoproliferative glomerulonephritis, and leukocytoclastic and systemic vasculitis. We could find no previous report of an association between RP with HCV and mixed cryoglobulinemia. Treatment with interferon gamma and ribavirin (IR) not only induced an undetectable viral load, but also resolved symptoms of RP. CONCLUSIONS We report a patient with RP, HCV, and mixed cryoglobulinemia. It is unknown if there is a cause-effect or chance relationship. Treatment with IR improved the symptoms of RP. It is not known whether the effects of IR were directly on the RP or suppressed RP indirectly through the actions on the viral load or active hepatitis.
Collapse
MESH Headings
- Aged
- Anti-Inflammatory Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Cryoglobulinemia/drug therapy
- Cryoglobulinemia/immunology
- Female
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/drug therapy
- Hepatitis C, Chronic/immunology
- Humans
- Interferons/therapeutic use
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/therapy
- Polychondritis, Relapsing/complications
- Polychondritis, Relapsing/diagnosis
- Polychondritis, Relapsing/immunology
- Polychondritis, Relapsing/therapy
- Prednisone/therapeutic use
- Ribavirin/therapeutic use
Collapse
Affiliation(s)
- Ivonne Herrera
- Department of Medicine, University of Miami School of Medicine, Miami, FL, USA
| | | | | | | | | |
Collapse
|
27
|
Kraus VB, Stabler T, Le ET, Saltarelli M, Allen NB. Urinary type II collagen neoepitope as an outcome measure for relapsing polychondritis. ACTA ACUST UNITED AC 2003; 48:2942-8. [PMID: 14558101 DOI: 10.1002/art.11281] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Herein we describe the case of a man who was diagnosed as having relapsing polychondritis (RP) when he was 18 years of age and was treated over the course of 2 years with numerous immunosuppressive agents, including tumor necrosis factor alpha (TNFalpha) inhibitors. His respiratory symptoms were refractory to treatment. Serum and urine samples were obtained periodically for measurement of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, anti-type II collagen (anti-CII) antibodies, and urinary type II collagen neoepitope (uTIINE) levels. The uTIINE assay is specific for collagenase cleavage products CII present in urine. ESRs and CRP levels varied widely but were rarely normal. Anti-CII antibody titers were high initially and decreased slowly and steadily for a year following the start of immunosuppressive medication, remaining low throughout the remainder of the patient's monitored disease course. The uTIINE levels were elevated prior to the initiation of TNFalpha inhibitors. Upon initiation of etanercept, they decreased abruptly to normal and stayed nearly normal. The uTIINE levels rose abruptly again upon discontinuation of TNFalpha inhibitor treatment. The dramatic decline in CII degradation, coincident with the administration of the TNFalpha inhibitors, suggested that this treatment dramatically reduced the chondritis. Serum levels of Th1 cytokines (interferon-gamma, interleukin-12 [IL-12], and IL-2) paralleled changes in uTIINE levels, while those of Th2 cytokines (IL-4, IL-5, IL-6, and IL-10) showed little or no association with disease state or uTIINE levels. These results indicate that RP might be a Th1-mediated disease process. Moreover, the uTIINE assay appears to provide an objective measure of the severity of chondritis that could assist clinical decisions regarding adjustments of steroid and other immunosuppressive therapy. This outcome measure merits investigation in a broader spectrum of RP patients.
Collapse
Affiliation(s)
- Virginia B Kraus
- Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | | | |
Collapse
|
28
|
Nobukiyo S, Iwatake H, Watanabe S, Akao I, Tomisawa H, Koizuka I. A case of relapsing polychondritis involving placement of an expandable metallic stent. Auris Nasus Larynx 2003; 30 Suppl:S141-4. [PMID: 12543181 DOI: 10.1016/s0385-8146(02)00133-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Relapsing polychondritis is a relatively uncommon disease characterized by recurrence of progressive inflammation of cartilaginous structures. Laryngotracheal involvement occurs in 50-70% of cases, and occasionally results in acute airway obstruction. We reported a case of relapsing polychondritis with severe tracheal stenosis that was treated by the placement of two expandable metallic stents. A 58-year-old man was hospitalized with fever and breathing difficulties. A tracheostomy was performed and a silicone T-tube was placed. A diagnosis of relapsing polychondritis was made based on the biopsy from auricular and tracheal cartilages. Two expandable metallic stents were placed in the trachea to bilateral main bronchus. This dilated the airway lumen and resulted in the dyspnea disappearing completely. However, 18 months later a sudden massive hemorrhage occurred through the tracheostoma, and he died of respiratory failure. Autopsy showed a tracheoinnominate artery fistula. We discuss the management of relapsing polychondritis with severe tracheal stenosis.
Collapse
Affiliation(s)
- Shigenori Nobukiyo
- Department of Otolaryngology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, 216-8511, Kawasaki, Japan.
| | | | | | | | | | | |
Collapse
|
29
|
Gerber B, Crottaz M, von Tscharner C, Schärer V. Feline relapsing polychondritis: two cases and a review of the literature. J Feline Med Surg 2002; 4:189-94. [PMID: 12468311 DOI: 10.1053/jfms.2002.0170] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Only 11 reports of cats with relapsing polychondritis (RPC) were found in the literature. We describe two additional cases and provide a review of the literature. Predominantly young to middle aged cats are affected (range 1.5 to 14.5 years, median 3 years). There is no sex predilection for feline RPC. In all cats with feline RPC, the ears were affected. The findings in one of our cases and one case in the literature raise the question if other organs such as the joints, the eyes or the heart may be involved in feline RPC. The histological lesions observed in biopsy samples of the ears were similar in all cats. Glucocorticoids were not effective in the treatment of RPC. Dapsone appeared to result in some clinical improvement but side effects were observed in one of four cats. Some cats improved without treatment.
Collapse
Affiliation(s)
- B Gerber
- Clinic for Small Animal Internal Medicine, University of Zürich, Winterthurstrasse 260, 8057, Zürich, Switzerland
| | | | | | | |
Collapse
|
30
|
Prince JS, Duhamel DR, Levin DL, Harrell JH, Friedman PJ. Nonneoplastic lesions of the tracheobronchial wall: radiologic findings with bronchoscopic correlation. Radiographics 2002; 22 Spec No:S215-30. [PMID: 12376612 DOI: 10.1148/radiographics.22.suppl_1.g02oc02s215] [Citation(s) in RCA: 177] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nonneoplastic diseases of the central airways are uncommon but can be categorized as either focal or diffuse, although there is some overlap. Focal diseases include postintubation stenosis, postinfectious stenosis, posttransplantation stenosis, and various systemic diseases that may involve the airways and lead to focal stenosis (eg, Crohn disease, sarcoidosis, Behçet syndrome). Diffuse diseases of the central airways include Wegener granulomatosis, relapsing polychondritis, tracheobronchopathia osteochondroplastica, amyloidosis, papillomatosis, and rhinoscleroma. Conventional radiography is often the first step in the evaluation of suspected central airway disease and may be adequate in itself to identify the abnormality. However, computed tomography (CT) improves both the detection and characterization of central airway disease. Bronchoscopy remains the primary procedure for the diagnostic work-up of these disease entities. Nevertheless, a thorough radiologic evaluation with radiography and CT may demonstrate specific imaging findings (eg, calcification) that can help narrow the differential diagnosis and aid in the planning of bronchoscopy or therapeutic intervention.
Collapse
Affiliation(s)
- Jeffrey S Prince
- Department of Radiology, Division of Pulmonary and Critical Care Medicine, UCSD Medical Center, 200 W Arbor Dr, Mail Code 8756, San Diego, CA 92103-8756, USA
| | | | | | | | | |
Collapse
|
31
|
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.
Collapse
Affiliation(s)
- Erik Letko
- Uveitis and Immunology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | | | | | | | | | | |
Collapse
|
32
|
Afshari NA, Afshari MA, Foster CS. Inflammatory conditions of the eye associated with rheumatic diseases. Curr Rheumatol Rep 2001; 3:453-8. [PMID: 11564378 DOI: 10.1007/s11926-996-0017-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ocular inflammation occurs in many patients with systemic rheumatic disease. The best examples are rheumatoid arthritis, juvenile rheumatoid arthritis, temporal arteritis, systemic lupus erythematosus, Wegener's granulomatosis, polyarteritis nodosa, relapsing polychondritis, and Adamantiades-Behçet's disease. Ocular inflammation may precede the symptoms of the systemic disease and can be helpful in systemic diagnosis. After diagnosis, ocular inflammation can mark the severity of the systemic condition. Thus, prompt diagnosis and treatment of inflammatory conditions of the eye are warranted and may be sight- and life-saving.
Collapse
Affiliation(s)
- N A Afshari
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | | | | |
Collapse
|
33
|
Rockall AG, Rickards D, Shaw PJ. Imaging of the pulmonary manifestations of systemic disease. Postgrad Med J 2001; 77:621-38. [PMID: 11571369 PMCID: PMC1742125 DOI: 10.1136/pmj.77.912.621] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A G Rockall
- Department of Radiology, University College London Hospitals, London, UK
| | | | | |
Collapse
|
34
|
Affiliation(s)
- W T Miller
- Department of Radiology, Suite 3390 Gibbon, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA 19107, USA
| |
Collapse
|
35
|
Abstract
BACKGROUND Relapsing polychondritis (RPC) is a rare, chronic, and potentially fatal multisystemic inflammatory disorder targeting cartilaginous structures. This disorder is frequently associated with rheumatoid arthritis, systemic vasculitis, connective tissue diseases, and/or hematologic disorders. RPC afflicts patients with recurrent and often progressive episodes of inflammation with the potential for destruction of the affected structures. Tissues involved include the ears, joints, nose, larynx, trachea, eyes, heart valves, kidneys,and skin. Ocular manifestations commonly include episcleritis, scleritis, conjunctivitis, iridocyclitis, chorioretinitis, and proptosis. Lid edema, orbital inflammation, muscle palsies, and corneal melting may also occur. CASE REPORT An 83-year-old man previously diagnosed with RPC presented to our clinic with acute unilateral chemosis, conjunctivitis, lid edema, proptosis, and extraocular muscle restriction. After orbital cellulitis was ruled out, further evaluation revealed posterior scleritis with choroidal detachment OS. A course of oral indomethacin and topical antibiotic-steroid combination drops was implemented in the treatment of the ocular manifestations. The quick positive response to the anti-inflammatory agents confirmed the diagnosis of ocular complications secondary to RPC. DISCUSSION The presenting ocular signs and symptoms of RPC often resemble other commonly encountered ocular conditions. It is important for the eye care practitioner to be familiar with the ocular manifestations of RPC because the eyes are sometimes the initial site of involvement and may be a marker of severity. Early diagnosis and intervention may significantly improve the patient's outcome. This case report with literature review will hopefully bring to light features of this disease which will help the eye care practitioner in the diagnosis and management of this condition.
Collapse
Affiliation(s)
- M T Chow
- VA Greater Los Angeles Healthcare System, Sepulveda Ambulatory Care Center and Southern California College of Optometry, Fullerton, USA
| | | |
Collapse
|
36
|
Abstract
The onset of peripheral ulcerative keratitis in the course of a connective tissue disorder, such as rheumatoid arthritis, relapsing polychondritis, or systemic lupus erythematosus, may reflect the presence of potentially lethal systemic vasculitis. Moreover, peripheral ulcerative keratitis may be the first sign of systemic necrotizing vasculitis in patients with Wegener's granulomatosis, polyarteritis nodosa, microscopic polyangiitis, or Churg-Strauss syndrome. Although the exact pathogenesis of this severe corneal inflammation and destruction is not well understood, evidence points to a dysfunction in immunoregulation with immune complexes formed in response to autoantigens or to some unknown microbial antigen depositing in scleral and limbal vessels. These events lead to changes that are mainly responsible for the resulting tissue damage. In pauci-immune vasculitides positive for antineutrophil cytoplasmic antibodies, cell-mediated cytotoxicity may play an important role in the pathogenesis of peripheral ulcerative keratitis. Untreated systemic conditions such as those mentioned above may carry a grave prognosis for the eye and may also be life-threatening. Immunosuppressive therapy with corticosteroids and cytotoxic agents is, we believe, mandatory in the treatment of these multisystem disorders associated with vasculitic peripheral ulcerative keratitis.
Collapse
|
37
|
Tillie-Leblond I, Wallaert B, Leblond D, Salez F, Perez T, Remy-Jardin M, Vanhille P, Brouillard M, Marquette C, Tonnel AB. Respiratory involvement in relapsing polychondritis. Clinical, functional, endoscopic, and radiographic evaluations. Medicine (Baltimore) 1998; 77:168-76. [PMID: 9653428 DOI: 10.1097/00005792-199805000-00002] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although respiratory involvement occurs in 50% of patients with relapsing polychondritis (RP) and augurs a poor prognosis, few previous studies have provided complete descriptions of respiratory tract involvement. For this reason, we investigated the respective role of clinical, functional, endoscopic, and radiographic (computed tomography [CT]) examinations in 9 consecutive patients with RP and lower respiratory tract localization. All exhibited cough, dyspnea, and wheezing. Eight had a nonreversible obstructive pattern with a marked decrease of the maximal flow ratio at 75% and 25% of vital capacity. Rotman functional criteria were evaluated to differentiate upper from lower respiratory tract involvement; they were consistent with the results of other examinations in 4/9 cases. Endoscopic examination showed moderate to severe inflammation in 8/9 patients; tracheal stenosis was present in 6/9 patients, bronchial stenosis in 4/9 patients, and tracheal collapse in 7 cases. CT showed tracheal stenosis in 8/9 patients (diffuse, 7; localized, 1) and bronchial stenosis in 6/9 patients. Tracheobronchial wall thickening and/or calcifications were observed in 7 cases. Clinical symptoms are of poor specificity for defining respiratory involvement precisely, although degree of dyspnea is correlated to the decrease in forced expiratory volume in 1 second (FEV1). Functional criteria were helpful in evaluating the obstructive ventilatory defect but did not differentiate, in most cases, the respective part of lower and upper respiratory involvement when using Rotman criteria. Compared to CT findings, endoscopic examination failed to identify tracheal and bronchial stenosis and tracheal wall alterations at an early stage of the disease. In our series CT appears to be a reliable method to identify tracheal and bronchial involvement and can be repeated safely during the course of the disease.
Collapse
Affiliation(s)
- I Tillie-Leblond
- Clinique des Maladies Respiratoires, Hôpital Calmette, CHRU, Lille, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
PURPOSE This article describes a clinically-diagnosed case of relapsing polychondritis (RP), attended at the Hospital São Paulo, and presents a literature review of the subject. SOURCE OF RESEARCH: The literature review was made via Medline (1990-96). Lilacs (1980-96), textbooks of rheumatology, and some articles about the history of the disease. In Medline, 113 articles from 1990 to 1996 were found, and there were 23 articles from 1980 to 1996 in Lilacs. RESEARCH PROCEDURE: We reviewed the articles available at BIREME (Biblioteca Regional de Medicina) with the primary focus being on the disease in question. SUMMARY RP is a rare disease of unknown etiology described initially by Jackson-Wartenhorst in 1923 and characterized by a recurrent and acute inflammatory process that causes the collapse of the cartilaginous structures and their subsequent replacement by fibrous connective tissue. The cartilage most commonly attacked is that of the auricle of the ear and nasal septum, while the cartilage of the trachea, larynx, epiglottis, ribs, and articulations may also be involved. Ocular inflammations and systemic reactions with fever are also described. In 1976, McAdam presented a complete prospective study of 23 patients, reviewed the 136 cases described up until that time, and then proposed diagnostic criteria which were later expanded by Damiani and Levine. Currently, more than 550 cases have been described. CONCLUSION Although a rare disease, better knowledge of it is needed, as RP may be lethal with tracheal collapse and obstruction of respiratory pathways, making precise diagnosis and adequate therapeutic intervention necessary.
Collapse
Affiliation(s)
- L S Miyasaka
- Internal Medicine Division of Hospital São Paulo, Escola Paulista de Medicina of Universidade Federal de São Paulo, Brazil
| | | | | | | |
Collapse
|
39
|
Spraggs PD, Tostevin PM, Howard DJ. Management of laryngotracheobronchial sequelae and complications of relapsing polychondritis. Laryngoscope 1997; 107:936-41. [PMID: 9217135 DOI: 10.1097/00005537-199707000-00020] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Relapsing polychondritis is a rare multisystem disorder of unknown etiology characterized by recurrent inflammation and degeneration of cartilage and connective tissue. Laryngotracheobronchial complications are the most severe manifestations of the disease and present the most challenging management decisions. We present four cases of relapsing polychondritis with laryngotracheobronchial manifestations that illustrate the clinical features and review the treatment options.
Collapse
Affiliation(s)
- P D Spraggs
- The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | | | | |
Collapse
|
40
|
Abstract
Upper airway obstruction is a potentially life-threatening event that can be managed effectively when promptly recognized and treated. For this reason, all patients who are suspected of having disease affecting the larynx or trachea should be regarded as having a potentially compromised airway until proven otherwise. Although clinically significant upper airway diseases occur infrequently in rheumatic disorders, these manifestations should be considered in such patients who present with upper airway symptomatology.
Collapse
Affiliation(s)
- C A Langford
- Laboratory of Immunoregulation, national Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | |
Collapse
|
41
|
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.
Collapse
Affiliation(s)
- J A Dunne
- Bradford Royal Infirmary, Yorkshire, England
| | | |
Collapse
|
42
|
Abstract
The CT findings of a patient with relapsing polychondritis involving the larynx, tracheobronchial tree, and nasal cartilage are described. In the proper clinical setting, a characteristic constellation of findings when noted on CT can aid in differentiating this rare inflammatory disease from other causes of airway compromise. CT is the most useful imaging modality, because cartilage and soft tissue components are well visualized. If diagnosed early, appropriate treatment may prevent life-threatening airway obstruction.
Collapse
Affiliation(s)
- J L Port
- Department of Radiology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11042
| | | | | |
Collapse
|
43
|
Clark LJ, Wakeel RA, Ormerod AD. Relapsing polychondritis--two cases with tracheal stenosis and inner ear involvement. J Laryngol Otol 1992; 106:841-4. [PMID: 1431531 DOI: 10.1017/s002221510012105x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Relapsing polychondritis is a rare disease which often presents firstly to ear, nose and throat (ENT) departments. Its complications, respiratory, cardiovascular, renal and neurological are life-threatening; thus it is important to recognize the disease and its complications early. Treatment for relapsing polychondritis may have serious side-effects which should be taken into account when managing these patients. We report two young patients with relapsing polychondritis and their treatments; both had severe tracheal stenosis responding in one case to pharmacological and in the other to surgical intervention.
Collapse
Affiliation(s)
- L J Clark
- Beatson Institute for Cancer Research, Wolfson Laboratory for Molecular Pathology, Bearsden, Glasgow
| | | | | |
Collapse
|
44
|
Buckley LM, Ades PA. Progressive aortic valve inflammation occurring despite apparent remission of relapsing polychondritis. ARTHRITIS AND RHEUMATISM 1992; 35:812-4. [PMID: 1622420 DOI: 10.1002/art.1780350716] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a patient with relapsing polychondritis in whom aortic valve inflammation developed 3 years after diagnosis, when the polychondritis had been in apparent remission for an extended period of time. Infection and cardiac involvement can be significant complications of relapsing polychondritis. Recommendations for monitoring and treatment of patients with this disease are discussed.
Collapse
Affiliation(s)
- L M Buckley
- Rheumatology and Clinical Immunology Unit, University of Vermont College of Medicine, Burlington 05405
| | | |
Collapse
|
45
|
Van Besien K, Tricot G, Hoffman R. Relapsing polychondritis: a paraneoplastic syndrome associated with myelodysplastic syndromes. Am J Hematol 1992; 40:47-50. [PMID: 1340759 DOI: 10.1002/ajh.2830400110] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We report an unusual case of a patient with a myelodysplastic syndrome associated with life threatening relapsing polychondritis. The improvement in symptoms attributable to the relapsing polychondritis during treatment of the hematologic disorder suggests that relapsing polychondritis is a paraneoplastic syndrome associated with myelodysplastic syndromes.
Collapse
Affiliation(s)
- K Van Besien
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis
| | | | | |
Collapse
|
46
|
Helm TN, Valenzuela R, Glanz S, Parker L, Dijkstra J, Bergfeld WF. Relapsing polychondritis: a case diagnosed by direct immunofluorescence and coexisting with pseudocyst of the auricle. J Am Acad Dermatol 1992; 26:315-8. [PMID: 1569249 DOI: 10.1016/0190-9622(92)70044-g] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A case of relapsing polychondritis with perichondrial IgG and C3, dermoepidermal IgG, and a coexisting pseudocyst of the auricle is reported. The use of direct immunofluorescence testing in establishing a diagnosis of relapsing polychondritis and the expected findings are reviewed. In some cases direct immunofluorescence may allow a diagnosis of relapsing polychondritis before clinical criteria or a routine histologic evaluation suggests a definite diagnosis.
Collapse
Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, OH 44195-5131
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Auricular pain, redness, and swelling are usually the result of infectious cellulitis. However, relapsing polychondritis is another cause of this symptom complex and is the result of an autoimmune phenomenon. It presents with inflammation and destruction of both articular and nonarticular cartilage, with the external ear and joint cartilage most often involved. Although usually indolent with multiple acute exacerbations, relapsing polychondritis can be rapidly fatal if the airway or cardiovascular system is involved. We present a case of relapsing polychondritis initially mistaken for auricular cellulitis. The clinical manifestations and course of relapsing polychondritis are reviewed, along with the emergency department management.
Collapse
Affiliation(s)
- M Coppola
- Emergency Medicine Residency, Darnall Army Community Hospital, Fort Hood, Texas
| | | |
Collapse
|
48
|
Albers FW, Majoor MH, Van der Gaag R. Corneal autoimmunity in a patient with relapsing polychondritis. Eur Arch Otorhinolaryngol 1992; 249:296-9. [PMID: 1524814 DOI: 10.1007/bf00714497] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report our experiences with a patient with relapsing polychondritis, in whom circulating antibodies against corneal epithelium were determined by immunofluorescence before and after medical treatment. The results provide further evidence for an autoimmune pathogenesis of the disease.
Collapse
Affiliation(s)
- F W Albers
- Department of Otorhinolaryngology, University Hospital, Ghent, Belgium
| | | | | |
Collapse
|
49
|
Gaffney RJ, Harrison M, Blayney AW. Nebulized racemic ephedrine in the treatment of acute exacerbations of laryngeal relapsing polychondritis. J Laryngol Otol 1992; 106:63-4. [PMID: 1541897 DOI: 10.1017/s002221510011864x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A case of relapsing polychondritis of the larynx and upper trachea is presented. We report the use of nebulized racemic ephedrine, as a new treatment modality of the life threatening airway oedema which characterizes acute exacerbations of this disease.
Collapse
Affiliation(s)
- R J Gaffney
- Department of Otolaryngology, Trinity College, Dublin
| | | | | |
Collapse
|
50
|
Hussain SS. Relapsing polychondritis presenting with stridor from bilateral vocal cord palsy. J Laryngol Otol 1991; 105:961-3. [PMID: 1761956 DOI: 10.1017/s0022215100117931] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A case of bilateral vocal cord palsy caused by relapsing polychondritis is presented. The diagnosis was not suspected preoperatively and was made solely on histopathology. A case is made for histological examination of cartilage removed during routine tracheostomy.
Collapse
Affiliation(s)
- S S Hussain
- Department of ENT Surgery, General Infirmary, Leeds
| |
Collapse
|