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Cardoneanu A, Rezus II, Burlui AM, Richter P, Bratoiu I, Mihai IR, Macovei LA, Rezus E. Autoimmunity and Autoinflammation: Relapsing Polychondritis and VEXAS Syndrome Challenge. Int J Mol Sci 2024; 25:2261. [PMID: 38396936 PMCID: PMC10889424 DOI: 10.3390/ijms25042261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Relapsing polychondritis is a chronic autoimmune inflammatory condition characterized by recurrent episodes of inflammation at the level of cartilaginous structures and tissues rich in proteoglycans. The pathogenesis of the disease is complex and still incompletely elucidated. The data support the important role of a particular genetic predisposition, with HLA-DR4 being considered an allele that confers a major risk of disease occurrence. Environmental factors, mechanical, chemical or infectious, act as triggers in the development of clinical manifestations, causing the degradation of proteins and the release of cryptic cartilage antigens. Both humoral and cellular immunity play essential roles in the occurrence and perpetuation of autoimmunity and inflammation. Autoantibodies anti-type II, IX and XI collagens, anti-matrilin-1 and anti-COMPs (cartilage oligomeric matrix proteins) have been highlighted in increased titers, being correlated with disease activity and considered prognostic factors. Innate immunity cells, neutrophils, monocytes, macrophages, natural killer lymphocytes and eosinophils have been found in the perichondrium and cartilage, together with activated antigen-presenting cells, C3 deposits and immunoglobulins. Also, T cells play a decisive role in the pathogenesis of the disease, with relapsing polychondritis being considered a TH1-mediated condition. Thus, increased secretions of interferon γ, interleukin (IL)-12 and IL-2 have been highlighted. The "inflammatory storm" formed by a complex network of pro-inflammatory cytokines and chemokines actively modulates the recruitment and infiltration of various cells, with cartilage being a source of antigens. Along with RP, VEXAS syndrome, another systemic autoimmune disease with genetic determinism, has an etiopathogenesis that is still incompletely known, and it involves the activation of the innate immune system through different pathways and the appearance of the cytokine storm. The clinical manifestations of VEXAS syndrome include an inflammatory phenotype often similar to that of RP, which raises diagnostic problems. The management of RP and VEXAS syndrome includes common immunosuppressive therapies whose main goal is to control systemic inflammatory manifestations. The objective of this paper is to detail the main etiopathogenetic mechanisms of a rare disease, summarizing the latest data and presenting the distinct features of these mechanisms.
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Affiliation(s)
- Anca Cardoneanu
- Discipline of Rheumatology, Medical Department II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (A.C.); (A.M.B.); (P.R.); (I.B.); (I.R.M.); (L.A.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ioana Irina Rezus
- Discipline of Radiology, Surgery Department II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania;
| | - Alexandra Maria Burlui
- Discipline of Rheumatology, Medical Department II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (A.C.); (A.M.B.); (P.R.); (I.B.); (I.R.M.); (L.A.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Patricia Richter
- Discipline of Rheumatology, Medical Department II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (A.C.); (A.M.B.); (P.R.); (I.B.); (I.R.M.); (L.A.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ioana Bratoiu
- Discipline of Rheumatology, Medical Department II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (A.C.); (A.M.B.); (P.R.); (I.B.); (I.R.M.); (L.A.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ioana Ruxandra Mihai
- Discipline of Rheumatology, Medical Department II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (A.C.); (A.M.B.); (P.R.); (I.B.); (I.R.M.); (L.A.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Luana Andreea Macovei
- Discipline of Rheumatology, Medical Department II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (A.C.); (A.M.B.); (P.R.); (I.B.); (I.R.M.); (L.A.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Elena Rezus
- Discipline of Rheumatology, Medical Department II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (A.C.); (A.M.B.); (P.R.); (I.B.); (I.R.M.); (L.A.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
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Venetsanopoulou AI, Voulgari PV, Drosos AA. TNFα inhibitor biosimilar associated with polychondritis. A case-based review. Rheumatol Int 2023; 43:1751-1754. [PMID: 37316633 DOI: 10.1007/s00296-023-05364-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
Relapsing polychondritis (RP) is a rare autoimmune disease characterized by inflammation of the cartilage structures of the body with typical features of auricular chondritis, nasal and ocular inflammation, audio-vestibular damage, as well as respiratory tract manifestations. It is associated with several autoimmune diseases and many other disorders. Tumor necrosis factor alpha (TNFα) inhibitors treat many chronic inflammatory disorders. They have proven effective and relatively safe in many clinical trials and observational studies. However, several autoimmune phenomena and paradoxical inflammation have been described with TNFα inhibitors, among them RP. This report presents a 43-year-old man with psoriatic arthritis treated with ABP-501 (Amgevita), an adalimumab (ADA) biosimilar and who developed RP, 8 months after the initiation of the treatment. This, is the first report of RP development during TNFα inhibitors biosimilar. We concluded that rheumatologists dealing with patients treated with TNFα inhibitors (originators or biosimilars), should be aware of several paradoxical reactions which may emerge and RP, is one of them.
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Affiliation(s)
- Aliki I Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece.
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.
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Kumagai K, Tsuruoka H, Morikawa K, Handa H, Mineshita M. Pre-treatment bronchoscopic evaluation in a case of relapsing polychondrits. BMC Pulm Med 2023; 23:108. [PMID: 37013530 PMCID: PMC10069111 DOI: 10.1186/s12890-023-02400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Relapsing polychondritis (RP) is a chronic and recurrent inflammatory disease of the cartilage tissues in the body. The cause of RP is unknown, and since it is a rare disease with symptoms that affect multiple organs, diagnosis is often delayed. CASE PRESENTATION A 62-year-old woman with no smoking history visited our institution complaining of fever, cough, and dyspnoea. Chest CT showed a stenosis from the left main bronchus to the left lower lobe branch. Bronchoscopy visualised intense erythema and oedema at the left main bronchus, with airway narrowing. Biopsy of the ear revealed degenerative vitreous cartilage and fibrous connective tissue with a mild inflammatory cell infiltrate. She was subsequently diagnosed with RP and administered systemic corticosteroid therapy. Her symptoms improved rapidly, and post-treatment bronchoscopy revealed that although mild erythema of the airway epithelium remained, oedema markedly improved, and the airway stenosis was resolved. CONCLUSIONS We report a case where pre-treatment bronchoscopy was able to visually confirm RP at the acute stage. Since RP is difficult to diagnose, severe airway narrowing can occur prior to diagnosis. Therefore, to determine the stage of the disease, it is helpful to perform bronchoscopic observation before treatment. However, bronchoscopic observation before treatment should be performed by experienced bronchoscopists due to the risk of airway obstruction.
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Affiliation(s)
- Kosumi Kumagai
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan
| | - Hajime Tsuruoka
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan
| | - Kei Morikawa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan
| | - Hiroshi Handa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan.
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Arakawa S, Nakao M, Sone K, Hayashi S, Sugihara M, Hirata Y, Kuriyama M, Takeda N, Ohtakara K, Horikawa Y, Muramatsu H. Lung Cancer Complicated by Relapsing Polychondritis. Intern Med 2023; 62:1049-1054. [PMID: 36070940 PMCID: PMC10125820 DOI: 10.2169/internalmedicine.0203-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old man presented with a 1-month history of cough, pharyngeal discomfort, and weight loss. Chest radiography revealed a mass shadow in the right upper lung field. Bronchoscopy showed multiple white nodules along the tracheal cartilage ring. Although adenocarcinoma cells were detected in the mass, several biopsy specimens of the tracheal lesions exhibited no malignancy. 18F-fluorodeoxyglucose positron emission tomography revealed an intense accumulation in the mass, nasal septum, and tracheal cartilage. Furthermore, anti-type II collagen antibody levels were elevated. We finally diagnosed him with lung cancer complicated by relapsing polychondritis. Treatment with oral prednisolone was initiated, followed by sequential chemoradiotherapy for lung cancer.
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Affiliation(s)
- Sosuke Arakawa
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Makoto Nakao
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Kazuki Sone
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Shuntaro Hayashi
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Masahiro Sugihara
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Yuya Hirata
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Mamiko Kuriyama
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Norihisa Takeda
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Kazuhiro Ohtakara
- Department of Radiation Oncology, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Yoshimi Horikawa
- Department of Radiation Oncology, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Hideki Muramatsu
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
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Teles C, Liyanage CK, Chow G, Denton CP, Ong V. Relapsing polychondritis in systemic sclerosis: A rare vasculitic mimic. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023. [DOI: 10.1177/23971983221141599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: Relapsing polychondritis is a rare, immune-mediated disease characterised by inflammation of cartilaginous structures. Auricular chondritis, sparing the fatty lobule, is the most typical feature, followed by nose and laryngotracheal involvement. Albeit rare, neurologic involvement is reported with relapsing polychondritis. Cranial nerve involvement is the most frequent neurologic manifestation and is probably due to an underlying vasculitic process. Approximately one-third of relapsing polychondritis patients can overlap with other systemic diseases, including other autoimmune connective tissue diseases, but association with systemic sclerosis has very rarely been described. Case description: A 63-year-old woman presented with acute new-onset severe dysphagia, accompanied by hoarseness and preceded by pain, swelling and erythema of the left pinna, unresponsive to antibiotics. She had a history of long-standing limited cutaneous systemic sclerosis. Cranial nerve examination revealed right-sided palatal palsy, and left vocal cord palsy was found on fibreoptic nasendoscopy. Magnetic resonance imaging of the head and neck showed bilateral enhancement of an extracranial segment of the glossopharyngeal and vagus nerves. Clinical features and imaging findings were consistent with relapsing polychondritis, which successfully responded to high-dose steroids. Conclusions: This is a case of relapsing polychondritis mimicking progression of systemic sclerosis, showcasing its challenging features. It emphasises the importance of early diagnosis and prompt management with potential impact on the outcome, while highlighting the complex interplay between these two disease entities and vasculitic mechanisms, which may reflect the shared network of genetic predisposition across autoimmune rheumatic diseases.
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Affiliation(s)
- Carolina Teles
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Chiranthi Kongala Liyanage
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Geoffrey Chow
- Department of Imaging, Royal Free Hospital London, London, UK
| | - Christopher P Denton
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Voon Ong
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
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Ríos-Rivera RA, Vilá LM. Coexistent Relapsing Polychondritis and Clinically Amyopathic Dermatomyositis: A Rare Association of Autoimmune Disorders. Case Rep Rheumatol 2023; 2023:3719502. [PMID: 37082027 PMCID: PMC10113061 DOI: 10.1155/2023/3719502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
Relapsing polychondritis (RPC) is an uncommon autoimmune systemic disease characterized by recurrent inflammation of the cartilage tissue. It can occur alone or in association with other autoimmune diseases, vasculitis, or hematologic disorders. However, the association of RPC with dermatomyositis is extremely rare. Herein, we present a case of a 38-year-old man who developed concurrent RPC and clinically amyopathic dermatomyositis (CADM) manifested by auricular chondritis, nasal chondritis, polyarthritis, gottron papules, fingertip papules, skin biopsy consistent with dermatomyositis, and positive antimelanoma differentiation-associated gene 5 (MDA5) antibodies. RPC features resolved with corticosteroids, but CADM manifestations were resistant to corticosteroids, cyclophosphamide, azathioprine, and hydroxychloroquine. Subsequent therapy with rituximab was effective to control CADM manifestations. This case highlights the importance of recognizing CADM as part of the autoimmune diseases linked with RPC and maintaining a high level of awareness to initiate effective therapy to avoid the long-term complications associated with these conditions.
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Affiliation(s)
- Rafael A. Ríos-Rivera
- Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Luis M. Vilá
- Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
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Chen JY, Li XY, Zong C. Relapsing polychondritis with isolated tracheobronchial involvement complicated with Sjogren's syndrome: A case report. World J Clin Cases 2022; 10:6563-6570. [PMID: 35979285 PMCID: PMC9294918 DOI: 10.12998/wjcc.v10.i19.6563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/17/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Relapsing polychondritis (RP) is a rare, long-term, and potentially life-threatening disease characterised by recurrent paroxysmal inflammation that can involve and destroy the cartilage of the external ear, nose, larynx, and trachea.
CASE SUMMARY We here report a case of RP involving solely the tracheobronchial cartilage ring (and not the auricular. nasal or articular cartilage) complicated by Sjögren's syndrome in a 47-year-old female whose delayed diagnosis caused a sharp decline in pulmonary function. After corticosteroid treatment, her pulmonary function improved.
CONCLUSION In such cases, our experience suggested that 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and fiberoptic bronchoscopy should be used to diagnose airway chondritis as relapsing polychondritis in the early phase of disease.
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Affiliation(s)
- Jun-Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
| | - Xiao-Yan Li
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
| | - Chen Zong
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
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Zhou P, Fu B, Zhang C, Chen K, Xia Q, Tang W, Yu W, Huang W. Bronchoscopy-Guided Intervention Therapy With Extracorporeal Membrane Oxygenation Support for Relapsing Polychondritis With Severe Tracheobronchomalacia: A Case Report and Literature Review. Front Med (Lausanne) 2021; 8:695505. [PMID: 34888317 PMCID: PMC8649689 DOI: 10.3389/fmed.2021.695505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/04/2021] [Indexed: 12/24/2022] Open
Abstract
Relapsing polychondritis is an immune disorder of unknown etiology involving multiple systems that is characterized by persistent inflammation and destruction of cartilage, including the ears, nose, costal, joint, and airways. Airway involvement caused by relapsing polychondritis is common, and tracheobronchomalacia is the most serious complication, which is life-threatening. Currently, the exact mechanism of relapsing polychondritis with tracheobronchomalacia is unknown. Although glucocorticoids and immunosuppressive agents are administered, failures often occur. Currently, bronchoscopy-guided intervention therapy used in tracheobronchomalacia caused by chronic obstructive pulmonary disease or other etiology has gradually increased, but bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation assist used in tracheobronchomalacia caused by relapsing polychondritis has not been reported. Here, we report a case of relapsing polychondritis with severe tracheobronchomalacia. Although drug therapy was provided and airway stent implantation was performed, the tracheal stenosis was further aggravated. Because conventional anesthesia and mechanical ventilation cannot meet the needs of bronchoscopy-guided intervention therapy or guarantee sufficient safety. The intervention treatment was performed with the support of extracorporeal membrane oxygenation, which was successfully completed without obvious complications. The symptoms were significantly improved, and the patient was discharged uneventfully.
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Affiliation(s)
- Pengcheng Zhou
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bing Fu
- Department of Cardiothoracic Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chuantao Zhang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Keling Chen
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qianming Xia
- Department of Respiratory Medicine, The Aviation Industry Corporation of China (AVIC) 363 Hospital, Chengdu, China
| | - Wenjun Tang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Yu
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenhui Huang
- Department of Cardiothoracic Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Matsumoto H, Tokimura R, Fujita Y, Matsuoka N, Asano T, Sato S, Temmoku J, Yashiro-Furuya M, Yoshida K, Takahashi R, Tanaka S, Itagaki Y, Honma M, Matsuda N, Watanabe H, Migita K, Kanai K. Meningoencephalitis in relapsing polychondritis: A case report. Medicine (Baltimore) 2021; 100:e26315. [PMID: 34128872 PMCID: PMC8213297 DOI: 10.1097/md.0000000000026315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Aseptic meningoencephalitis is a rare central nervous system complication of relapsing polychondritis (RP). PATIENT We report a 61-year-old Japanese male patient with spiking fever and impaired consciousness. Neurological examination revealed meningealirritation, and cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis with elevated protein (199 mg/dL) and interleukin-6 (3810 pg/mL). Serological analysis showed high levels of anti-type II collagen antibodies, and the result of auricular biopsy was consistent with the diagnosis of RP showing cartilage degeneration surrounded by inflammatory cell infiltrations. DIAGNOSIS A clinical diagnosis of RP was made according to the diagnostic criteria established by MacAdams et al. INTERVENTION Steroid pulse therapy (methylprednisolone 1000 mg, consecutive 3 days) followed by oral prednisolone (60 mg/day) resolved the patient's high fever and disturbance of consciousness. OUTCOMES The patient rapidly improved after steroid treatments and has a normal quality of life under the maintenance dose of steroid plus methotrexate (4 mg/week). LESSONS RP-associated meningoencephalitis is a rare complication with significant morbidity and mortality. It should be considered and differentiated in patients with RP with unexplained spiking fever and impaired consciousness. In addition, the assessment of cerebrospinal fluid interleukin-6 levels may be useful to investigate the disease activity of RP-related meningoencephalitis. Further prospective studies are required to confirm this result.
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Affiliation(s)
| | - Ryo Tokimura
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | | | | | | | | | | | | | - Kenji Yoshida
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Ryoma Takahashi
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Shoko Tanaka
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Yuya Itagaki
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | - Mari Honma
- Department of Neurology, Masu Memorial Hospital, Nihonmatsu, Fukushima, Japan
| | - Nozomu Matsuda
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
| | | | | | - Kazuaki Kanai
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima
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Hanioka Y, Shimizu K, Yamagami K, Yao S, Nakamura R, Nakamura T, Goto H. Exacerbation of Ulcerative Colitis with Tocilizumab: A Report of Two Cases, One with Takayasu Arteritis and the Other with Relapsing Polychondritis. Intern Med 2021; 60:1615-1620. [PMID: 33281154 PMCID: PMC8188011 DOI: 10.2169/internalmedicine.5215-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Tocilizumab (TCZ), a biologic that blocks the signal transduction of interleukin-6, has been used for the treatment of various autoimmune diseases. Many of these cases are sometimes complicated by ulcerative colitis (UC). However, the effect of TCZ on UC is unclear. We experienced two cases with concomitant UC that were treated with TCZ, one for Takayasu arteritis (TAK) and the other for relapsing polychondritis (RP). TCZ did not improve UC in either of these cases. TCZ might have adverse effects on the intestinal tract, since interleukin-6 signaling plays an important role in intestinal epithelium maintenance. Treatment with TCZ should therefore be carefully provided in patients complicated with UC.
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Affiliation(s)
- Yusuke Hanioka
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Katsushu Shimizu
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Keiko Yamagami
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Shuhei Yao
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | - Ryota Nakamura
- Department of Internal Medicine, Osaka City General Hospital, Japan
| | | | - Hitoshi Goto
- Department of Internal Medicine, Osaka City General Hospital, Japan
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AlE'ed AA. Treatment of auricular relapsing polychondritis in a Saudi child using only non-steroidal anti-inflammatory drugs: a case report. Pan Afr Med J 2020; 37:217. [PMID: 33520056 PMCID: PMC7821814 DOI: 10.11604/pamj.2020.37.217.22998] [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: 04/21/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022] Open
Abstract
Relapsing polychondritis (RP) is an autoimmune disease that can involve multiple sites within the human body. It is characterized by recurrent bouts of painful cartilage inflammation, and it can cause severe complications if it affects the vital organs. This report describes the case of a five-year-old child with limited auricular RP. The patient's history was obtained from his family, and a physical examination was performed at a pediatric rheumatology clinic. The patient was successfully treated using only a non-steroidal anti-inflammatory drug, and he completely recovered. This treatment and recovery have not been reported in the literature. Therefore, these results are worthy of mention in order to avoid the use of immunosuppressant medications with localized involvement.
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Affiliation(s)
- Ashwaq Ahmed AlE'ed
- Department of Pediatrics, College of Medicine, Qassim University, Al-Qassim, Saudi Arabia
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12
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Aurikuläre Chondritis als Erstsymptom einer ANCA-assoziierten Vaskulitis. Z Rheumatol 2020; 79:902-905. [DOI: 10.1007/s00393-020-00841-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Feng J, Zuo X, Gui L, Qi J, Guo X, Lv Q, Zhang Y, Fang L, Zhang X, Gu J, Lin Z. Genetic basis of relapsing polychondritis revealed by family‐based whole‐exome sequencing. Int J Rheum Dis 2020; 23:641-646. [PMID: 32107856 DOI: 10.1111/1756-185x.13809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 12/04/2019] [Accepted: 02/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Junmei Feng
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Xiaoyu Zuo
- State Key Laboratory of Oncology in South China Cancer Center Sun Yat‐Sen University Guangzhou China
| | - Lian Gui
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Jun Qi
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Xinghua Guo
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Qing Lv
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Yanli Zhang
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Linkai Fang
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Xi Zhang
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Jieruo Gu
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Zhiming Lin
- Department of Rheumatology Third Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
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Diagnosing relapsing polychondritis remains a common challenge: experience from a Chinese retrospective cohort. Clin Rheumatol 2020; 39:2179-2184. [PMID: 32036586 DOI: 10.1007/s10067-019-04852-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The diagnosis of relapsing polychondritis (RP) is often mistaken or delayed. In this retrospective cohort, we aimed to unveil the causes responsible for such phenomenon, to determine the associated factors, and to compare diagnosis in clinical settings with the current diagnostic criteria. METHOD Eighty-seven RP patients followed-up by rheumatologists from January 1, 2008, to October 31, 2018, were retrospectively analyzed. RESULTS A total of 50 male and 37 female patients were included with a mean age of 45.9 ± 14.5 years. Ninety-three percent were initially admitted by non-rheumatologic specialists .Twenty-eight percent were correctly diagnosed, while 72% were misdiagnosed at the first visits, all by non-rheumatologic specialists. Patients admitted by non-rheumatologic specialists had increased odds of misdiagnosis (odds ratio [OR] = 1.3, 95% confidence interval [95% CI] 1.1-1.7, P = 0.000). Fifty-seven (65.5%) patients did not meet with Michet or Damiani criteria, with 16 (18.4%) patients diagnosed as partial RP and 41( 47.1%) patients diagnosed as limited RP. CONCLUSIONS Incorrect and delayed diagnosis of RP is common in our cohort, and insufficient awareness of the disease in non-rheumatologic specialists at least partially contributes to this. It is imperative to revise the current criteria for early diagnosis.Key Points• Diagnosing relapsing polychondritis (RP) in early stage remains challenging after all these years, especially among non-rheumatologic specialists, indicating the importance of teaching non-rheumatologic specialists to improve their understanding of this rare disease.• Many RP patients did not fully meet with the current criteria, suggesting that revision of the current criteria is imperative for early diagnosis of this rare disease.
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A case of localized tracheobronchial relapsing polychondritis with positive matrilin-1 staining. BMC Rheumatol 2020; 4:1. [PMID: 32016169 PMCID: PMC6988282 DOI: 10.1186/s41927-019-0103-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/30/2019] [Indexed: 11/24/2022] Open
Abstract
Background Relapsing polychondritis (RPC) is a rare progressive autoimmune disease characterized by inflammation in the cartilage of multiple organs. Tracheobronchial involvement appears in nearly half of RPC patients during the course of their disease and represents the main cause of death. Localized tracheobronchial RPC is much rarer, and the pathogenesis remains unclear. Matrilin-1 is a non-collagenous cartilage matrix protein and has been suggested to be a potent autoantigen that induces the airway disease of RPC in animal models. However, the expression of matrilin-1 in tracheobronchial tissue in human remains unclear. Therefore, we examined the expression of matrilin-1 in the tracheal and auricular tissues in a localized tracheobronchial RPC patient. Case presentation A 62-year-old man with systemic sclerosis presented with cough and dyspnea on exertion. The lung function test showed an expiratory flow limitation and chest computed tomography showed diffuse thickness from the trachea to the bronchiole. No other tests showed abnormal findings. To evaluate further, bronchoscopy was performed and endobronchial ultrasonography showed thickness in the fourth-marginal echo layer suggesting inflammation of the cartilage. However, the tracheal biopsy showed no specific findings. The subsequent surgical tracheal biopsies showed inflammatory cell infiltration with destruction of the cartilage. Neither auricular nor nasal deformity, except for a tracheobronchial lesion, was detected. Biopsy from the left auricular cartilage also did not show any inflammatory changes. Finally, we diagnosed the patient with localized tracheobronchial RPC. To address the hypothesis that autoimmunity against matrilin-1 is involved in the pathogenesis of localized tracheobronchial RPC, we evaluated the expression level of matrilin-1 in a tracheal and auricular specimen from this patient. Immunohistochemical staining with anti-matrilin-1 antibody showed matrilin-1 in the tracheal but not in the auricular cartilage. Conclusions We first demonstrated the expression of matrilin-1 in tracheal but not in auricular cartilage in a localized tracheobronchial RPC patient. This result supports the possibility that matrilin-1 is involved in the pathogenesis of localized tracheobronchial RPC. However, this is only one case report and further observations will be needed to confirm this result.
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Lin H, Huang Y, Zeng H, Wang M, Guan S, Chen G, Guan H. Overlapping Clinical Syndromes in Patients with Glial Fibrillary Acidic Protein IgG. Neuroimmunomodulation 2020; 27:69-74. [PMID: 32101879 DOI: 10.1159/000505730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this paper is to report 2 cases with overlapping syndromes in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy. METHODS Antibodies were detected by indirect immunofluorescence assay. Patient data were analyzed retrospectively. RESULTS One patient presented with overlapping neuromyelitis optica spectrum disorder (NMOSD) and positive GFAP-IgG and aquaporin-4-IgG. His main symptoms included vision loss, hiccups, fever, headache, and ataxia. High leukocyte count and protein levels were found in cerebrospinal fluid. Brain magnetic resonance imaging (MRI) revealed abnormalities in the hippocampus, midbrain, pons, medulla, and meninges. Characteristic radial enhancing patterns were seen. The other patient was a male with relapsing polychondritis (RP) and positive GFAP-IgG. His main manifestations were meningoencephalitis and dementia. MRI showed extensive abnormalities in the white matter around the ventricles, temporal lobe, and thalamus, with enhancement. Both patients responded well to the treatment with steroids and immunosuppressants. CONCLUSIONS Although overlapping syndromes are rare, we report positive GFAP-IgG in 2 cases with NMOSD or RP. Both patients had clinical features of GFAP astrocytopathy, but diagnosis of the condition was very challenging because of the overlapping presentation.
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Affiliation(s)
- Han Lin
- Department of Neurology, The Affiliated Dongguan Houjie Hospital of Guangdong Medical University, Dongguan, China
| | - Yihong Huang
- Department of Neurology, The Affiliated Dongguan Houjie Hospital of Guangdong Medical University, Dongguan, China,
| | - Huanzhong Zeng
- Department of Radiology, The Affiliated Dongguan Houjie Hospital of Guangdong Medical University, Dongguan, China
| | - Mingxia Wang
- Department of Neurology, The Affiliated Dongguan Houjie Hospital of Guangdong Medical University, Dongguan, China
| | - Shaobing Guan
- Department of Neurology, The Affiliated Dongguan Houjie Hospital of Guangdong Medical University, Dongguan, China
| | - Guohua Chen
- Department of Neurology, The Affiliated Dongguan Houjie Hospital of Guangdong Medical University, Dongguan, China
| | - Hongbing Guan
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
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Biya J, Dury S, Perotin JM, Launois C, Dewolf M, Deslée G, Lebargy F. Assessment of TNF-α inhibitors in airway involvement of relapsing polychondritis: A systematic review. Medicine (Baltimore) 2019; 98:e17768. [PMID: 31689839 PMCID: PMC6946571 DOI: 10.1097/md.0000000000017768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Relapsing polychondritis (RP) is a rare immune-mediated disease affecting cartilaginous structures. Respiratory tract manifestations are frequent and constitute a major cause of morbidity and mortality. The present review of the literature was designed to assess the efficacy of tumor necrosis factor alpha (TNF-α) inhibitors in respiratory tract involvement of RP.A MEDLINE literature search was performed from January 2000 to December 2016 to identify all studies and case reports of anti-TNF-α therapy in RP. Articles published in English or French concerning patients with respiratory tract involvement were eligible. Two authors (JB, FL) independently reviewed and extracted data concerning each patient and 2 personal cases were added. Treatment efficacy was assessed according to systemic and/or respiratory criteria.A total of 28 patients (mean age: 41.6 years; 16 females/12 males) were included in the final analysis. Anti-TNF-α therapy was associated with improved health status and respiratory symptoms in 67.8% and 60.1% of cases, respectively.These results suggest that TNF-α inhibitors could be considered for the treatment of respiratory tract involvement of RP.
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Affiliation(s)
- Josette Biya
- Department of Respiratory Diseases, Reims University Hospital
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital
- EA 4683 Medical and Pharmacological Sciences
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, Reims University Hospital
- UMRS 903, Reims University Hospital, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital
| | - Maxime Dewolf
- Department of Respiratory Diseases, Reims University Hospital
| | - Gaëtan Deslée
- Department of Respiratory Diseases, Reims University Hospital
- UMRS 903, Reims University Hospital, Reims, France
| | - François Lebargy
- Department of Respiratory Diseases, Reims University Hospital
- EA 4683 Medical and Pharmacological Sciences
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Girit S, Senol E. A Rare Diagnosis: Keutel Syndrome. Medeni Med J 2019; 34:329-332. [PMID: 32821457 PMCID: PMC7433741 DOI: 10.5222/mmj.2019.91979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/24/2019] [Indexed: 11/05/2022] Open
Abstract
Tracheobronchial cartilage calcification is a rare finding in the pediatric population. Keutel syndrome (OMIM 245150) is a very rare syndrome characterized with diffuse calcification of cartilage, brachytelephalangia, pulmonary stenosis, midline defects, stippled epiphysis in infancy, and hearing loss accompanied by recurrent respiratory infections and asthma-like attacks. Here, we present a 14-year-old patient who was followed up with the diagnosis of asthma, but did not respond to appropriate asthma treatment. She was subsequently diagnosed as having Keutel syndrome with cartilage calcification on the tracheobranchial tree and auricula, atypical facial features, recurrent otitis media, hearing loss, and recurrent asthma-like symptoms.
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Affiliation(s)
- Saniye Girit
- Istanbul Medeniyet University Medical Faculty Goztepe Research and Training Hospital, Division of Pediatric Pulmonology, Department of Pediatrics, Istanbul, Turkey
| | - Ebru Senol
- Health Sciences University Medical Faculty Kartal Dr. Lutfi Kırdar Educational and Research Hospital, Department of Pediatrics, Istanbul, Turkey
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Alqanatish JT, Alfarhan BA, Qubaiban SM. Limited auricular relapsing polychondritis in a child treated successfully with infliximab. BMJ Case Rep 2019; 12:12/5/e227043. [PMID: 31126928 PMCID: PMC6536242 DOI: 10.1136/bcr-2018-227043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare progressive and destructive multisystem disorder characterised by recurrent inflammation of cartilaginous structures. It is a rare disease in paediatrics compared with adults. In children, the diagnosis is either delayed or overlooked due to low incidence. Auricular chondritis has been described in more than half of paediatric cases with RP. However, isolated auricular chondritis has not been reported as the only presentation of pediatric-onset RP. We described a lad who presented with isolated auricular chondritis, which is refractory to conventional treatment, including glucocorticoids and methotrexate as steroid-sparing agent. Remission of his disease’s relapses was sustained with infliximab. Limited auricular involvement as a presenting feature of RP in the absence of systemic association is very rare in children. We describe a case of successful use of infliximab on limited auricular chondritis disease.
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Affiliation(s)
- Jubran Theeb Alqanatish
- Department of Paediatrics, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences - Ministry of National Guard, Riyadh, Saudi Arabia
| | - Basma Ali Alfarhan
- Department of Paediatrics, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences - Ministry of National Guard, Riyadh, Saudi Arabia
| | - Sara Mohammed Qubaiban
- Department of Paediatrics, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences - Ministry of National Guard, Riyadh, Saudi Arabia
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Rimland CA, Ferrada MA, Sinaii N, Sikora KA, Colbert RA, Grayson PC, Katz JD. Patient-perceived Burden of Disease in Pediatric Relapsing Polychondritis. J Rheumatol 2019; 46:1627-1633. [PMID: 31043550 DOI: 10.3899/jrheum.181456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess patient-reported burden of disease in pediatric patients with relapsing polychondritis (RP) and to compare those findings to adult patients. METHODS A survey based on known clinical symptoms of RP was developed and administered to patients with a pediatric diagnosis of RP. Adult patients completed a similar survey. RESULTS Twenty-one pediatric patients, or their parents, completed surveys. Median age at symptom onset was 6 years (interquartile range 1.8-12). Prior to diagnosis, most pediatric patients went to the emergency room (ER; 61.9%), saw > 3 physicians (57.1%), and took > 1 year to be diagnosed (61.9%). Pediatric patients were often diagnosed with asthma (42.9%), ear infections (42.9%), or sinusitis (33.3%) prior to diagnosis of RP. Symptoms prior to diagnosis included ear pain/redness (85.7%), joint pain/swelling (61.9%), and airway symptoms (38.1%). Four pediatric patients (19%) reported tracheomalacia requiring tracheostomy. Pediatric patients frequently missed school because of their disease (71.4%). Surveys from 290 adult patients were compared to pediatric patients. Pediatric patients were significantly more likely to undergo biopsy (42.9% vs 17.4%; p < 0.01) and be treated with biologics (42.9% vs 19%; p = 0.02). Adults were significantly more likely to be female (87.8% vs 28.6%; p < 0.01) and to report airway symptoms (77.9% vs 47.6%; p = 0.01). Prevalence of disease complications was not significantly different between adult and pediatric patients. CONCLUSIONS The burden of disease in pediatric patients with RP includes missed school, diagnostic delay, ER visits, and multisystem disease, with resultant damage to cartilaginous structures. Differences in airway involvement and treatment approaches may exist between pediatric and adult patients.
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Affiliation(s)
- Casey A Rimland
- From the US National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS), National Institutes of Health (NIH), Bethesda, Maryland; University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina; NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH, Bethesda, Maryland, USA.,C.A. Rimland, PhD, NIAMS, NIH, and the University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program; M.A. Ferrada, MD, NIAMS, NIH; N. Sinaii, MPH, PhD, NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH; K.A. Sikora, MD, NIAMS, NIH; R.A. Colbert, MD, PhD, NIAMS, NIH; P.C. Grayson, MSc, MD, NIAMS, NIH; J.D. Katz, MD, NIAMS, NIH.,C.A. Rimland and Dr. Ferrada are co-first authors. Drs. Grayson and Katz are co-senior authors
| | - Marcela A Ferrada
- From the US National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS), National Institutes of Health (NIH), Bethesda, Maryland; University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina; NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH, Bethesda, Maryland, USA.,C.A. Rimland, PhD, NIAMS, NIH, and the University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program; M.A. Ferrada, MD, NIAMS, NIH; N. Sinaii, MPH, PhD, NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH; K.A. Sikora, MD, NIAMS, NIH; R.A. Colbert, MD, PhD, NIAMS, NIH; P.C. Grayson, MSc, MD, NIAMS, NIH; J.D. Katz, MD, NIAMS, NIH.,C.A. Rimland and Dr. Ferrada are co-first authors. Drs. Grayson and Katz are co-senior authors
| | - Ninet Sinaii
- From the US National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS), National Institutes of Health (NIH), Bethesda, Maryland; University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina; NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH, Bethesda, Maryland, USA.,C.A. Rimland, PhD, NIAMS, NIH, and the University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program; M.A. Ferrada, MD, NIAMS, NIH; N. Sinaii, MPH, PhD, NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH; K.A. Sikora, MD, NIAMS, NIH; R.A. Colbert, MD, PhD, NIAMS, NIH; P.C. Grayson, MSc, MD, NIAMS, NIH; J.D. Katz, MD, NIAMS, NIH.,C.A. Rimland and Dr. Ferrada are co-first authors. Drs. Grayson and Katz are co-senior authors
| | - Keith A Sikora
- From the US National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS), National Institutes of Health (NIH), Bethesda, Maryland; University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina; NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH, Bethesda, Maryland, USA.,C.A. Rimland, PhD, NIAMS, NIH, and the University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program; M.A. Ferrada, MD, NIAMS, NIH; N. Sinaii, MPH, PhD, NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH; K.A. Sikora, MD, NIAMS, NIH; R.A. Colbert, MD, PhD, NIAMS, NIH; P.C. Grayson, MSc, MD, NIAMS, NIH; J.D. Katz, MD, NIAMS, NIH.,C.A. Rimland and Dr. Ferrada are co-first authors. Drs. Grayson and Katz are co-senior authors
| | - Robert A Colbert
- From the US National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS), National Institutes of Health (NIH), Bethesda, Maryland; University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina; NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH, Bethesda, Maryland, USA.,C.A. Rimland, PhD, NIAMS, NIH, and the University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program; M.A. Ferrada, MD, NIAMS, NIH; N. Sinaii, MPH, PhD, NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH; K.A. Sikora, MD, NIAMS, NIH; R.A. Colbert, MD, PhD, NIAMS, NIH; P.C. Grayson, MSc, MD, NIAMS, NIH; J.D. Katz, MD, NIAMS, NIH.,C.A. Rimland and Dr. Ferrada are co-first authors. Drs. Grayson and Katz are co-senior authors
| | - Peter C Grayson
- From the US National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS), National Institutes of Health (NIH), Bethesda, Maryland; University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina; NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH, Bethesda, Maryland, USA.,C.A. Rimland, PhD, NIAMS, NIH, and the University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program; M.A. Ferrada, MD, NIAMS, NIH; N. Sinaii, MPH, PhD, NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH; K.A. Sikora, MD, NIAMS, NIH; R.A. Colbert, MD, PhD, NIAMS, NIH; P.C. Grayson, MSc, MD, NIAMS, NIH; J.D. Katz, MD, NIAMS, NIH.,C.A. Rimland and Dr. Ferrada are co-first authors. Drs. Grayson and Katz are co-senior authors
| | - James D Katz
- From the US National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS), National Institutes of Health (NIH), Bethesda, Maryland; University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina; NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH, Bethesda, Maryland, USA. .,C.A. Rimland, PhD, NIAMS, NIH, and the University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program; M.A. Ferrada, MD, NIAMS, NIH; N. Sinaii, MPH, PhD, NIH Clinical Center, Biostatistics and Clinical Epidemiology Service, NIH; K.A. Sikora, MD, NIAMS, NIH; R.A. Colbert, MD, PhD, NIAMS, NIH; P.C. Grayson, MSc, MD, NIAMS, NIH; J.D. Katz, MD, NIAMS, NIH. .,C.A. Rimland and Dr. Ferrada are co-first authors. Drs. Grayson and Katz are co-senior authors.
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Meziara Wilson T, Machado M, De Sousa DER, Braúna T, Torres Neto R, Laufer-Amorim R, Szabó MPJ, De Castro MB. Immunopathological findings in a cat with auricular chondritis. Acta Vet Hung 2019; 67:81-86. [PMID: 30922093 DOI: 10.1556/004.2019.009] [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] [Indexed: 11/19/2022]
Abstract
At clinical examination, a 5-year-old male domestic short-haired cat exhibited painful swelling and erythema of the pinnae of both ears. Microscopically, the lesions on both pinnae were composed of diffuse granulomatous chondritis with degeneration and necrosis of the pinnal cartilage. Numerous mast cells were also observed within and surrounding the inflammatory lesion. Immunohistochemistry showed a mixed inflammatory infiltrate characterised by the predominance of macrophages (CD68+, MAC 387+ and Lysozyme+), T lymphocytes (CD3+), some B lymphocytes (CD79α+) and neutrophils. Immunopathological characterisation of the lesion showed a granulomatous inflammation profile and suggests that the morphological changes and immunopathogenesis of auricular chondritis in cats presents a similarity with relapsing polychondritis in humans.
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Affiliation(s)
| | - Mizael Machado
- 1 Laboratory of Veterinary Pathology, 70330-050 Brasília, DF, Brazil
| | | | - Tainã Braúna
- 2 Small Animal Veterinary Hospital, School of Veterinary Medicine, University of Brasília, Federal District, 70330-050 Brasília, DF, Brazil
| | | | - Renée Laufer-Amorim
- 4 School of Veterinary Medicine and Animal Science, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Matias Pablo Juan Szabó
- 5 Ixodology Laboratory, Faculty of Veterinary Medicine, Federal University of Uberlândia, MG, Brazil
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Zhu Z, Tian D, Ren N, Zhao Z, Wang X, Chen L. Limbic encephalitis with relapsing polychondritis: persistent white matter lesions and brain atrophy. J Int Med Res 2018; 46:5297-5302. [PMID: 30426814 PMCID: PMC6300954 DOI: 10.1177/0300060518805593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/17/2018] [Indexed: 11/16/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare autoimmune disorder affecting cartilage. Limbic encephalitis is a rare central nervous system manifestation of RP. This current case report describes a 66-year-old Chinese male patient who complained of developing myoclonus in the left leg, ataxia and speech difficulties 3 weeks prior to hospital admission. The patient presented with cognitive impairment, sleep disorder and extrapyramidal symptoms. The patient was diagnosed with RP that affected auricular cartilage, which also manifested as limbic encephalitis. Magnetic resonance imaging showed bilateral temporal lobe lesions involving the hippocampi and basal ganglia. Signal abnormalities in the white matter persisted during the 15-month follow-up period after treatment with corticosteroids and intravenous immunoglobulin. Over the same period, the bilateral hippocampi showed significant atrophy.
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Affiliation(s)
- Zilong Zhu
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Decai Tian
- Centre for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ren
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Zhihong Zhao
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Xin Wang
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Lei Chen
- Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
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Rose T, Schneider U, Bertolo M, Klotsche J, Casteleyn V, Biesen R, Burmester GR, Hiepe F. Observational study and brief analysis of diagnostic criteria in relapsing polychondritis. Rheumatol Int 2018; 38:2095-2101. [PMID: 30084004 DOI: 10.1007/s00296-018-4121-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
Observational study of patients with relapsing polychondritis (RPC) and brief evaluation of widely used diagnostic criteria. A retrospective analysis of 18 patients with RPC treated in the past 15 years at the Charté-Universitätsmedizin Berlin was performed. Three different diagnostic criteria were applied to our cohort. Sensitivities of diagnostic criteria of McAdam et al., Damiani and Levine and Michet et al. were calculated as well as the 5- and 10-year survival. Analysis of diagnostic criteria revealed a sensitivity of 88.9% using Damiani and Levine criteria, 66.7% for Michet et al. and 50% for McAdam et al., respectively. Modifying the criteria of Michet et al. increases the sensitivity to 88.9%. The 5- and 10-year survival were 100 and 90.9%, respectively. Current diagnostic criteria in RPC should be reappraised covering the diversity of clinical findings with the aim to improve clinical care and research in RPC.
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Affiliation(s)
- Thomas Rose
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany.
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Martina Bertolo
- Department of Nephrology, Charité Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Center, Berlin-Leibniz Institute, 10117, Berlin, Germany
| | - Vincent Casteleyn
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany
| | - Falk Hiepe
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany
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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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Masuda N, Nishikawa R, Ueda T, Ogata N. Severe panuveitis with relapsing polychondritis. Am J Ophthalmol Case Rep 2018; 11:3-5. [PMID: 30050999 PMCID: PMC6058060 DOI: 10.1016/j.ajoc.2018.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/14/2018] [Accepted: 04/18/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose Relapsing polychondritis is a rare multiorgan disease characterized by repeated episodes of inflammation and deterioration of cartilages. We report a case of relapsing polychondritis that presented with severe panuveitis. Observations A 53-year-old man visited our hospital because of ocular pain in both eyes of 2 weeks' duration. His best-corrected visual acuity was 20/20 in both eyes but he had severe hyperemia of the conjunctiva bilaterally. Inflammation in the anterior segment and vitreous opacity had been getting worse in his right eye. Systemic and topical treatments were not effective, and the visual acuity of the right eye was reduced to hand motion. Thus, pars plana vitrectomy with silicone oil tamponade was performed. After the operation, the vitreous opacities and white lesions in the retina were completely resolved. His visual acuity was improved to 20/20.Three years later, he developed dizziness and swelling of both auricles of his ears, and he was found to have sensorineural deafness. He was diagnosed with relapsing polychondritis after a laryngoscopic examination.Twelve months after the diagnosis, scleritis and panuveitis developed in his left eye, and his visual acuity fell to 20/2000. We performed pars plana vitrectomy with silicone oil tamponade on his left eye. After the vitrectomy, the inflammation of the left eye was resolved. Conclusion and importance: Ophthalmologist should be aware that severe panuveitis with vitreous opacities may be the initial signs of relapsing polychondritis. In addition, vitrectomy was effective for the treatment of the ocular complications.
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Affiliation(s)
- Naonori Masuda
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
| | - Ryoko Nishikawa
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
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Fousekis FS, Saridi M, Albani E, Daniel F, Katsanos KH, Kastanioudakis IG, Christodoulou DK. Ear Involvement in Inflammatory Bowel Disease: A Review of the Literature. J Clin Med Res 2018; 10:609-614. [PMID: 29977417 PMCID: PMC6031254 DOI: 10.14740/jocmr3465w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 05/15/2018] [Indexed: 11/12/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a multisystemic disease. The ear is a rare but recognized site of extraintestinal manifestations of IBD. In external ear, the more common manifestations of IBD are pyoderma gangrenosum, metastatic Crohn’s disease and relapsing polychondritis and the treatment includes corticosteroids and anti-TNF agents. Sensorineural hearing loss (SNHL) is the most common ear disease in IBD and especially in patients with ulcerative colitis. In most cases of IBD patients with SNHL, the hearing loss is attributable to autoimmune inner ear disease (AIED). Diagnosis of AIED is based on clinical presentation, the demonstration of a progressive sensorineural hearing loss in periodic audiological tests, a response to immunosuppressive drugs and exclusion of other causes of SNHL. The only diagnostic test that is available for clinical use is the Otoblot test (Western blot for antibodies against 68 kD protein-inner ear antigens). Initial therapy is usually steroids, with a step up to anti-TNF-a therapy and cochlear implantations with failure of treatment. Furthermore, Cogan’s syndrome, a chronic disease characterized by deafness, vertigo keratitis and aortitis, has been associated with IBD and mainly with Crohn’s disease.
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Affiliation(s)
- Fotios S Fousekis
- Department of Gastroenterology, Medical School of Ioannina, Ioannina, Greece
| | - Maria Saridi
- Department of Social and Educational Policy, University of Peloponnese, Corinth, Greece.,Hellenic Open University, Patras, Greece
| | - Eleni Albani
- Nursing Department, Technological University of Patras, Patra, Greece
| | - Fady Daniel
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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Xuan YY, Li TF, Zhang L, Liu SY. ANCA positive relapsing polychondritis, Graves disease, and suspected moyamoya disease: A case report. Medicine (Baltimore) 2017; 96:e9378. [PMID: 29390537 PMCID: PMC5758239 DOI: 10.1097/md.0000000000009378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIOINALE Relapsing polychondritis (RP) is a rare and heterogeneous disease complex of unknown origin which basically affects cartilaginous structures, 40% of which accompanied by rheumatic, hematologic, and endocrine disease. Among them, vasculitis is the most common accompanying type and usually presented with positive antineutrophilic cytoplasmic antibody (ANCA). The presence of ANCA could be primary or drug-induced like propylthiouracil (PTU). Central involvement of RP is very rare, and there is almost no report of cerebral vasculopathy manifested as moyamoya. PATIENT CONCERNS A 26-year-old woman complained about recurrent fever, auricular chondritis, ocular inflammation, and arthritis. She had an 8-year drug intake of PTU for Graves disease. Myeloperoxidase antineutrophilc cytoplasmic antibodies (MPO-ANCA) were found positive. Magnetic resonance angiography (MRA) detected multiple intracranial vasculopathy which we highly suspected it as moyamoya disease. DIAGNOSES Relapsing polychondritis, Graves disease and suspected moyamoya disease were clinically diagnosed. INTERVENTIONS AND OUTCOMES In case of possible PTU-induced vasculitis and the aggravation of vasculopathy, PTU was replaced by Iodine-131 (I) therapy. Induction treatment included oral prednisone 30 mg daily and oral cyclophosphamide 100 mg daily. Symptoms rapidly relieved before discharge. Inflammation markers were normal and MPO-ANCA decreased in 3 weeks after admission. Prednisone was gradually tapered to 7.5 mg daily and at month 10 azathioprine was continued for maintenance. LESSONS RP can overlap with Graves disease and moyamoya disease; comprehensive tests should be performed when admission. When relapsing polychondritis is accompanied with Graves disease, especially when ANCA is positive, PTU should be avoided.
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Pak S, Logemann S, Dee C, Fershko A. Breaking the Magic: Mouth and Genital Ulcers with Inflamed Cartilage Syndrome. Cureus 2017; 9:e1743. [PMID: 29218258 PMCID: PMC5714402 DOI: 10.7759/cureus.1743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome refers to a condition in which features of Behcet’s disease (BD) and relapsing polychondritis (RP) occur in the same individual. The existence of MAGIC syndrome suggests a potential common etiology for BD and RP. However, connecting these two diseases and referring to this condition as MAGIC syndrome might have been premature, as there is currently insufficient knowledge on BD and RP. In this critical review, we argue that these two clinical entities could possibly be unique disease processes rather than two ends of the same disease spectrum. Distinguishing the clinical difference between BD and RP is critical for the management of patients diagnosed with MAGIC syndrome, as biological therapeutic approaches for BD and RP differ. Also, inaccurate perception regarding the relationship of these two diseases could mislead researchers in their endeavors to unravel the pathophysiological mechanisms behind these two diseases.
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Affiliation(s)
- Stella Pak
- Internal Medicine, Kettering Medical Center
| | | | - Christine Dee
- Wright State University Boonshoft School of Medicine
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Mydlak A, Sołdacki D, Foroncewicz B, Stopa Z, Powała A, Budlewski T, Pączek L, Mucha K. Relapsing polychondritis in a liver transplant recipient: A case report. Medicine (Baltimore) 2017; 96:e8360. [PMID: 29069021 PMCID: PMC5671854 DOI: 10.1097/md.0000000000008360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RATIONALE Relapsing polychondritis (RP) is a multisystemic, progressive disease of unknown etiology characterized by recurrent inflammation and progressive cartilage destruction. It can involve all types of cartilage including ears and nose, tracheobronchial tree, joints, and any other tissue rich in proteoglycans such as heart, eyes, and blood vessels. Recurrent chondritis can be life-threatening if the respiratory tract, heart valves, or blood vessels are affected. To date there is no data in the literature on the post solid organ transplantation RP. PATIENT CONCERNS We present a 59-year-old male liver transplant recipient with primary sclerosing cholangitis who developed RP of the earlobes and nose despite post-transplant immunosuppression. DIAGNOSES Based on the clinical criteria, scintigraphy and biopsy from the left auricle his condition was diagnosed as RP. INTERVENTIONS Pulses of methylprednisolone followed by high-dose oral steroids along with azathioprine were administered. OUTCOMES Such therapy diminished local cartilage inflammation, improved patient's general condition and the laboratory results. Significant loss of ear cartilage and characteristic "saddlenose" were observed after remission of acute symptoms. The control scintigraphy proved very good treatment response. LESSONS To the best of our knowledge this is the first report on the RP in liver transplant recipient. Based on our patient presentation, we suggest that RP should be suspected in any transplant recipient with cartilage inflammation, and that the Michet's clinical criteria and scintigraphy seem to be the best diagnostic tools for solid organ transplant recipients suspected of RP.
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Affiliation(s)
- Anna Mydlak
- Department of Cranio-Maxillofacial Surgery, Oral Surgery and Implantology, Medical University of Warsaw
| | - Dariusz Sołdacki
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw
| | - Bartosz Foroncewicz
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw
| | - Zygmunt Stopa
- Department of Cranio-Maxillofacial Surgery, Oral Surgery and Implantology, Medical University of Warsaw
| | | | - Tadeusz Budlewski
- Nuclear Medicine Unit, Department of Diagnostic Radiology, Central Clinical Hospital Ministry of Internal Affairs
| | - Leszek Pączek
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Krzysztof Mucha
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
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Aseptic meningitis in relapsing polychondritis: a case report and literature review. Clin Rheumatol 2017; 37:251-255. [PMID: 28361234 DOI: 10.1007/s10067-017-3616-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/14/2017] [Accepted: 03/25/2017] [Indexed: 02/05/2023]
Abstract
Aseptic meningitis is an extremely rare neurologic complication of relapsing polychondritis (RP). We reported a case of a 58-year-old Chinese female with intractable headache, puffy ears, pleocytosis, and cranial magnetic resonance imaging (MRI) showing thickened and enhanced meninges. She was finally diagnosed of aseptic meningitis due to RP after full exclusion of infectious causes. She gradually developed neurosensory hearing loss, vertigo, and saddle nose while glucocorticosteroid therapy and combined cyclophosphamide could not control her headache. Ultimately, cyclosporin A was tried showing a good response. Only 18 previous cases were found in the literature and the clinical manifestation, cerebrospinal fluid (CSF) characteristics, imaging features, and therapy considerations of RP-related aseptic meningitis were summarized by reviewing the literature. Aseptic meningitis due to RP is a rare condition of undetermined pathoetiology. Its diagnosis is primarily based on clinical manifestations combined with CSF and MRI examinations plus adequate exclusion of possible infections. Corticosteroid is the basic therapy but choice of protocol should be individualized.
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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.
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Sharma A, Dhooria A, Aggarwal A, Rathi M, Chandran V. Connective Tissue Disorder-Associated Vasculitis. Curr Rheumatol Rep 2017; 18:31. [PMID: 27097818 DOI: 10.1007/s11926-016-0584-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Vasculitides secondary to connective tissue diseases are classified under the category of 'vasculitis associated with systemic disease' in the revised International Chapel Hill Consensus Conference (CHCC) nomenclature. These secondary vasculitides may affect any of the small, medium or large vessels and usually portend a poor prognosis. Any organ system can be involved and the presentation would vary depending upon that involvement. Treatment depends upon the type and severity of presentation. In this review, we describe secondary vasculitis associated with rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, relapsing polychondritis, systemic sclerosis, Sjogren's syndrome and idiopathic inflammatory myositis, focusing mainly on recent advances in the past 3 years.
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Affiliation(s)
- Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012.
| | - Aadhaar Dhooria
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Ashish Aggarwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Manish Rathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinod Chandran
- Department of Medicine, Division of Rheumatology, & Division of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, ON, Canada
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34
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Ahn SW, Park MS, Jeong HB, Kwon OS, Yoon BN, Kim HS, Choi ST. Relapsing Polychondritis Presented with Encephalitis Followed by Brain Atrophy. Exp Neurobiol 2016; 26:66-69. [PMID: 28243168 PMCID: PMC5326716 DOI: 10.5607/en.2017.26.1.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/06/2016] [Accepted: 12/14/2016] [Indexed: 12/26/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare autoimmune disease that is characterized by inflammatory reaction of unknown etiology and destruction of cartilaginous structures. Characteristic symptoms of this disease include cartilage inflammation of the ear, nose, larynx, trachea, bronchi, joints, eyes, heart and skin. Concomitance with neurologic symptom is very rare in RP, and the detailed underlying mechanism of neurological involvement associated with RP is not fully understood. We herein described an unusual recurrent case of inflammatory brain lesions associated with RP, with attention to clinical manifestations, autoimmune disease involvement, and therapeutic effects.
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Affiliation(s)
- Suk-Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Moo-Seok Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Hae-Bong Jeong
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Oh-Sang Kwon
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Byung-Nam Yoon
- Department of Neurology, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Sang Tae Choi
- Department of Rheumatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06974, Korea
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35
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Vos FI, Merkus P, van Nieuwkerk EBJ, Hensen EF. Rare cause of bilateral sudden deafness. BMJ Case Rep 2016; 2016:bcr-2016-216004. [PMID: 28049117 DOI: 10.1136/bcr-2016-216004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In this paper, we describe the case of a 62-year-old female with recurring episodes of sudden deafness with vertigo and facial paresis. Within a month's time, this resulted in bilateral deafness and vestibular areflexia. Erroneously, the patient was diagnosed with sudden deafness of unknown origin and subsequently with neuroborreliosis (Lyme disease). The true diagnosis of relapsing polychondritis (RP) was revealed 9 months after initial presentation. The diagnostic delay is in part explained by the fact that, by definition, the disease has to relapse before the diagnosis can be made, but also by its pluriform clinical presentation. Timely identification of RP as the cause of this profound sensorineural hearing loss proved to be important. It was key in instigating adequate follow-up, and allowed for cochlear implantation before total cochlear obliteration, which might have hampered optimal hearing rehabilitation.
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Affiliation(s)
- F I Vos
- Department of Otolaryngology-Head and Neck Surgery, Section Ear & Hearing, VU University Medical Center, Amsterdam, The Netherlands
| | - P Merkus
- Department of Otolaryngology-Head and Neck Surgery, Section Ear & Hearing, VU University Medical Center, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | | | - E F Hensen
- Department of Otolaryngology-Head and Neck Surgery, Section Ear & Hearing, VU University Medical Center, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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36
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Rees CA, Rubalcava DM, Chumpitazi CE. A child with a painful swollen ear. Arch Dis Child 2016; 101:859. [PMID: 27102760 DOI: 10.1136/archdischild-2015-310310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Chris A Rees
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel M Rubalcava
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Corrie E Chumpitazi
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Abstract
Our PubMed search for peer-reviewed articles published in the 2014 solar year retrieved a significantly higher number of hits compared to 2013 with a net 28 % increase. Importantly, full articles related to autoimmunity constitute approximately 5 % of immunology articles. We confirm that our understanding of autoimmunity is becoming a translational paradigm with pathogenetic elements rapidly followed by new treatment options. Furthermore, numerous clinical and pathogenetic elements and features are shared among autoimmune diseases, and this is well illustrated in the recent literature. More specifically, the past year witnessed critical revisions of our understanding and management of antiphospholipid syndrome with new exciting data on the pathogenicity of the serum anti-beta2 glycoprotein autoantibody, a better understanding of the current and new treatments for rheumatoid arthritis, and new position papers on important clinical questions such as vaccinations in patients with autoimmune disease, comorbidities, or new classification criteria. Furthermore, data confirming the important connections between innate immunity and autoimmunity via toll-like receptors or the critical role of T regulatory cells in tolerance breakdown and autoimmunity perpetuation were also reported. Lastly, genetic and epigenetic data were provided to confirm that the mosaic of autoimmunity warrants a susceptible individual background which may be geographically determined and contribute to the geoepidemiology of diseases. The 2014 literature in the autoimmunity world should be cumulatively regarded as part of an annus mirabilis in which, on a different level, the 2014 Annual Meeting of the American College of Rheumatology in Boston was attended by over 16,000 participants with over selected 3000 abstracts.
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Affiliation(s)
- Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, via A. Manzoni 56, 20089 Rozzano, Milan, Italy. .,BIOMETRA Department, University of Milan, Milan, Italy.
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Abstract
BACKGROUND Relapsing polychondritis (RP) is an uncommon autoimmune inflammatory disease that may affect cartilage throughout the body. CASE REPORT We report on a case of fever of unknown origin in which 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed to make a diagnosis of RP. CONCLUSION Our case demonstrates that the use of 18F-FDG PET/CT is a useful diagnostic tool to accurately determine the extent of inflammation throughout the body which can be identified by an increased 18F-FDG uptake.
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Affiliation(s)
| | | | - Lin Li
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
- Correspondence: Lin Li, Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37, Guoxue xiang, Wuhou District, Chengdu, Sichuan Province 610041, China (e-mail: )
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Horváth A, Páll N, Molnár K, Kováts T, Surján G, Vicsek T, Pollner P. A nationwide study of the epidemiology of relapsing polychondritis. Clin Epidemiol 2016; 8:211-30. [PMID: 27418855 PMCID: PMC4934462 DOI: 10.2147/clep.s91439] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Relapsing polychondritis (RP) is a rare autoimmune inflammatory disease that attacks mainly cartilaginous structures or causes serious damage in proteoglycan-rich structures (the eyes, heart, blood vessels, inner ear). This study shows results regarding the epidemiology, progression, and associations of this highly variable disease by collecting all cases from a 124-million-person-year Central European nationwide cohort. METHODS We used the Hungarian Health Care Database to identify all persons with possible RP infection. We followed patients who had International Classification of Diseases 10th edition code M94.1 at least once in their inpatient or outpatient records between January 1, 2002 and December 31, 2013 in Hungary. We classified these patients into disease severity groups by their drug consumption patterns between January 1, 2010 and December 31, 2013. We analyzed the regional distribution of RP incidences as well. Overall maps of comorbidity are presented with network layouts. RESULTS We identified 256 patients with RP among cumulatively 11.5 million registered inhabitants. We classified these patients into four severity classes as "extremely mild" (n=144), "mild" (n=22), "moderate" (n=41), and "severe" (n=4). Two additional groups were defined for patients without available drug data as "suspected only" (n=23) and "confirmed but unknown treatment" (n=22). The age and sex distributions of patients were similar to worldwide statistics. Indeed, the overall survival was good (95% confidence interval for 5 years was 83.6%-92.9% and for 10 years was 75.0%-88.3% which corresponds to the overall survival of the general population in Hungary), and the associations with other autoimmune disorders were high (56%) in Hungary. Almost any disease can occur with RP; however, the symptoms of chromosomal abnormalities are only incidental. Spondylosis can be a sign of the activation of RP, while Sjögren syndrome is the most frequent autoimmune association. Regional distribution of incidences suggests arsenic drinking water and sunlight exposure as possible triggering factors. CONCLUSION The good survival rate of RP in Hungary is probably associated with the early diagnosis of the disease.
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Affiliation(s)
- Anna Horváth
- 3rd Department of Internal Medicine, Semmelweis University
| | - Nóra Páll
- Regional Science Center, Faculty of Science, Eötvös Loránd University
| | - Katalin Molnár
- 3rd Department of Internal Medicine, Semmelweis University
| | | | | | - Tamás Vicsek
- MTA-ELTE Statistical and Biological Physics Research Group; Department of Biological Physics, Eötvös Loránd University Budapest, Hungary
| | - Péter Pollner
- Regional Science Center, Faculty of Science, Eötvös Loránd University; MTA-ELTE Statistical and Biological Physics Research Group
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40
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Shroff GS, Ocazionez D, Vargas D, Carter BW, Wu CC, Nachiappan AC, Gupta P, Restrepo CS. Pathology of the Trachea and Central Bronchi. Semin Ultrasound CT MR 2016; 37:177-89. [DOI: 10.1053/j.sult.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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41
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Selvi F, Messina J, Faquin WC, Keith DA. Relapsing Polychondritis Concomitant With Synovial Chondromatosis of the Temporomandibular Joint. J Oral Maxillofac Surg 2016; 74:2207-2215. [PMID: 27292528 DOI: 10.1016/j.joms.2016.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 02/07/2023]
Abstract
Relapsing polychondritis (RP) is a rare, multisystem autoimmune disease characterized by inflammation, structural damage, and impaired function of cartilaginous tissues throughout the body. In the craniofacial region, this rare disease has been reported to affect structures of the ear and nose; however, reports of temporomandibular joint (TMJ) involvement are scarce. A second uncommon disorder of cartilage is synovial chondromatosis (SC), a progressive and proliferative disorder of the synovial membrane associated with the formation of variably sized cartilaginous and calcified loose bodies, often causing dysfunction of the joints and enlargement of the joint capsule. It commonly affects the larger joints; TMJ involvement is uncommon. We present the case of a 45-year-old woman with previously diagnosed RP in whom right TMJ pathology subsequently developed, undergoing arthroscopy and biopsy followed by arthroplasty, which was proved to be SC, likely due to her autoimmune disease. To our knowledge, this is the first case describing concomitant SC of the TMJ presumably from pre-existing RP.
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Affiliation(s)
- Firat Selvi
- Chief Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA; Associate Professor of Oral Surgery, Department of Oral Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Justin Messina
- Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - William C Faquin
- Associate Professor of Pathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David A Keith
- Clinical Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine; Attending Oral and Maxillofacial Surgeon, Massachusetts General Hospital, Boston, MA.
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A Case of Relapsing Polychondritis Initiating with Unexplained Fever. Case Rep Med 2016; 2016:9462489. [PMID: 26981127 PMCID: PMC4769741 DOI: 10.1155/2016/9462489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare autoimmune disease affecting the multiple organ system. Here, we describe a case of RP initially presenting with high fever. The patient was referred to our hospital for further examination of fever of unknown origin (FUO). On admission, the patient reported dry cough in addition to fever. On physical examination, her red, swollen ears were noted, attributed on histology to inflammation with auricular perichondritis. She was diagnosed with RP and treated with oral prednisone (50 mg/day); her fever and auricular inflammation resolved. The patient no longer reported cough and body temperature returned to normal and the elevated levels of C-reactive protein (CRP) were normalized. In this case, identification of the origin of fever was a challenge because of unspecific symptoms; however, awareness of the systemic manifestations of RP may lead to the prompt diagnosis and therapeutic intervention.
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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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Drott U, Huberman A. [Relapsing polychondritis : A rare differential diagnosis in clinical practice]. Z Rheumatol 2016; 74:329-39. [PMID: 25962454 DOI: 10.1007/s00393-014-1499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Relapsing polychondritis (RPC) is a chronic immune-mediated inflammatory, systemic disease primarily leading to structural damage and impaired function of cartilage tissue. However, the systemic inflammatory process in RPC can also affect sensory organ structures, the respiratory tract, the nervous and cardiovascular systems as well as the kidneys. The immune-mediated disease leads to recurrent inflammatory attacks causing a progressive degradation of elastic and hyaline cartilage structures, especially in the ears, nose, larynx, trachea and diarthrodial joints. However, other connective tissue structures in the eye and the heart valves may also be involved. The RPC is regarded as an orphan disease as the number of reported cases has so far remained confined to approximately 600 worldwide. The rarity of the disease has limited systematic clinical studies and the available empirical data are exclusively derived from casuistic studies or evaluation of small case series. The therapeutic interventions depend on the extent and localization of the disease manifestation. Thus, nonsteroidal anti-inflammatory drugs (NSAID), glucocorticoids and immunosuppressive agents with conventional synthetic disease-modifying antirheumatic drugs (DMARD) have been demonstrated to be beneficial. More severe and refractory diseases may require a targeted pharmacological intervention with biologic DMARDs.
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Affiliation(s)
- U Drott
- Zentrum für Innere Medizin II, Rheumatologie, Johann Wolfgang Goethe-Universität, Theodor-Stern Kai 7, 60590, Frankfurt, Deutschland,
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45
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Abstract
This review covers the histopathology and pathogenesis of non-infectious inflammatory diseases of the sinonasal tract, in particular, sarcoidosis, granulomatous vasculitides Wegener, Churg-Strauss), relapsing polychondritis, eosinophilic angiocentric fibrosis, chronic rhinosinusitis and nasal perforations. Molecular associations and mechanisms are emphasised to assist pathologists to put their observations into the context of clinical, genetic and environmental influences on patients' diseases.
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46
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Relapsing Polychondritis: an Update on Pathogenesis, Clinical Features, Diagnostic Tools, and Therapeutic Perspectives. Curr Rheumatol Rep 2015; 18:3. [PMID: 26711694 DOI: 10.1007/s11926-015-0549-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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48
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Coiffard B, Laroumagne S, Plojoux J, Astoul P, Dutau H. [Diffuse and circumferential expiratory collapse]. Rev Mal Respir 2015; 32:296-300. [PMID: 25847209 DOI: 10.1016/j.rmr.2014.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- B Coiffard
- Oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, CHU Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 20, France
| | - S Laroumagne
- Oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, CHU Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 20, France
| | - J Plojoux
- Oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, CHU Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 20, France
| | - P Astoul
- Oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, CHU Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 20, France; Aix-Marseille université, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France
| | - H Dutau
- Oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, CHU Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13915 Marseille cedex 20, France.
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Abstract
A 48-year-old man with progressive respiratory symptoms was suspected of having relapsing polychondritis (RPC). A 99mTc-MDP bone scintigraphy showed only mild activity in the bilateral costal cartilage. In contrast, 18F-fluoride PET/CT revealed intense radioactivity accumulation in the tracheal cartilages. Biopsy results from tracheal cartilage were consistent with a diagnosis of RPC. The patient received therapy toward RPC, and his symptoms was gradually alleviated.
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Affiliation(s)
- Wei Zhang
- From the Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Nara M, Komatsuda A, Togashi M, Wakui H. Relapsing polychondritis with encephalitis: a case report and literature review. Intern Med 2015; 54:231-4. [PMID: 25743018 DOI: 10.2169/internalmedicine.54.3568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 39-year-old man who developed bilateral auricular chondritis, conjunctivitis, and central neurological symptoms. He was diagnosed with encephalitis associated with relapsing polychondritis (RP) based on the findings of an ear cartilage biopsy, cerebrospinal fluid examination and magnetic resonance imaging. Although oral prednisolone (60 mg/day) was administered, the initial steroid therapy did not improve his symptoms. In contrast, methylprednisolone (mPSL) pulse therapy followed by prednisolone gradually ameliorated his condition. There were no episodes of recurrence during the two-year follow-up period. A review of the literature revealed that meningoencephalitis and encephalitis are rare, but important, complications of RP responsive to mPSL pulse therapy.
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Affiliation(s)
- Mizuho Nara
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
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