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Grandière L, Gille T, Brillet PY, Didier M, Freynet O, Vicaire H, Clero D, Martinod E, Mathian A, Uzunhan Y. [Tracheobronchial involvement in relapsing polychondritis and differential diagnoses]. Rev Mal Respir 2024; 41:421-438. [PMID: 38762394 DOI: 10.1016/j.rmr.2024.03.009] [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: 01/17/2024] [Accepted: 03/22/2024] [Indexed: 05/20/2024]
Abstract
Relapsing polychondritis is a systemic auto-immune disease that mainly affects cartilage structures, progressing through inflammatory flare-ups between phases of remission and ultimately leading to deformation of the cartilages involved. In addition to characteristic damage of auricular or nasal cartilage, tracheobronchial and cardiac involvement are particularly severe, and can seriously alter the prognosis. Tracheobronchial lesions are assessed by means of a multimodal approach, including dynamic thoracic imaging, measurement of pulmonary function (with recent emphasis on pulse oscillometry), and mapping of tracheal lesions through flexible bronchoscopy. Diagnosis can be difficult in the absence of specific diagnostic tools, especially as there may exist a large number of differential diagnoses, particularly as regards inflammatory diseases. The prognosis has improved, due largely to upgraded interventional bronchoscopy techniques and the development of immunosuppressant drugs and targeted therapies, offering patients a number of treatment options.
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Affiliation(s)
- L Grandière
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - T Gille
- Service de physiologie-explorations fonctionnelles, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France; Inserm UMR 1272 hypoxie et poumon, UFR SMBH Léonard de Vinci, université Sorbonne Paris Nord, 125, rue de Stalingrad, 93000 Bobigny, France
| | - P-Y Brillet
- Service de radiologie, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - M Didier
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - O Freynet
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - H Vicaire
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France
| | - D Clero
- Service d'oto-rhino-laryngologie, hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris - Sorbonne université, Paris 13(e), France
| | - E Martinod
- Service de chirurgie thoracique et vasculaire, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France; Inserm UMR 1272 hypoxie et poumon, UFR SMBH Léonard de Vinci, université Sorbonne Paris Nord, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Mathian
- Centre de référence pour le lupus, le syndrome des anti-phospholipides et autres maladies auto-immunes rares, service de médecine interne 2, Institut E3M, Assistance publique-Hôpitaux de Paris (AP-HP), groupement hospitalier Pitié-Salpêtrière, Paris, France
| | - Y Uzunhan
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Avicenne, Assistance publique-Hôpitaux de Paris - Hôpitaux universitaires de Paris Seine-Saint-Denis, Bobigny, France; Inserm UMR 1272 hypoxie et poumon, UFR SMBH Léonard de Vinci, université Sorbonne Paris Nord, 125, rue de Stalingrad, 93000 Bobigny, France.
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Bica BERG, de Souza AWS, Pereira IA. Unveiling the clinical spectrum of relapsing polychondritis: insights into its pathogenesis, novel monogenic causes, and therapeutic strategies. Adv Rheumatol 2024; 64:29. [PMID: 38627861 DOI: 10.1186/s42358-024-00365-z] [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: 03/01/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Relapsing polychondritis is a rare multisystem disease involving cartilaginous and proteoglycan-rich structures. The diagnosis of this disease is mainly suggested by the presence of flares of inflammation of the cartilage, particularly in the ears, nose or respiratory tract, and more rarely, in the presence of other manifestations. The spectrum of clinical presentations may vary from intermittent episodes of painful and often disfiguring auricular and nasal chondritis to an occasional organ or even life-threatening manifestations such as lower airway collapse. There is a lack of awareness about this disease is mainly due to its rarity. In 2020, VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, a novel autoinflammatory syndrome, was described. VEXAS syndrome is attributed to somatic mutations in methionine-41 of UBA1, the major E1 enzyme that initiates ubiquitylation. This new disease entity connects seemingly unrelated conditions: systemic inflammatory syndromes (relapsing chondritis, Sweet's syndrome, and neutrophilic dermatosis) and hematologic disorders (myelodysplastic syndrome or multiple myeloma). Therefore, this article reviews the current literature on both disease entities.
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Affiliation(s)
- Blanca E R G Bica
- Reumatology Division of Hospital Universitário Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro, Rua Esteves Junior 62, CEP 22231-160, Laranjeiras, Rio de Janeiro, RJ, Brazil.
| | | | - Ivânio Alves Pereira
- Reumatologia da Universidade do Sul de Santa Catarina-UNISUL, Florian?polis, RJ, Brazil
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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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Kojima S, Matsumoto S, Koito Y, Miura T, Sekine M, Uehara T, Asano T, Yamaguchi Y, Mashima H. Successful Response to Golimumab in a Case of Relapsing Polychondritis Overlapping with Ulcerative Colitis. Biologics 2024; 18:1-6. [PMID: 38235068 PMCID: PMC10790666 DOI: 10.2147/btt.s436301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
A 51-year-old Japanese man was diagnosed with left-sided ulcerative colitis (UC) at age 41. He was treated with mesalazine and azathioprine and maintained remission. At age 51, the patient developed bloody stools, abdominal pain, scleritis, arthritis, cough, bloody sputum, and pericardial effusion. Considering that pericardial effusion is an atypical extraintestinal complication of UC, and the patient met the diagnostic criteria for relapsing polychondritis (RP), a diagnosis of RP complicating a relapse of UC was made. Steroid therapy was administered, and both diseases improved. Golimumab, an anti-tumor necrosis factor-α inhibitor, was introduced as maintenance therapy for UC. All symptoms, including pericardial effusion, improved. Subsequently, no relapse of UC or RP was observed. As only a few cases of RP overlapping with UC have been reported and no treatment protocol has been established, we considered this case valuable and worthy of publication.
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Affiliation(s)
- Shu Kojima
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yudai Koito
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takaya Miura
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masanari Sekine
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takeshi Uehara
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takeharu Asano
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yasuhiro Yamaguchi
- Department of Respiratory Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Sangle SR, Hughes CD, Barry L, Qureshi S, Cheah CK, Poh YJ, D'Cruz DP. Relapsing polychondritis - A single Centre study in the United Kingdom. Autoimmun Rev 2023; 22:103352. [PMID: 37146927 DOI: 10.1016/j.autrev.2023.103352] [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: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES Relapsing Polychondritis (RP) is a rare immune mediated inflammatory disorder that may result in damage and destruction of cartilaginous tissues. PATIENTS AND METHODS We retrospectively analysed patients with a clinical diagnosis of RP. Patients were investigated using pulmonary function tests, dynamic high-resolution CT scans, bronchoscopy, laryngoscopy and/or PET-CT scans along with autoimmune serology. Patients had other specialist reviews when indicated. RESULTS We identified 68 patients with a diagnosis of RP, 55 (81%) were Caucasian, 8 (12%) Afro Caribbean, 4 (6%) Asian and 1 patient had Mixed Ethnicity. Twenty-nine (43%) had pulmonary involvement and in 16, pulmonary involvement was the initial presentation. The mean age at onset was 44 years (range 17-74). There was a mean diagnostic delay of 55 weeks. 66 (97%) patients received a combination of oral Prednisolone and disease modifying anti-rheumatic drugs. Twelve of 19 (63%) received biologics, with an initial good response, and 10 remain on treatment. 11 patients with respiratory collapse required CPAP to maintain airway patency. Twelve (18%) patients died due to RP and 9 had respiratory complications. Two patients developed myelodysplasia and one had lung carcinoma. In a multivariate regression analysis, the prognostic variables were ethnicity, nasal chondritis, laryngotracheal stricture and elevated serum creatinine. CONCLUSION RP is a rare autoimmune condition often associated with significant delays in diagnosis and initiation of treatment. Pulmonary involvement in RP may cause significant morbidity and mortality due to organ damage. Disease modifying anti rheumatic drugs and biologics should be considered early in the disease course to minimise adverse effects of long-term corticosteroid therapy and organ damage.
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Affiliation(s)
- Shirish R Sangle
- The Louise Coote Lupus Unit, 4th Floor, Tower Wing, Guy's Hospital, Guy's and St Thomas' and King's College Medical School, London SE1 9RT, UK
| | - Catherine D Hughes
- The Louise Coote Lupus Unit, 4th Floor, Tower Wing, Guy's Hospital, Guy's and St Thomas' and King's College Medical School, London SE1 9RT, UK
| | - Lucinda Barry
- The Louise Coote Lupus Unit, 4th Floor, Tower Wing, Guy's Hospital, Guy's and St Thomas' and King's College Medical School, London SE1 9RT, UK
| | - Sumera Qureshi
- The Louise Coote Lupus Unit, 4th Floor, Tower Wing, Guy's Hospital, Guy's and St Thomas' and King's College Medical School, London SE1 9RT, UK
| | - Chee Ken Cheah
- The Louise Coote Lupus Unit, 4th Floor, Tower Wing, Guy's Hospital, Guy's and St Thomas' and King's College Medical School, London SE1 9RT, UK
| | - Yih Jia Poh
- The Louise Coote Lupus Unit, 4th Floor, Tower Wing, Guy's Hospital, Guy's and St Thomas' and King's College Medical School, London SE1 9RT, UK
| | - David P D'Cruz
- The Louise Coote Lupus Unit, 4th Floor, Tower Wing, Guy's Hospital, Guy's and St Thomas' and King's College Medical School, London SE1 9RT, UK. david.d'
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Mertz P, Sparks J, Kobrin D, Ogbonnaya SA, Sevim E, Michet C, Arnaud L, Ferrada M. Relapsing polychondritis: Best Practice & Clinical Rheumatology. Best Pract Res Clin Rheumatol 2023; 37:101867. [PMID: 37839908 DOI: 10.1016/j.berh.2023.101867] [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: 05/18/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 10/17/2023]
Abstract
Relapsing polychondritis (RP) is an uncommon inflammatory disorder that predominantly targets cartilaginous structures. The disease frequently affects the nose, ears, airways, and joints, but it can also impact organs that aren't primarily cartilage-based, such as blood vessels, skin, inner ear, and eyes. Given its infrequent occurrence and recurrent symptoms, patients often experience delays in proper diagnosis. Lately, based on the organs involved, the disease's diverse manifestations have been categorized into specific clinical groups, based on the most likely organ involvement including auricular, nasal, pulmonary, and musculoskeletal. More recently the discovery of a new disease, called (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) VEXAS syndrome, due to mutations in UBA1 gene, identified the cause of 8 % of the patients with a clinical diagnosis of RP. VEXAS is likely the cause of a previously described "hematologic subgroup" in RP. This discovery is proof of concept that RP is likely more than one disease (Beck et al., Dec 31 2020; Ferrada et al., 2021). People diagnosed with RP face numerous hurdles, with the quality of their lives and overall prognosis being affected. Diagnosing the condition is particularly challenging due to its fluctuating symptoms, the absence of specific markers, and the lack of universally recognized classification criteria. For a correct diagnosis, it's imperative for healthcare professionals to identify its unique clinical patterns. Moreover, there are no approved metrics to gauge the disease's severity, complicating patient management. This review seeks to equip clinicians with pertinent insights to better diagnose and attend to these complex patients.
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Affiliation(s)
- Phillip Mertz
- Hôpitaux Universitaires de Strasbourg, Centre National de Référence RESO-Lupus, 67000 Strasbourg, France
| | - Joshua Sparks
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | - Dale Kobrin
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Sandra Amara Ogbonnaya
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Ecem Sevim
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Clement Michet
- Mayo Clinic School of Medicine, Division of Rheumatology, USA
| | - Laurent Arnaud
- Hôpitaux Universitaires de Strasbourg, Centre National de Référence RESO-Lupus, 67000 Strasbourg, France
| | - Marcela Ferrada
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA.
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Denisov LN, Vinogradova IB, Bakhtina LA. Recurrent polychondritis: a review of the literature and a clinical case description. MODERN RHEUMATOLOGY JOURNAL 2023. [DOI: 10.14412/1996-7012-2023-1-83-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Relapsing polychondritis (RPC) is a rare disease, its diagnosis presents certain difficulties. This is due to the absence of characteristic clinical manifestations at the initial stages of the disease, late diagnosis and difficulties in selecting adequate therapy.The article presents a review of the literature on the diagnosis and treatment of RPC, as well as a clinical case with tracheobronchial tree and other organ systems involvement in the absence of classical auricular involvement.
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Muacevic A, Adler JR, Jha P, Paudel HR. Relapsing Polychondritis in a Patient With Auricular Chondritis and Inflammatory Bowel Disease: A Case Report With Literature Review. Cureus 2022; 14:e31738. [PMID: 36569669 PMCID: PMC9770012 DOI: 10.7759/cureus.31738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
Relapsing polychondritis (RP) most commonly presents as inflammation and degeneration of cartilaginous tissue in the auricles, nasal septum, and lungs (in severe instances). RP is a rare autoimmune condition associated with other autoimmune diseases in 30% of cases. The prevalence of gastrointestinal involvement with RP is tenuous; however, there is a growing collection of case studies associating auricular chondritis with concomitant inflammatory bowel disease (IBD), including both ulcerative colitis and Crohn's disease. We report the case of a 35-year-old patient presenting with autoimmune pancreatitis, with a past medical history of Crohn's disease, primary sclerosing cholangitis (PSC), and suspected RP. Although RP is rare, the disease's multiple clinical presentations and recurrent episodic nature can cause significant diagnostic delays and are often overlooked by physicians. Thus, low disease prevalence may be due to under-recognition and under-reporting of disease symptoms. As RP is a clinical diagnosis, increased awareness of the disease presentation and clinical characteristics may increase disease recognition and improve treatment outcomes.
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Tocilizumab in Recalcitrant Bilateral Scleritis in a Case of Relapsing Polychondritis: A 17-year Follow Up. Ocul Immunol Inflamm 2022; 31:870-873. [PMID: 35695904 DOI: 10.1080/09273948.2022.2058555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report a challenging case of relapsing polychondritis with bilateral diffuse scleritis, with 17-year follow-up. METHODS Case report. RESULTS A 36-year-old female presented 17 years ago with bilateral diffuse scleritis and peripheral corneal infiltrates. Detailed systemic work-up was negative. Fourteen months later, she developed saddle nose deformity, debilitating myalgias, and severe recurrence of scleritis clinching the diagnosis of relapsing polychondritis. Despite high-dose oral corticosteroids, oral immunosuppressants, and cyclophosphamide infusions and adalimumab infusions, the condition showed waxing and waning over the next decade. In 2017, she was started on Tocilizumab injections after which both the systemic and ocular conditions stabilised and has been remained stable for the past 4 years. CONCLUSION Relapsing polychondritis has a well-known association with scleritis. The ocular disease may precede systemic symptoms in some cases. Newer agent such as tocilizumab appears to be effective in controlling this relentless and recurrent disease.
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Padoan R, Campaniello D, Iorio L, Doria A, Schiavon F. Biologic therapy in relapsing polychondritis: navigating between options. Expert Opin Biol Ther 2022; 22:661-671. [PMID: 35230215 DOI: 10.1080/14712598.2022.2048647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Relapsing polychondritis (RP) is a rare systemic inflammatory disease of unknown etiology, primarily affecting cartilaginous tissue and proteoglycan-rich structures. Clinical manifestations vary from mild symptoms to occasional organ or life-threatening complications. Treatment can be challenging and is mostly based on experience or case reports/series. AREAS COVERED There is growing literature investigating the role of biologics in the management of RP. TNFα antagonists, abatacept, tocilizumab, rituximab, anakinra and tofacitinib have been prescribed in several RP patients, mainly as second-line treatment, after conventional immunosuppressive agents' failure. EXPERT OPINION : Glucocorticoids represent the gold standard treatment of RP. Conventional immunosuppressants should be administered in refractory patients or when a glucocorticoid-sparing effect is needed. Biologic therapy should be used after failure of conventional treatments or in severe manifestations. TNFα inhibitors are the most prescribed biologic agent, with partial or complete response in several cases; but loss of efficacy may occur over time. Infliximab and adalimumab should be preferred among TNFα antagonists. Abatacept and tocilizumab proved to be effective as second-line biologic agents, but frequent infections are reported with the former. Data on anakinra and rituximab are controversial, therefore they are not recommended as first-line biologic drugs. The use of JAK inhibitors is still anecdotal.
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Affiliation(s)
- Roberto Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Debora Campaniello
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Luca Iorio
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Franco Schiavon
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
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Nationwide cross-sectional survey of patients with relapsing polychondritis in 2019 demonstrates reduction of airway involvement compared with that in 2009. Sci Rep 2022; 12:465. [PMID: 35013504 PMCID: PMC8748451 DOI: 10.1038/s41598-021-04493-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/16/2021] [Indexed: 01/29/2023] Open
Abstract
We conducted retrospective cohort studies of patients with relapsing polychondritis (RP) twice in 2009 and 2019, using a physician questionnaire. We compared the patients’ clinical statuses between the years. Age and gender were comparable between the two surveys. Mean disease duration was longer in 2019 survey (8.3 years) than that in 2009 survey (4.8 years, P < 0.001). The mortality rate declined in 2019 survey compared with those in 2009 survey (from 9.2 to 1.6%, P < 0.001). Incidence of airway involvement decreased in 2019 survey compared with that in 2009 survey (from 49 to 37%, P = 0.012). In 2019 survey, we found more frequent use of biological agents and immunosuppressants in patients with airway involvement. When we focused on RP patients with airway involvement, physicians in 2019 chose methotrexate and calcineurin inhibitors preferentially, compared with azathioprine and cyclophosphamide. Of note is that increased use of infliximab was observed in RP patients with airway involvement, but not in those without. Reduction of airway involvement and mortality in patients with RP was observed in 2019 survey. The reduction may associate with the frequent use of biologics including infliximab in RP patients with airway involvement.
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12
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Coexistence of Relapsing Polychondritis and Sickle Cell Disease in a Child. Case Rep Rheumatol 2021; 2021:3600451. [PMID: 34868694 PMCID: PMC8635928 DOI: 10.1155/2021/3600451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare, severe connective tissue disease of unknown etiology affecting cartilaginous and proteoglycan-rich structures in an episodic and inflammatory manner. Approximately a third of RP cases occur in conjunction with another disease usually systemic autoimmune rheumatic disease, or myelodysplastic syndrome. Sickle cell disease (SCD) is a common inherited hematologic condition characterized by the inheritance of two abnormal hemoglobins, of which one is a hemoglobin S, presenting with severe acute and chronic complications from vaso-occlusive phenomena, which can be difficult to differentiate from RP. The pathogenesis of RP is poorly understood but suggests an autoimmune mechanism with a link to sickle cell disease yet to be established. Treatment is empiric with steroids, anti-inflammatory, and disease-modifying antirheumatic drugs being the mainstay of therapy. Severe complications occur despite treatment, with respiratory involvement being the most catastrophic. This case report reviews a complex case of RP in an 11-year-old girl with sickle cell disease (SF genotype) presenting with bilateral red painful eyes, a painful swollen left ear, and knee pain. Laboratory findings revealed elevated inflammatory markers with negative immune serology. A diagnosis of RP was made based on the patient's symptomatology, presentation, and fulfillment of 5 out of the 6 clinical features using McAdam's criteria. Management was instituted with a myriad of conventional and biologic DMARDs and other anti-inflammatory medications with no significant improvement and the development of complications of airway obstruction from disease activity and osteoporotic fracture from steroid therapy and underlying hemoglobinopathy. In children, the diagnosis of RP is delayed or overlooked due to its low incidence, variability in clinical symptoms, or sharing similar clinical features with other coexisting disease entities. This article reports its occurrence in the pediatric population and highlights the difficulty in managing such cases as there are no defined standard treatment protocols.
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13
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Fukuda K, Mizobuchi T, Nakajima I, Kishimoto T, Miura Y, Taniguchi Y. Ocular Involvement in Relapsing Polychondritis. J Clin Med 2021; 10:jcm10214970. [PMID: 34768492 PMCID: PMC8584789 DOI: 10.3390/jcm10214970] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 01/17/2023] Open
Abstract
Relapsing polychondritis (RPC) is a rare systemic immune-mediated disease characterized by recurrent inflammation of cartilaginous and proteoglycan-rich tissues throughout the body. Auricular, nasal, tracheal, and articular chondritis and arthritis are common systemic symptoms in patients with RPC. Ocular tissues are also targets of inflammation in RPC, and a variety of ocular symptoms are observed in approximately half of the patients with RPC. Scleritis/episcleritis, uveitis, and conjunctivitis are common symptoms associated with RPC. Less frequently, keratitis, retinopathy, optic neuropathy, muscle palsy, and orbital inflammation are also observed. Ocular inflammation could also be the first manifestation of RPC. Although RPC is a potentially fatal and sight-threatening disease, the rarity of the disease and its protean clinical presentation may lead to delayed diagnosis or misdiagnosis. Given the high prevalence of ocular involvement in RPC, to avoid misdiagnosis, physicians should be suspicious of RPC when they see patients with recurrent ocular inflammatory conditions and various systemic symptoms. In this article, we provide a comprehensive review of ocular manifestations associated with RPC.
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Affiliation(s)
- Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
- Correspondence: ; Tel.: +81-88880-2391
| | - Tomoka Mizobuchi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
| | - Isana Nakajima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
| | - Tatsuma Kishimoto
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
| | - Yusaku Miura
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan; (T.M.); (I.N.); (T.K.); (Y.M.)
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi University, Nankoku, Kochi 783-8505, Japan;
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14
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Contreras D, Dhillon N, Sharma R, Bali V, Katayon S, Quynh B, Heidari A. When You "Can't See" a Case of Relapsing Polychondritis. J Investig Med High Impact Case Rep 2021; 9:23247096211052175. [PMID: 34663132 PMCID: PMC8529316 DOI: 10.1177/23247096211052175] [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] [Indexed: 11/21/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare and, if not treated, potentially lethal
autoimmune disorder. Involvement of central nervous system (CNS) in RP is rare
and, when present, makes it extremely difficult to diagnose. In this report, we
present a case of a 22-year-old Hispanic woman who presented with sudden onset
of headache and blurred vision. Magnetic resonance imaging (MRI) of her brain
and orbit showed leptomeningeal enhancements in addition to asymmetrical
thickening and enhancement of globes. Her lumbar puncture was consistent with
aseptic meningitis picture, and she was placed on empirical treatment for
presumptive CNS tuberculosis. Her vision deteriorated, and she was diagnosed
with RP with CNS and ocular involvement and placed on high-dose steroids with
dramatic rapid response. She has been on immunosuppressive treatment, including
Sulfasalazine and Methotrexate, since then and her disease has been under
control with decreased need for ophthalmic steroid drops. There have been only
19 previous cases found in literature reporting an association of RP with CNS
involvement.
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Affiliation(s)
| | - Navpreet Dhillon
- Kern Medical, Bakersfield, CA, USA.,Valley Fever Institute at Kern Medical, Bakersfield, CA, USA
| | - Rupam Sharma
- Kern Medical, Bakersfield, CA, USA.,Valley Fever Institute at Kern Medical, Bakersfield, CA, USA
| | | | | | | | - Arash Heidari
- Kern Medical, Bakersfield, CA, USA.,Valley Fever Institute at Kern Medical, Bakersfield, CA, USA
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15
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Jung HI, Kim HJ, Kim JM, Lee JY, Park KS, Cho KB, Lee YJ. Co-existence of relapsing polychondritis and Crohn disease treated successfully with infliximab. Yeungnam Univ J Med 2020; 38:70-73. [PMID: 32668525 PMCID: PMC7787902 DOI: 10.12701/yujm.2020.00304] [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: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 11/04/2022] Open
Abstract
Relapsing polychondritis (RP) is a rare, progressive immune-mediated systemic inflammatory disease of unknown etiology, characterized by recurrent inflammation of cartilaginous structures. Approximately 30% of RP cases are associated with other autoimmune diseases. However, the co-occurrence of RP and Crohn disease (CD) has rarely been reported. Herein, we present a 35-year-old woman diagnosed with RP and CD, who was refractory to initial conventional medications, including azathioprine and glucocorticoid, but who subsequently responded to infliximab (IFX). For both diseases, remission was sustained with IFX. There has been no previous report regarding the successful treatment of co-existing RP and CD with IFX.
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Affiliation(s)
- Hye-In Jung
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun Jung Kim
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Ji-Min Kim
- Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Ju Yup Lee
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Sik Park
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kwang Bum Cho
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yoo Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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16
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Farhat R, Clavel G, Villeneuve D, Abdelmassih Y, Sahyoun M, Gabison E, Sené T, Cochereau I, Titah C. Sustained Remission with Tocilizumab in Refractory Relapsing Polychondritis with Ocular Involvement: A Case Series. Ocul Immunol Inflamm 2020; 29:9-13. [PMID: 32643976 DOI: 10.1080/09273948.2020.1763405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: Describe our experience with tocilizumab in the treatment of refractory relapsing polychondritis with ocular involvement.Methods: Retrospective consecutive interventional case series that included all patients that received tocilizumab for the treatment of relapsing polychondritis with ocular manifestations.Results: Three cases were selected and the duration of tocilizumab treatment ranged from 1 to 2 years. One of our patients received tocilizumab as a first-line immunosuppressive treatment directly after prednisone. All achieved complete response to tocilizumab 1 month after treatment initiation. No advert events were reported during the follow-up period except for transient neutropenia without any associated infection.Conclusion: Our three cases suggest that tocilizumab may be an effective and safe treatment for ocular manifestation associated with relapsing polychondritis.
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Affiliation(s)
- Rebecca Farhat
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France.,Ophthalmology Department, Cochin Hospital, Paris, France
| | - Gaël Clavel
- Internal Medicine Department, Rothschild Foundation Hospital, Paris, France
| | | | | | - Marwan Sahyoun
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Eric Gabison
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Thomas Sené
- Internal Medicine Department, Rothschild Foundation Hospital, Paris, France
| | | | - Cherif Titah
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
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17
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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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18
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de Montmollin N, Dusser D, Lorut C, Dion J, Costedoat-Chalumeau N, Mouthon L, Chassagnon G, Revel MP, Puéchal X. Tracheobronchial involvement of relapsing polychondritis. Autoimmun Rev 2019; 18:102353. [DOI: 10.1016/j.autrev.2019.102353] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 12/18/2022]
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19
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Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment. J Immunol Res 2018; 2018:5072582. [PMID: 30356417 PMCID: PMC6178164 DOI: 10.1155/2018/5072582] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochleovestibular involvement, focusing on the clinical presentation, diagnosis, and treatment of immune-mediated inner ear diseases including autoimmune inner ear disease (AIED), Meniere's disease, and bilateral vestibulopathy, as well as of systemic autoimmune diseases with audiovestibular disorders, namely, Behçet's disease, Cogan's syndrome, sarcoidosis, autoimmune thyroid disease, Vogt-Koyanagi-Harada syndrome, relapsing polychondritis, systemic lupus erythematosus, antiphospholipid syndrome, IgG4-related disease, and ANCA-associated vasculitides.
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Affiliation(s)
- Laura Girasoli
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Diego Cazzador
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Padoan
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Ennio Nardello
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mara Felicetti
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Franco Schiavon
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Bovo
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
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20
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Kingdon J, Roscamp J, Sangle S, D'Cruz D. Relapsing polychondritis: a clinical review for rheumatologists. Rheumatology (Oxford) 2018; 57:1525-1532. [PMID: 29126262 DOI: 10.1093/rheumatology/kex406] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Indexed: 12/19/2022] Open
Abstract
Relapsing polychondritis (RPC) is a rare autoimmune rheumatic disorder that is traditionally classified as a systemic vasculitis. It is characterized by inflammation of cartilage, and typical presenting features include chondritis of the nasal bridge, auricular chondritis, ocular inflammation and involvement of the bronchial tree. Its rarity often leads to considerable delay in establishing a diagnosis and poses a significant management challenge to clinicians, as no conventional guidelines exist. This review summarizes the clinical features of RPC and provides guidance for rheumatologists on making the diagnosis and assessing organ involvement. The current state of RPC management is reviewed, with a focus on the use of the anti-TNF-α agents in patients with pulmonary involvement, the leading cause of mortality and morbidity in RPC.
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Affiliation(s)
- Jack Kingdon
- School of Medical Education, King's College London, UK
| | | | | | - David D'Cruz
- Louise Coote Lupus Unit, Guy's Hospital, London, UK
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21
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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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22
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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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23
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Relapsing Polychondritis following Treatment with Secukinumab for Ankylosing Spondylitis: Case Report and Review of the Literature. Case Rep Rheumatol 2018; 2018:6760806. [PMID: 30057845 PMCID: PMC6051248 DOI: 10.1155/2018/6760806] [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: 03/23/2018] [Accepted: 06/19/2018] [Indexed: 01/21/2023] Open
Abstract
Relapsing polychondritis (RP) is an autoimmune disorder that often occurs concomitantly with other autoimmune diseases, though RP has been infrequently associated with ankylosing spondylitis (AS). There is a small, but growing, body of the literature demonstrating case reports describing RP secondary to AS in patients treated with tumor necrosis alpha inhibitors (TNFi's). We present the first case in which RP developed in AS while treated with an interleukin 17A inhibitor (IL-17Ai), secukinumab. With this case report, we hope to raise physician awareness of the possible autoimmune disorders that may arise subsequent to novel immunomodulation therapies, particularly that RP may develop subsequent to inhibition of IL-17A.
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24
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Dion J, Leroux G, Mouthon L, Piette JC, Costedoat-Chalumeau N. Polychondrite atrophiante : actualités en 2017. Rev Med Interne 2018; 39:400-407. [DOI: 10.1016/j.revmed.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/25/2017] [Indexed: 01/16/2023]
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25
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Abstract
Relapsing polychondritis is a severe systemic immune-mediated disease characterized by an episodic and progressive inflammatory condition with progressive destruction of cartilaginous structures. This disease has for nearly a century kept secrets not yet explained. The real incidence and prevalence of this rare disease are unknown. The multiple clinical presentations and episodic nature of relapsing polychondritis cause a significant diagnosis delay. No guidelines for the management of patients with relapsing polychondritis have been validated to date. The challenges remain, both in the understanding of its pathophysiology and diagnosis, evaluation of its activity and prognosis, and its treatment. Possible solutions involve the sharing of data for relapsing polychondritis from worldwide reference centers. Thus, we would be able to evolve toward a better knowledge of its pathophysiology, the publication of new diagnosis criteria, which will include biological markers and imaging findings, the prediction of life-threatening or organ-threatening situations, and the publication of therapeutic evidence-based guidelines after performing at randomized controlled trials.
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Affiliation(s)
- Fernando Kemta Lekpa
- Faculty of Health Sciences, University of Buea, Buea.,Reheumatology Unit, Internal Medicine Department, General Hospital, Douala, Cameroon
| | - Xavier Chevalier
- Department of Rheumatology, Henri Mondor Hospital, University Paris 12, Créteil, France
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26
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Cuestas D, Peñaranda E, Mora S, Cortes C, Galvis I, Patiño M, Velasquez O. Relapsing polychondritis, an underestimated dermatological urgency: case report and literature review. Int J Dermatol 2017; 56:1379-1386. [PMID: 28994110 DOI: 10.1111/ijd.13755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/16/2017] [Accepted: 08/16/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Relapsing polychondritis is an autoimmune multisystemic disease with primary chondral involvement. Its high mortality and morbidity make it a real clinical challenge. CASE DESCRIPTION A 32-year-old woman with a history of relapsing polychondritis, refractory to multiple treatments, with multisystem compromise, imminent risk of death due to severe tracheobronchial damage and difficult ventilatory support, and successful treatment with infliximab. DISCUSSION AND EVALUATION Several treatments have been described in the literature, such as nonsteroidal anti-inflammatory drugs, corticosteroids, dapsone, azathioprine, cyclosporine, cyclophosphamide, and methotrexate. However, the cases refractory to conventional therapy may lead to chronicity, irreversibility, and death. As a result, a third-line therapy could improve the prognosis of these patients. CONCLUSIONS Biological therapy is a good option for disease control and quality of life improvement. In addition, the physician should consider these treatments to avoid the chronicity and risk of death of these patients.
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Affiliation(s)
- Daniel Cuestas
- Dermatology Service, Samaritana University Hospital - ESE, Bogotá, Colombia.,Dermatology Program, El Bosque University, Bogotá, Colombia
| | - Elkin Peñaranda
- Dermatology Service, Samaritana University Hospital - ESE, Bogotá, Colombia.,Dermatology Program, National University of Colombia, Bogotá, Colombia
| | - Sergio Mora
- Rheumatology Service, Samaritana University Hospital - ESE, Bogotá, Colombia
| | - Carolina Cortes
- Dermatology Service, Samaritana University Hospital - ESE, Bogotá, Colombia.,Dermatology Program, National University of Colombia, Bogotá, Colombia
| | - Ingrid Galvis
- Rheumatology Service, Samaritana University Hospital - ESE, Bogotá, Colombia.,Radiology Program, La Sabana University, Chia, Coloumbia
| | - Mónica Patiño
- Dermatology Service, Samaritana University Hospital - ESE, Bogotá, Colombia
| | - Oscar Velasquez
- Dermatology Service, Samaritana University Hospital - ESE, Bogotá, Colombia.,Dermatology Program, National University of Colombia, Bogotá, Colombia
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27
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Afridi F, Frosh S. Silent tracheobronchial chondritis in a patient with a delayed diagnosis of relapsing polychondritis. BMJ Case Rep 2017; 2017:bcr-2017-220172. [PMID: 28739564 DOI: 10.1136/bcr-2017-220172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Relapsing polychondritis is a very rare autoimmune disease characterised by a relapsing inflammation of hyaline, elastic and fibrous cartilaginous tissues. The incidence is estimated to be between 3.5 and 4.5 per million people per year. Clinical signs and symptoms can be very subtle, and if left undiagnosed for a prolonged period, airway involvement can cause fibrosis of the tracheobronchial wall, leading to a fixed tracheobronchial stenosis. Eventually, this can progress to life-threatening tracheobronchomalacia due to irreversible damage and loss of tissue integrity. We report an elderly man who presented with recurrent bilateral ear inflammation and intermittent polyarthritis who was diagnosed with relapsing polychondritis with asymptomatic involvement of his large airways.
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Affiliation(s)
- Faraz Afridi
- Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Seema Frosh
- Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA.,Rheumatology, Orlando VA Medical Center, Orlando, Florida, USA
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Dion J, Costedoat-Chalumeau N, Sène D, Cohen-Bittan J, Leroux G, Dion C, Francès C, Piette JC. Relapsing Polychondritis Can Be Characterized by Three Different Clinical Phenotypes: Analysis of a Recent Series of 142 Patients. Arthritis Rheumatol 2017; 68:2992-3001. [PMID: 27331771 DOI: 10.1002/art.39790] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/14/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Relapsing polychondritis (RP) is a rare condition characterized by recurrent inflammation of cartilaginous tissue and systemic manifestations. Data on this disease remain scarce. This study was undertaken to describe patient characteristics and disease evolution, identify prognostic factors, and define different clinical phenotypes of RP. METHODS We performed a retrospective study of 142 patients with RP who were seen between 2000 and 2012 in a single center. RESULTS Of the 142 patients, 86 (61%) were women. The mean ± SD age at first symptoms was 43.5 ± 15 years. Patients had the following chondritis types: auricular (89%; n = 127), nasal (63%; n = 89), laryngeal (43%; n = 61), tracheobronchial (22%; n = 32), and/orcostochondritis (40%; n = 57). The main other manifestations were articular (69%; n = 98), ophthalmologic (56%; n = 80), audiovestibular (34%; n = 48), cardiac (27%; n = 38), and cutaneous (28%; n = 40). At a mean ± SD followup of 13 ± 9 years, the 5- and 10-year survival rates were 95 ± 2% and 91 ± 3%, respectively. Factors associated with death on multivariable analysis were male sex (P = 0.01), cardiac abnormalities (P = 0.03), and concomitant myelodysplastic syndrome (MDS) (P = 0.004) or another hematologic malignancy (P = 0.01). Cluster analysis revealed that separating patients into 3 groups was clinically relevant, thereby separating patients with associated MDS, those with tracheobronchial involvement, and those without the 2 features in terms of clinical characteristics, therapeutic management, and prognosis. CONCLUSION This large series of patients with definite RP revealed an improvement in survival as compared with previous studies. Factors associated with death were male sex, cardiac involvement, and concomitant hematologic malignancy. We identified 3 distinct phenotypes.
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Affiliation(s)
- Jérémie Dion
- Université René Descartes Paris V, AP-HP, and Centre de référence maladies auto-immunes et systémiques rares, Hôpital Cochin, AP-HP, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Nathalie Costedoat-Chalumeau, MD, PhD: Université René Descartes Paris V, AP-HP, Centre de référence maladies auto-immunes et systémiques rares, Hôpital Cochin, AP-HP, and INSERM U1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris, France
| | - Damien Sène
- Université Paris-Diderot Paris VII, AP-HP, and Hôpital Lariboisière, Paris, France
| | - Judith Cohen-Bittan
- Université Pierre et Marie Curie Paris VI, AP-HP, and Hôpital Pitié Salpêtrière, Paris, France
| | - Gaëlle Leroux
- Université Pierre et Marie Curie Paris VI, AP-HP, and Centre de référence maladies auto-immunes et systémiques rares, Hôpital Pitié Salpêtrière, Paris, France
| | | | - Camille Francès
- Université Pierre et Marie Curie Paris VI, AP-HP, and Hôpital Tenon, Paris, France
| | - Jean-Charles Piette
- Université Pierre et Marie Curie Paris VI, AP-HP, and Centre de référence maladies auto-immunes et systémiques rares, Hôpital Pitié Salpêtrière, Paris, France
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Relapsing polychondritis: a chameleon among orphan diseases. Wien Med Wochenschr 2017; 167:227-233. [PMID: 28364136 DOI: 10.1007/s10354-017-0559-1] [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: 10/19/2016] [Accepted: 03/09/2017] [Indexed: 01/22/2023]
Abstract
Relapsing polychondritis (RPC) is a rare disease with recurrent episodes of inflammation of cartilage tissue leading to fibrosis and organ damage. Despite unknown etiology, there is some evidence of a genetic predisposition. The clinical presentation is heterogeneous and an association with other autoimmune disorders such as rheumatoid arthritis or different forms of vasculitis has been described. All organ systems containing cartilage can be affected, such as ear, nose, joints, trachea, aorta, and coronary arteries. Given the broad spectrum of potential manifestations, a variety of medical specialists may be involved in the management of RPC patients. As establishing the diagnosis of RPC may be difficult, an interdisciplinary approach may be preferable. Treatment options include glucocorticoids, dapsone, disease-modifying antirheumatic drugs, and biologics. Prognosis is as heterogeneous as the clinical picture, depending on the severity of organ damage. In this paper we give an overview of the current knowledge with regard to pathogenesis, clinical picture, diagnosis, and therapy of RPC.
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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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Relapsing polychondritis: A 2016 update on clinical features, diagnostic tools, treatment and biological drug use. Best Pract Res Clin Rheumatol 2016; 30:316-333. [PMID: 27886803 DOI: 10.1016/j.berh.2016.08.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Relapsing polychondritis (RP) is a very rare autoimmune disease characterised by a relapsing inflammation of the cartilaginous tissues (joints, ears, nose, intervertebral discs, larynx, trachea and cartilaginous bronchi), which may progress to long-lasting atrophy and/or deformity of the cartilages. Non-cartilaginous tissues may also be affected, such as the eyes, heart, aorta, inner ear and skin. RP has a long and unpredictable course. Because no randomised therapeutic trials are available, the treatment of RP remains mainly empirical. Minor forms of the disease can be treated with non-steroidal anti-inflammatory drugs, whereas more severe forms are treated with systemic corticosteroids. Life-threatening diseases and corticosteroid-dependent or resistant diseases are an indication for immunosuppressant therapy such as methotrexate, azathioprine, mycophenolate mofetil and cyclophosphamide. Biologics could be given as second-line treatment in patients with an active disease despite the use of steroids and immunosuppressive drugs. Although the biologics represent new potential treatment for RP, very scarce information is available to draw any firm conclusion on their use in RP.
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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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Henes JC, Xenitidis T, Horger M. Tocilizumab for refractory relapsing polychondritis-long-term response monitoring by magnetic resonance imaging. Joint Bone Spine 2015; 83:365-6. [PMID: 26750763 DOI: 10.1016/j.jbspin.2015.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/26/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Joerg Christoph Henes
- University Hospital Tuebingen, Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases, Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology, Pulmology), Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany.
| | - Theodoros Xenitidis
- University Hospital Tuebingen, Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases, Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology, Pulmology), Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany
| | - Marius Horger
- Department of diagnostic and interventional radiology, Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany
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Emmungil H, Aydın SZ. Relapsing polychondritis. Eur J Rheumatol 2015; 2:155-159. [PMID: 27708954 DOI: 10.5152/eurjrheum.2015.0036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/25/2015] [Indexed: 12/13/2022] Open
Abstract
Relapsing polychondritis (RPC) is a unique and rarely observed autoimmune condition regarded as recurrent extensive chondritis of the auricular, nasal, and tracheal cartilages. Moreover, heart, main arteries, skin, and eyes may be involved. Several forms of clinical manifestations may be seen, and the pathogenesis still remains anonymous. A concomitant disease, particularly myelodysplasia or other systemic autoimmune disease can be detected in one-third of the patients with RPC. The treatment of RPC should be considered on personal basis and classified according to disease activity and severity. This study reviews the available data on clinical manifestations, pathogenesis, diagnosis, and therapeutics of the RPC.
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Affiliation(s)
- Hakan Emmungil
- Department of Rheumatology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Sibel Zehra Aydın
- Department of Rheumatology, Koç University Faculty of Medicine, İstanbul, Turkey
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Relapsing polychondritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Yi NH, Park SW, Park IS, Park CH, Lee CW. A Case of Relapsing Polychondritis Associated with Ankylosing Spondylitis. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.1.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Nam Hee Yi
- Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Seung Woon Park
- Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea
| | - In Seong Park
- Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Chi Hwan Park
- Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Choong Won Lee
- Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea
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Melikoğlu MA, Şenel K. Relapsing polychondritis: inflamed joints and ears. Balkan Med J 2015; 32:121-3. [PMID: 25759785 DOI: 10.5152/balkanmedj.2014.14144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/17/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Relapsing polychondritis (RP) is an episodic and progressive inflammatory disease of the cartilaginous structures, including elastic cartilage of the ear and nose, hyaline cartilage of the peripheral joints, fibrocartilage at axial sites, and cartilage of the tracheo-bronchial tree. The spectrum of its presentations may vary from intermittent mild episodes of chondritis to occasional organ involvement or even life-threatening manifestations. CASE REPORT We presented a 64 year-old male patient with bilaterally knee arthritis and discoloration of pinna. CONCLUSION There is lack of awareness about this disease due to its rarity. With this case presentation, our goal was to draw attention to this disease, which could be delayed for the diagnosis.
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Affiliation(s)
| | - Kazım Şenel
- Department of Physical Medicine and Rehabilitation, Atatürk University Faculty of Medicine, Erzurum, Turkey
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Nobata H, Banno S, Ikeda K, Ichihara S, Itoh M, Kojima M, Wakamatsu R, Suzuki K, Miura N, Imai H, Imai H. [Case report: relapsing polychondritis in a young woman with delayed diagnosis due to the coverage by hair of painless red auricles]. ACTA ACUST UNITED AC 2014; 103:3096-8. [PMID: 25812341 DOI: 10.2169/naika.103.3096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kawakami Y, Endo K, Ishii T, Haneda S, Fujishima F, Kakuta Y, Shiga H, Kinouchi Y, Shimosegawa T. Ileocecal ulcers accompanied by relapsing polychondritis: a case report. SPRINGERPLUS 2014; 3:714. [PMID: 25674454 PMCID: PMC4320181 DOI: 10.1186/2193-1801-3-714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 12/02/2022]
Abstract
Introduction Mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome is a rare overlap syndrome that includes features characteristic of both Behçet’s disease (BD) and relapsing polychondritis (RP). Case description A 30-year-old female complained of lower abdominal pain and bloody stools during medical treatment for RP. Total colonoscopy revealed oval-shaped deep ulcers on the terminal ileum similar to those of intestinal BD. After performing the ileocecal resection, both RP and gastrointestinal lesions relapsed, but improved with infliximab treatment. Discussion and evaluation During medical treatment for RP, we experienced a rare case with ileocecal ulcers similar to intestinal BD. Although our case did not meet the diagnosis criteria of intestinal BD because of the lack of BD’s major clinical symptoms, intestinal lesions shared quite similar features with intestinal BD. Our case could possibly be a rare subtype of MAGIC syndrome that had the features characteristic of both intestinal BD and RP. Conclusions We described a rare case of ileocecal ulcers without any BD symptoms but accompanied by RP, possibly be a subtype of MAGIC syndrome. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-3-714) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoko Kawakami
- Division of Gastroenterology, Department of Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574 Japan
| | - Katsuya Endo
- Division of Gastroenterology, Department of Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574 Japan
| | - Tomonori Ishii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574 Japan
| | - Sho Haneda
- Division of Gastrointestinal Surgery, Department of Surgery, Tohoku University Hospital, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574 Japan
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Hospital, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574 Japan
| | - Yoichi Kakuta
- Division of Gastroenterology, Department of Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574 Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Department of Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574 Japan
| | - Yoshitaka Kinouchi
- Division of Gastroenterology, Department of Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574 Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Department of Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574 Japan
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Relapsing polychondritis in a patient with ankylosing spondylitis using etanercept. Case Rep Rheumatol 2014; 2014:353782. [PMID: 25276463 PMCID: PMC4172987 DOI: 10.1155/2014/353782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 11/17/2022] Open
Abstract
Relapsing polychondritis (RP) is an autoimmune disease characterized by recurrent episodes of inflammation and progressive destruction of cartilaginous tissues, especially of the ears, nose, joints, and tracheobronchial tree. Its etiology is not well understood, but some studies have linked its pathophysiology with autoimmune disease and autoantibody production. We described a case of a 46-year-old male patient with ankylosing spondylitis who developed RP after the use of etanercept. Few similar cases have been described in the literature. However, they show a possible association between the use of biological inhibitors of tumor necrosis factor (anti-TNFα), which potentially produces autoantibodies, and the development of RP. The treatment was based on data in the literature and included the cessation of biological therapy and the addition of corticosteroids with substantial improvement.
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Stael R, Smith V, Wittoek R, Creytens D, Mielants H. Sustained response to tocilizumab in a patient with relapsing polychondritis with aortic involvement: a case based review. Clin Rheumatol 2014; 34:189-93. [PMID: 24831688 DOI: 10.1007/s10067-014-2670-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 11/30/2022]
Abstract
This paper presents a case with refractory relapsing polychondritis (RPC), complicated with severe aortic involvement, which is successfully treated with tocilizumab. Previous treatments consisted of methotrexate, corticosteroids, cyclosporine, cyclophosphamide, infliximab, and etanercept. With these treatments, the patient had recurrent episodes of fever, polyarthritis, tenosynovitis, subcutaneous nodules, and progressive cardiac disease. One year after the start of treatment with tocilizumab, there is resolution of all symptoms, normalization of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and the dose of prednisolone is tapered down to 2 mg/day. We have reviewed the English literature for reports of patients with refractory RPC, successfully treated with tocilizumab. We found five additional case reports. In one case report, a patient with refractory RPC complicated with aortitis was successfully treated with tocilizumab. In three case reports, patients with refractory RPC complicated with laryngotracheal involvement were successfully treated with tocilizumab. All cases had, like our patient, failed conventional treatment. We also reviewed the literature for reports of the effect of biologicals on cardiac involvement in RPC. Current literature is presented and discussed.
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Affiliation(s)
- Rebecca Stael
- Department of Rheumatology, University Hospital of Ghent, De Pintelaan 185, 9000, Ghent, Belgium,
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Mahida RY, Bowman S, Naidu B, Thickett DR. Positron emission tomography aids diagnosis of relapsing polychondritis. BMJ Case Rep 2014; 2014:bcr-2013-203367. [PMID: 24599430 DOI: 10.1136/bcr-2013-203367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 39-year-old man presented to the hospital in April 2011 with a 2-month history of tonsillitis, night sweats, fatigue, weight loss, shortness of breath on exertion and a dry cough. He was a non-smoker, previously fit and well with no regular medication. Examination of the respiratory, cardiovascular and gastrointestinal systems was normal; he appeared generally well. C reactive protein and erythrocyte sedimentation rate were raised. A CT of the thorax showed mediastinal thickening and mediastinal lymphadenopathy. Whole body (18)F-fluorodeoxyglucose positron emission tomography showed diffuse tracheobronchial activity. Tracheal and lymph node biopsies showed non-specific features. Lung function tests showed an obstructive picture. A diagnosis of relapsing polychondritis was made. Immunosuppressive treatment was started, initially with oral methotrexate and prednisolone, later progressing to intravenous methylprednisolone and intravenous cyclophosphamide. Repeat bronchoscopy showed improvement in inflammation; however, the patient's symptoms were not improved. The patient's symptoms and lung function currently remain stable on maintenance oral prednisolone.
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Puéchal X, Terrier B, Mouthon L, Costedoat-Chalumeau N, Guillevin L, Le Jeunne C. Relapsing polychondritis. Joint Bone Spine 2014; 81:118-24. [PMID: 24556284 DOI: 10.1016/j.jbspin.2014.01.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2013] [Indexed: 02/08/2023]
Abstract
Relapsing polychondritis (RP) is a rare disease in which recurrent bouts of inflammation, in some cases followed by destruction, affect the cartilage of the ears, nose, larynx, and tracheobronchial tree. At presentation, however, arthritis is the most common manifestation and more than half the patients have no evidence of chondritis. The subsequent development of chondritis provides the correct diagnosis in patients who present with polyarthritis, ocular inflammation, or skin or audiovestibular manifestations of unknown origin. A concomitant autoimmune disease is present in one-third of patients with RP. The pathogenesis of RP involves an autoimmune response to as yet unidentified cartilage antigens followed by cartilage matrix destruction by proteolytic enzymes. The diagnosis rests on clinical grounds and can benefit from use of Michet's criteria. Anti-collagen type II and anti-matrilin-1 antibodies are neither sensitive nor specific and consequently cannot be used for diagnostic purposes. In addition to the physical evaluation and laboratory tests, useful investigations include dynamic expiratory computed tomography, magnetic resonance imaging, Doppler echocardiography, and lung function tests. Bronchoscopy has been suggested as a helpful investigation but can worsen the respiratory dysfunction. The treatment of RP is not standardized. The drug regimen should be tailored to each individual patient based on disease activity and severity. Glucocorticoid therapy is the cornerstone of the treatment of RP and is used chronically in most patients. Immunosuppressive agents are given to patients with severe respiratory or vascular involvement and to those with steroid-resistant or steroid-dependent disease. Methotrexate is often effective. Cyclophosphamide is used in severe forms.
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Affiliation(s)
- Xavier Puéchal
- Centre de Référence des Maladies Auto-immunes et Systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Cochin, Inserm U1016, CNRS UMR 8104, Université Paris Descartes, Paris, France.
| | - Benjamin Terrier
- Centre de Référence des Maladies Auto-immunes et Systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Cochin, Inserm U1016, CNRS UMR 8104, Université Paris Descartes, Paris, France
| | - Luc Mouthon
- Centre de Référence des Maladies Auto-immunes et Systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Cochin, Inserm U1016, CNRS UMR 8104, Université Paris Descartes, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Centre de Référence des Maladies Auto-immunes et Systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Cochin, Inserm U1016, CNRS UMR 8104, Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- Centre de Référence des Maladies Auto-immunes et Systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claire Le Jeunne
- Centre de Référence des Maladies Auto-immunes et Systémiques rares, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
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Wendling D, Godfrin-Valnet M, Prati C. Treatment of relapsing polychondritis with tocilizumab. J Rheumatol 2014; 40:1232. [PMID: 23818726 DOI: 10.3899/jrheum.130371] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Weber E, Gaultier JB, Paul S, Guichard I, Monard E, Cathébras P. [Sustained response with tocilizumab in a case of refractory relapsing polychondritis]. Rev Med Interne 2013; 35:196-8. [PMID: 24074969 DOI: 10.1016/j.revmed.2013.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/08/2013] [Accepted: 02/11/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Relapsing polychondritis (RP) is a rare inflammatory disease characterized by diffuse cartilage involvement, especially those of the respiratory tract, leading to potentially life threatening complications. Corticosteroids remain the first-line empirical therapy. Immunosuppressive drugs such as azathioprine, cyclophosphamide and tumor necrosis factor blockers (anti-TNFα) are commonly used as second-line therapy with varying degrees of success. CASE REPORT We report a 40-year-old man with severe RP for whom conventional therapy and immunosuppressive treatments were ineffective. Prolonged clinical remission was obtained after introduction of the anti-interleukin-6 receptor antibody (tocilizumab), which was perfectly tolerated and allowed to taper steroids and methotrexate to a very low dosage. CONCLUSION Our patient is the fifth published one documenting the efficacy of tocilizumab in severe refractory RP, which strengthens the use of anti-IL-6 in that indication.
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Affiliation(s)
- E Weber
- Service de médecine interne, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - J-B Gaultier
- Service de médecine interne, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - S Paul
- Laboratoire d'immunologie, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - I Guichard
- Service de médecine interne, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - E Monard
- Service de médecine interne, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - P Cathébras
- Service de médecine interne, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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Abstract
Relapsing Polychondritis (RP) is an uncommon, chronic, and potentially life-threatening multisystem disorder characterized by recurrent inflammatory episodes affecting the cartilaginous tissues of the external ears, nose, peripheral joints, larynx and tracheobronchial tree, sometimes leading to their destruction. RP can also inflame other proteoglycan-rich structures, such as the eye, heart, blood vessels and inner ears. Systemic symptoms are common, and vasculitis affecting skin or internal organs may occur. The etiology of RP is still unknown, but the pathogenetic role of the autoimmunity is suggested by frequent overlaps with various autoimmune diseases, and by the presence of autoantibody against cartilage in the serum of patients with RP. Although several reports have demonstrated the clinicopathologic manifestations and radiologic findings of RP, there are no specific features of RP. Therefore, it is difficult to show the diagnosis of RP. Airway involvements are major causes of morbidity and mortality, and they have accounted for most of the deaths due to RP. To suppress the inflammation of airway mucosa and cartilage is extremely important in the successful treatment for RP. Above all, earlier diagnosis would lead to better outcomes.
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Affiliation(s)
- Naoto Azuma
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Arnaud L, Mathian A, Haroche J, Gorochov G, Amoura Z. Pathogenesis of relapsing polychondritis: a 2013 update. Autoimmun Rev 2013; 13:90-5. [PMID: 24051104 DOI: 10.1016/j.autrev.2013.07.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 07/27/2013] [Indexed: 02/08/2023]
Abstract
Relapsing polychondritis (RP) is a systemic inflammatory disease primarily affecting not only the cartilaginous structures of the ears, nose and tracheobronchial tree but also the joints, the inner ear, the eyes, and the cardiovascular system. RP is an immune-mediated disease during which target antigens are still unknown, but data from human studies and murine models strongly support a role of both Collagen Type II (CII) and matrilin-1 as potential candidates. RP is likely a Th1-mediated disease as serum levels of interferon (IFN)-γ, interleukin [IL]-12, and IL-2 parallel changes in disease activity, while the levels of Th2 cytokines do not. Serum levels of sTREM-1, interferon-γ, CCL4, vascular endothelial growth factor, and matrix metalloproteinases-3 are significantly higher in RP patients than in healthy donors, with sTREM-1 correlating with disease activity. Patients with active RP also have significantly higher levels of MCP-1, MIP-1β, MIF, and IL-8 than controls. These pro-inflammatory chemokines are involved in the modulation and recruitment of monocytes and neutrophils. Altogether, these data suggest that a complex cytokine network orchestrates the recruitment of infiltrating cells in RP lesions. Cytokine modulation using TNFα blockers, rituximab, anakinra, tocilizumab, and abatacept has recently been shown effective in some RP cases but further data are needed. Better understanding of the repertoire of infiltrating cells may provide interesting clues to further define the putative RP auto-antigens. Study of circulating mononuclear cells during RP flares may also provide crucial information about the ongoing cellular trafficking and recruitment processes involved in this rare disease.
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Affiliation(s)
- Laurent Arnaud
- Service de Médecine Interne 2, French National Reference Center for Systemic Lupus Erythematosus and the Antiphospholipid Syndrome, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, F-75013 Paris, France; Université Pierre et Marie Curie, UPMC Univ Paris 06, F-75013 Paris, France; Institut National de la Recherche Médicale et de la Santé, INSERM UMR-S 945, Paris, France.
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Moulis G, Pugnet G, Sailler L, Astudillo L, Arlet P. Abatacept in relapsing polychondritis. Ann Rheum Dis 2013; 72:e27. [DOI: 10.1136/annrheumdis-2013-204336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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