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Mertz P, Costedoat-Chalumeau N, Ferrada MA, Moulis G, Mekinian A, Grayson PC, Arnaud L. Relapsing polychondritis: clinical updates and new differential diagnoses. Nat Rev Rheumatol 2024; 20:347-360. [PMID: 38698240 DOI: 10.1038/s41584-024-01113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/05/2024]
Abstract
Relapsing polychondritis is a rare inflammatory disease characterized by recurrent inflammation of cartilaginous structures, mainly of the ears, nose and respiratory tract, with a broad spectrum of accompanying systemic features. Despite its rarity, prompt recognition and accurate diagnosis of relapsing polychondritis is crucial for appropriate management and optimal outcomes. Our understanding of relapsing polychondritis has changed markedly in the past couple of years with the identification of three distinct patient clusters that have different clinical manifestations and prognostic outcomes. With the progress of pangenomic sequencing and the discovery of new somatic and monogenic autoinflammatory diseases, new differential diagnoses have emerged, notably the vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome, autoinflammatory diseases and immune checkpoint inhibitor-related adverse events. In this Review, we present a detailed update of the newly identified clusters and highlight red flags that should raise suspicion of these alternative diagnoses. The identification of these different clusters and mimickers has a direct impact on the management, follow-up and prognosis of patients with relapsing polychondritis and autoinflammatory syndromes.
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Affiliation(s)
- Philippe Mertz
- Department of Rheumatology, National Reference Center for Rare Autoimmune Diseases (RESO), INSERM UMR-S 1109, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nathalie Costedoat-Chalumeau
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Marcela A Ferrada
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France
| | - Arsène Mekinian
- Service de Médecine Interne, DHUi2B, Hôpital Saint-Antoine, Paris, France
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Rare Autoimmune Diseases (RESO), INSERM UMR-S 1109, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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2
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Villa-Piñeros J, Ramos-Santodomingo M, Rojas-Carabali W, de-la-Torre A. Ocular Inflammation as the First Sign of Relapsing Polychondritis in Hispanic Patients: Report of Three Cases. Ocul Immunol Inflamm 2024; 32:244-249. [PMID: 36638347 DOI: 10.1080/09273948.2023.2165112] [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: 07/29/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Relapsing polychondritis (RP) is a rare inflammatory systemic disease characterized by recurrent inflammatory episodes of cartilaginous and proteoglycan-rich tissues, particularly ears, nose, respiratory tract, eyes, and joints. PURPOSE To present the clinical features, management, and prognosis of three Hispanic patients presenting with RP and ocular involvement as the first manifestation of the disease. CONCLUSION This study extends the knowledge regarding ocular disease characteristics in patients with RP. Furthermore, it increases ophthalmologists' awareness of the findings, leading to earlier diagnoses and adequate treatment for improved patients' prognoses.
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Affiliation(s)
- Jerónimo Villa-Piñeros
- Neurosciences Research Group (NEUROS), NeuroVitae Center for Neuroscience, Translational Medicine Institute, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia
| | - Mario Ramos-Santodomingo
- Neurosciences Research Group (NEUROS), NeuroVitae Center for Neuroscience, Translational Medicine Institute, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia
| | - William Rojas-Carabali
- Neurosciences Research Group (NEUROS), NeuroVitae Center for Neuroscience, Translational Medicine Institute, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neurosciences Research Group (NEUROS), NeuroVitae Center for Neuroscience, Translational Medicine Institute, School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá, Colombia
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3
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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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4
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Husein S, Murayama Y, Koo A, Wakefield M, Buccoliero R. Relapsing polychondritis presenting with sero-negative limbic encephalitis. Clin Med (Lond) 2023; 23:618-620. [PMID: 38065590 PMCID: PMC11046591 DOI: 10.7861/clinmed.2023-0430] [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] [Indexed: 12/18/2023]
Abstract
The presented case highlights a rare instance of relapsing polychondritis (RP) manifesting as seronegative limbic encephalitis, an uncommon neurological complication. A 70-year-old female patient with a history of RP-related inflammation, along with neuropsychiatric symptoms, was diagnosed through multidisciplinary collaboration. Swift administration of steroid therapy, followed by azathioprine, led to remarkable physical and cognitive recovery. This case emphasises the importance of a multidisciplinary approach in diagnosing and treating complex autoimmune disorders with neurological manifestations.
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Affiliation(s)
- Salman Husein
- Harrogate and District NHS Foundation Trust, Harrogate, UK
- equal contributions
| | - Yuna Murayama
- Harrogate and District NHS Foundation Trust, Harrogate, UK
- equal contributions
| | - Andrew Koo
- Harrogate and District NHS Foundation Trust, Harrogate, UK
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5
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Ngeyvijit J, Nuansuwan S, Phoophiboon V. CYP3A4/P-glycoprotein inhibitors related colchicine toxicity mimicking septic shock. BMJ Case Rep 2023; 16:e257186. [PMID: 37813551 PMCID: PMC10565285 DOI: 10.1136/bcr-2023-257186] [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] [Indexed: 10/13/2023] Open
Abstract
Colchicine toxicity is uncommon when patients receive a therapeutic dose regularly. However, inadvertent drug interactions can result in unpredicted adverse outcomes. The toxicity of colchicine can manifest in various ways, ranging from mild and non-specific symptoms to severe form known as multiple organ dysfunction syndrome. This case highlights (1) the diagnostic challenge that arises when distinguishing between the severe manifestation of colchicine toxicity and septic shock and (2) concomitant prescription of colchicine with potent CYP3A4 and P-glycoprotein inhibitors (ie, clarithromycin) can lead to colchicine toxicity despite normal renal and hepatic clearance. Unfortunately, specific tests of colchicine toxicity were not routinely available. A high index of clinical suspicion and recognition of drug interactions with their common presentations are crucial for making diagnosis and management. Failure to recognise drug toxicity can result in poor outcomes.
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Affiliation(s)
- Jinjuta Ngeyvijit
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand
| | - Sopita Nuansuwan
- Department of Medicine, Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand
| | - Vorakamol Phoophiboon
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Critical Care Medicine, St.Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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6
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Ruffer N, Krusche M. VEXAS syndrome: a diagnostic puzzle. RMD Open 2023; 9:e003332. [PMID: 37532466 PMCID: PMC10401208 DOI: 10.1136/rmdopen-2023-003332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
The VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is an adult-onset systemic autoinflammatory condition that is caused by an acquired deficiency of the UBA1 gene in hematopoietic progenitor cells. The clinical spectrum of the VEXAS syndrome currently comprises a broad range of phenotypes such as vasculitis, relapsing polychondritis and Sweet's syndrome. In the past, VEXAS patients have left clinicians puzzled and the true nature of this disease has not been captured until late 2020. This viewpoint describes the relevant clinical features of the VEXAS syndrome and reviews different approaches to establish the diagnosis. Finally, future directions within the field of systemic inflammatory diseases caused by somatic mutations are being discussed.
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Affiliation(s)
- Nikolas Ruffer
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Krusche
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Martín‐Serrano P, Sarrió‐Badenes E, Durá‐Aranda M, Molero‐Sala L. Management of preeclampsia with severe features in a patient with relapsing polychondritis affecting the tracheobronchial tree. Anaesth Rep 2023; 11:e12249. [PMID: 37736065 PMCID: PMC10511154 DOI: 10.1002/anr3.12249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
Relapsing polychondritis is a rare disease that affects cartilaginous structures throughout the body. Progressive destruction of the laryngeal structures and the tracheobronchial tree occurs in 50% of patients, potentially leading to loss of patency and collapse of the airway. Respiratory involvement in relapsing polychondritis includes airway stenosis, tracheomalacia and recurrent lung infections due to chronic inflammation caused by the destruction of upper and lower airway cartilage. Pregnancy and preeclampsia can worsen pharyngolaryngeal oedema, while treatment with magnesium sulphate can affect neuromuscular function, exacerbating the degree of airway collapse in the most serious cases of relapsing polychondritis, possibly altering obstetric outcomes. Here, we present the management of a pregnant woman with relapsing polychondritis who presented with features of severe preeclampsia at 29 weeks and 6 days gestation. We believe that this is the first published case of the combination of the two disorders, complicated by acute respiratory failure after treatment with magnesium sulphate.
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Affiliation(s)
- P. Martín‐Serrano
- Department of Anaesthesiology and ResuscitationComplejo Hospitalario Universitario Insular Materno InfantilLas PalmasSpain
| | - E. Sarrió‐Badenes
- Department of Anaesthesiology and ResuscitationComplejo Hospitalario Universitario Insular Materno InfantilLas PalmasSpain
| | - M. Durá‐Aranda
- Department of Anaesthesiology and ResuscitationComplejo Hospitalario Universitario Insular Materno InfantilLas PalmasSpain
| | - L. Molero‐Sala
- Department of Obstetrics and Gynaecology, Complejo Hospitalario Universitario Insular Materno InfantilLas PalmasSpain
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8
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Kwok SH, Choi F. Relapsing Polychondritis: The Oto-Rhino-Tracheobronchial Triad on 18F-FDG PET/CT. Clin Nucl Med 2023; Publish Ahead of Print:00003072-990000000-00587. [PMID: 37276545 DOI: 10.1097/rlu.0000000000004698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT We present a 54-year-old woman with 3-month history of skin rash and bilateral hearing loss. Multiple investigations including biopsy failed to reveal the underlying diagnosis of relapsing polychondritis, until 18F-FDG PET/CT demonstrated a characteristic FDG activity pattern-the oto-rhino-tracheobronchial triad. The patient was subsequently diagnosed to have relapsing polychondritis and received treatment. The second FDG PET/CT revealed a differential response in different disease sites, which prompted an escalation of treatment.
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Affiliation(s)
- Sing Hon Kwok
- From the Department of Nuclear Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
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9
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Toledano M. Neurologic Manifestations of Rheumatologic Disease. Continuum (Minneap Minn) 2023; 29:734-762. [PMID: 37341329 DOI: 10.1212/con.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE This article describes the neurologic manifestations of systemic rheumatologic disorders. LATEST DEVELOPMENTS Although most have historically been classified as autoimmune disorders, rheumatologic diseases are increasingly conceptualized as distributed along a spectrum with various contributions of autoimmune (adaptive immune dysregulation) and autoinflammatory (innate immune dysregulation) mechanisms. Our evolving understanding of systemic immune-mediated disorders has been accompanied by an expansion in our differential diagnoses and therapeutic options. ESSENTIAL POINTS Rheumatologic disease involves both autoimmune and autoinflammatory mechanisms. Neurologic symptoms can be the first manifestation of these disorders, and familiarity with the systemic manifestations of specific diseases is essential to establish the correct diagnosis. Conversely, knowledge of the neurologic syndromes that are most likely to be associated with specific systemic disorders can help narrow the differential and increase confidence when attributing a neuropsychiatric symptom to an underlying systemic disorder.
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10
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Arnaud L, Costedoat-Chalumeau N, Mathian A, Sailler L, Belot A, Dion J, Morel N, Moulis G. French practical guidelines for the diagnosis and management of relapsing polychondritis. Rev Med Interne 2023:S0248-8663(23)00591-X. [PMID: 37236870 DOI: 10.1016/j.revmed.2023.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Relapsing polychondritis is a rare systemic disease. It usually begins in middle-aged individuals. This diagnosis is mainly suggested in the presence of chondritis, i.e. inflammatory flares on the cartilage, in particular of the ears, nose or respiratory tract, and more rarely in the presence of other manifestations. The formal diagnosis of relapsing polychondritis cannot be established with certainty before the onset of chondritis, which can sometimes occur several years after the first signs. No laboratory test is specific of relapsing polychondritis, the diagnosis is usually based on clinical evidence and the elimination of differential diagnoses. Relapsing polychondritis is a long-lasting and often unpredictable disease, evolving in the form of relapses interspersed with periods of remission that can be very prolonged. Its management is not codified and depends on the nature of the patient's symptoms and association or not with myelodysplasia/vacuoles, E1 enzyme, X linked, autoinflammatory, somatic (VEXAS). Some minor forms can be treated with non-steroidal anti-inflammatory drugs, or a short course of corticosteroids with possibly a background treatment of colchicine. However, the treatment strategy is often based on the lowest possible dosage of corticosteroids combined with background treatment with conventional immunosuppressants (e.g. methotrexate, azathioprine, mycophenolate mofetil, rarely cyclophosphamide) or targeted therapies. Specific strategies are required if relapsing polychondritis is associated with myelodysplasia/VEXAS. Forms limited to the cartilage of the nose or ears have a good prognosis. Involvement of the cartilage of the respiratory tract, cardiovascular involvement, and association with myelodysplasia/VEXAS (more frequent in men over 50years of age) are detrimental to the prognosis of the disease.
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Affiliation(s)
- L Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Auto-Immunes Est Sud-Ouest (RESO), Strasbourg, France.
| | - N Costedoat-Chalumeau
- Department of Internal Medicine, Île-de-France Rare Autoimmune and Systemic Diseases Reference Centre, hôpital Cochin, Paris, France; University of Paris Cité, Paris, France; Inserm U1153, Centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), Paris, France
| | - A Mathian
- Service de médecine interne 2, Institut E3M, Inserm UMRS, Centre d'immunologie et des maladies infectieuses (CIMI-Paris)groupement hospitalier Pitié-Salpêtrière, Centre de référence du lupus, syndrome des anticorps antiphospholipides et autres maladies auto-immunes rares, Assistance publique-Hôpitaux de Paris, Paris, France
| | - L Sailler
- Internal Medicine Department URM Pavilion C.I.C. 1436 - module plurithématique adulte, hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - A Belot
- Department of Paediatric Nephrology-Rheumatology-Dermatology, Mère-enfant Hospital, hospices civils de Lyon, Lyon, France
| | - J Dion
- Department of Internal Medicine, Île-de-France Rare Autoimmune and Systemic Diseases Reference Centre, hôpital Cochin, Paris, France; University of Paris Cité, Paris, France; Inserm U1153, Centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), Paris, France
| | - N Morel
- Department of Internal Medicine, Île-de-France Rare Autoimmune and Systemic Diseases Reference Centre, hôpital Cochin, Paris, France; University of Paris Cité, Paris, France; Inserm U1153, Centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), Paris, France
| | - G Moulis
- Internal Medicine Department URM Pavilion C.I.C. 1436 - module plurithématique adulte, hôpital Purpan, CHU de Toulouse, Toulouse, France
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11
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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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12
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Chen JY, Li XY, Zong C. Relapsing polychondritis with isolated tracheobronchial involvement complicated with Sjogren's syndrome: A case report. World J Clin Cases 2022; 10:6563-6570. [PMID: 35979285 PMCID: PMC9294918 DOI: 10.12998/wjcc.v10.i19.6563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/17/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Relapsing polychondritis (RP) is a rare, long-term, and potentially life-threatening disease characterised by recurrent paroxysmal inflammation that can involve and destroy the cartilage of the external ear, nose, larynx, and trachea.
CASE SUMMARY We here report a case of RP involving solely the tracheobronchial cartilage ring (and not the auricular. nasal or articular cartilage) complicated by Sjögren's syndrome in a 47-year-old female whose delayed diagnosis caused a sharp decline in pulmonary function. After corticosteroid treatment, her pulmonary function improved.
CONCLUSION In such cases, our experience suggested that 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and fiberoptic bronchoscopy should be used to diagnose airway chondritis as relapsing polychondritis in the early phase of disease.
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Affiliation(s)
- Jun-Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
| | - Xiao-Yan Li
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
| | - Chen Zong
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
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13
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Khitri MY, Guedon AF, Georgin-Lavialle S, Terrier B, Saadoun D, Seguier J, le Besnerais M, De Moreuil C, Denis G, Gerfaud-Valentin M, Allain JS, Maria A, Bouillet L, Grobost V, Galland J, Kosmider O, Dumont A, Devaux M, Subran B, Schmidt J, Marianetti-Guingel P, Audia S, Palat S, Roux-Sauvat M, Jachiet V, Hirsch P, Fain O, Mekinian A. Comparison between idiopathic and VEXAS-relapsing polychondritis: analysis of a French case series of 95 patients. RMD Open 2022; 8:rmdopen-2022-002255. [PMID: 35868738 PMCID: PMC9315905 DOI: 10.1136/rmdopen-2022-002255] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Objective A new adult-onset autoinflammatory syndrome has been described, named VEXAS (Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic). We aimed to compare the clinical characteristics, the laboratory features and the outcomes between idiopathic-relapsing polychondritis (I-RP) and VEXAS-relapsing polychondritis (VEXAS-RP). Methods Patients from French retrospective multicentre cohort of RP were separated into two groups: a VEXAS-RP and an I-RP. Results Compared with patients with I-RP (n=40), patients with VEXAS-RP (n=55) were men (96% vs 30%, p<0.001) and were older at diagnosis (66 vs 44 years, p<0.001). They had a greater prevalence of fever (60% vs 10%, p<0.001), of skin lesions (82% vs 20%, p<0.001), of ocular involvement (57% vs 28%, p=0.01), of pulmonary infiltrates (46% vs 0%, p<0.001), of heart involvement (11% vs 0%, p=0.0336) and with higher median C-reactive protein levels (64 mg/L vs 10 mg/L, p<0.001). Seventy-five per cent of the patients with VEXAS-RP had myelodysplastic syndrome (MDS) versus none in I-RP group. The glucocorticoids use, and the number of steroid sparing agents were similar in both groups, but patients with VEXAS-RP had more frequent refractory disease (remission obtained in 27% vs 90%, p<0001). VEXAS-RP was associated with higher risk of death: six patients (11%) died in the VEXAS-RP group after a median follow-up of 37 months and none in the I-RP group after a median follow-up of 92 months (p<0.05). Conclusion We report the largest cohort of VEXAS-RP, characterised by high prevalence of male sex, fever, skin lesion, ocular involvement, pulmonary infiltration, heart involvement, older age and MDS association.
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Affiliation(s)
| | - Alexis F Guedon
- Pierre Louis Epidemiology and Public Health Research Institute, Paris, Île-de-France, France
| | | | | | - David Saadoun
- Hopital Universitaire Pitie Salpetriere, Paris, Île-de-France, France
| | - Julie Seguier
- Hospital Timone, Marseille, Provence-Alpes-Côte d'Azu, France
| | | | | | - Guillaume Denis
- Centre Hospitalier de Rochefort, Rochefort, Nouvelle-Aquitaine, France
| | | | | | | | - Laurence Bouillet
- Internal Medicine, Centre Hospitalier Universitaire Grenoble, Michallon Hospital, Grenoble, France
| | | | - Joris Galland
- Hospital Centre Fleyriat de Bourg-en-Bresse, Bourg-en-Bresse, Rhône-Alpes, France
| | - Olivier Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen, APHP, Paris, Île-de-France, France
| | | | - Mathilde Devaux
- Intermunicipal Hospital Centre Poissy-Saint-Germain-en-Laye Poissy Site, Poissy, Île-de-France, France
| | - Benjamin Subran
- Hôpital de la Croix Saint-Simon, Paris, Île-de-France, France
| | - Jean Schmidt
- Internal Medicine, Amiens University Hospital, Amiens, France
| | | | | | | | - Marielle Roux-Sauvat
- Service de médecine interne, Pierre Oudot Hospital of Bourgoin-Jallieu, Bourgoin-Jallieu, Rhône-Alpes, France
| | - Vincent Jachiet
- Hopital Saint-Antoine Service de Medecine Interne, Paris, Île-de-France, France
| | - Pierre Hirsch
- service d'hématologie biologique, Hôpital Saint-Antoine, Paris, Île-de-France, France
| | - Olivier Fain
- Hopital Saint-Antoine Service de Medecine Interne, Paris, Île-de-France, France
| | - Arsène Mekinian
- Service de Médecine Interne, DHUi2B, Hôpital Saint-Antoine, Paris, Île-de-France, France
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14
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Yang M, Margaretten M. Recurrent Eye and Ear Pain in an Older Patient. JAMA 2022; 327:2348-2349. [PMID: 35622372 PMCID: PMC9327438 DOI: 10.1001/jama.2022.8313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Monica Yang
- Department of Medicine, Division of Rheumatology, University of California, San Francisco
| | - Mary Margaretten
- Department of Medicine, Division of Rheumatology, University of California, San Francisco
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15
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Yoshida T, Yoshifuji H, Shirakashi M, Nakakura A, Murakami K, Kitagori K, Akizuki S, Nakashima R, Ohmura K, Morinobu A. Risk factors for the recurrence of relapsing polychondritis. Arthritis Res Ther 2022; 24:127. [PMID: 35637525 PMCID: PMC9150329 DOI: 10.1186/s13075-022-02810-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Although the survival rates of patients with relapsing polychondritis (RP) have increased remarkably, the high recurrence rate remains a significant concern for physicians and patients. This retrospective study aimed to investigate the risk factors for RP recurrence. Methods Patients with RP who presented to Kyoto University Hospital from January 2000 to March 2020 and fulfilled Damiani’s classification criteria were included. Patients were classified into recurrence and non-recurrence groups. Risk factors for RP recurrence were analysed using a Cox proportional hazards model, and Kaplan–Meier survival curves were drawn. Results Thirty-four patients were included. Twenty-five patients (74%) experienced 64 recurrences (mean: 2.56 recurrences per patient). The median duration before the first recurrence was 202 [55−382] days. The median prednisolone dose at the initial recurrence was 10 [5−12.75] mg/day. Tracheal involvement was significantly more frequent in the recurrence group at the initial presentation (44.0% vs. 0.0%, p=0.0172) than in the non-recurrence group, and pre-treatment C-reactive protein levels were significantly higher in the recurrence group than in the non-recurrence group (4.7 vs 1.15 mg/dL, p=0.0024). The Cox proportional hazards model analysis revealed that tracheal involvement (hazard ratio [HR] 4.266 [1.535−13.838], p=0.0048), pre-treatment C-reactive protein level (HR 1.166 [1.040−1.308], p=0.0085), and initial prednisolone monotherapy (HR 4.443 [1.515−16.267], p=0.0056) may be associated with recurrence. The median time before the initial recurrence was significantly longer in patients who received combination therapy with prednisolone and immunosuppressants or biologics (400 vs. 70 days, p=0.0015). Conclusions Tracheal involvement, pre-treatment C-reactive protein level, and initial prednisolone monotherapy were risk factors for recurrence in patients with RP. Initial combination therapy with prednisolone and immunosuppressants may delay recurrence.
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Affiliation(s)
- Tsuneyasu Yoshida
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Mirei Shirakashi
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kitagori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuji Akizuki
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Dawudi Y, Benali K, Beydon M, Hourseau M, Sacre K, Papo T. B-cell lymphoma mimicking relapsing polychondritis. Br J Haematol 2022; 198:222. [PMID: 35594183 DOI: 10.1111/bjh.18220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Yachar Dawudi
- Département de Médecine Interne, Hôpital Bichat, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Khadija Benali
- Département de Médecine Nucléaire, Hôpital Bichat, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Maxime Beydon
- Département de Médecine Interne, Hôpital Bichat, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Muriel Hourseau
- Département de Pathologie, Hôpital Bichat, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM UMR 1149, Centre de Recherche sur l'Inflammation, Laboratoire d'Excellence Inflamex, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM UMR 1149, Centre de Recherche sur l'Inflammation, Laboratoire d'Excellence Inflamex, Paris, France
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17
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Rose E, Ferrada MA, Quinn KA, Arnaud L, Goodspeed W, Kim J, Allen C, Sirajuddin A, Chen M, Grayson PC. Discordance in patient and physician global assessment in relapsing polychondritis. Rheumatology (Oxford) 2022; 61:2025-2033. [PMID: 34559216 PMCID: PMC9071565 DOI: 10.1093/rheumatology/keab587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/01/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Relapsing polychondritis (RP) is a rare, heterogeneous, systemic inflammatory disease that targets cartilage. Patient-reported outcome measures may differ from physician assessment. This study compared patient global assessment (PtGA) and physician global assessment (PhGA) scores in a prospective cohort of patients with RP. METHODS Adult patients with RP underwent a standardized comprehensive evaluation at ∼6 month intervals. At each visit, three physicians scored PhGA by consensus. The patient independently completed four patient-reported outcomes: PtGA, 36-item Short Form Health Survey (SF-36), Brief Illness Perception Questionnaire (BIPQ) and Multidimensional Fatigue Inventory (MFI). Patient-physician discordance was defined as a difference between PtGA and PhGA of ≥3 on a 0-10 scale. RESULTS A total of 76 patients were evaluated over 154 visits. The median PhGA was 3 [interquartile range (IQR) 2-3] and the median PtGA was 5 (IQR 4-7). PtGA and PhGA were concordant in 66 visits (42.9%) and patients scored disease severity ≥3 points higher than physicians scored disease activity (positive discordance) in 84 visits (54.5%). Compared with visits with concordance, visits with positive discordance were associated with significantly worse scores on the MFI, BIPQ, SF-36 physical component score and SF-36 mental component score. CONCLUSION Patients with RP typically self-report high PtGA that does not align with PhGA. Discordance is likely driven by the high physical and psychological burden of illness experienced by patients. Multifaceted treatment approaches that address the burden of disease in RP from the patient perspective are needed.
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Affiliation(s)
- Emily Rose
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Marcela A Ferrada
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlin A Quinn
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Autoimmune Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Wendy Goodspeed
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Clint Allen
- Otolaryngology, National Institute on Deafness and Other Communication Disorders
| | - Arlene Sirajuddin
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcus Chen
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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18
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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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19
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De Luca G, Bombace S, Monti L. Heart Involvement in Systemic Sclerosis: the Role of Magnetic Resonance Imaging. Clin Rev Allergy Immunol 2022; 64:343-357. [PMID: 35072931 DOI: 10.1007/s12016-022-08923-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/12/2022]
Abstract
Systemic sclerosis (SSc) is a severe connective tissue disease characterized by diffuse vascular damage and aberrant activation of immune system, resulting in inflammation and fibrosis of skin and internal organs, including the heart. Cardiac involvement is frequent in SSc, even though often unrecognized due to the occult nature at early stages and to the lack of a defined diagnostic algorithm. Once clinically evident, heart involvement is associated with a poor prognosis, representing the leading cause of death in about one third of SSc patients. Thus, its early recognition and monitoring are of crucial importance to allow a prompt therapeutic intervention and to improve patients' outcomes. Cardiac Magnetic Resonance (CMR) is a non-invasive, non-radiating imaging technique of great importance for the assessment of cardiovascular system, and represents the modality of choice for the morpho-functional and structural characterization of the heart. In SSc, CMR allows a precise definition of biventricular and biatrial size and function, and a detailed tissue characterization. CMR has been therefore extensively proposed in SSc as a non-invasive diagnostic tool to characterize heart involvement, particularly myocardial involvement. In this review, we summarize the most recent evidences to support the use of CMR in SSc as an important tool to recognize and characterize scleroderma heart disease. Furthermore, the unmet needs and the future perspectives of a CMR-based approach for the early detection of SSc heart involvement are discussed.
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20
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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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21
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Koster MJ, Warrington KJ. VEXAS within the spectrum of rheumatologic disease. Semin Hematol 2021; 58:218-225. [PMID: 34802543 DOI: 10.1053/j.seminhematol.2021.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022]
Abstract
The identification of the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome as a myeloid-driven inflammatory disease resulting from somatic mutations in the UBA1 gene further exposes the increasingly recognized overlap between hematologic disturbances and auto-immunity and/or auto-inflammatory presentations. Although single or multi-lineage cytopenias are a unifying aspect of VEXAS, patients with this condition can present with a wide array of inflammatory findings affecting the skin, lung, joints, eye, vascular system, and cartilaginous structures. As such, it is paramount that generalists, and subspecialty providers familiarize themselves with the clinical characteristics of this condition. This review summarizes the reported clinical symptoms of VEXAS syndrome with a particular focus on its non-hematologic inflammatory features.
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Affiliation(s)
- Matthew J Koster
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN.
| | - Kenneth J Warrington
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN
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22
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Grygiel-Górniak B, Tariq H, Mitchell J, Mohammed A, Samborski W. Relapsing polychondritis: state-of-the-art review with three case presentations. Postgrad Med 2021; 133:953-963. [PMID: 34533099 DOI: 10.1080/00325481.2021.1979873] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Relapsing polychondritis (RPC) is a complex immune-mediated systemic disease affecting cartilaginous tissue and proteoglycan-rich organs. The most common and earliest clinical features are intermittent inflammation involving the auricular and nasal regions, although all cartilage types can be potentially affected. The life-threatening effects of rpc involve the tracheobronchial tree and cardiac connective components. Rpc is difficult to identify among other autoimmune comorbidities; diagnosis is usually delayed and based on nonspecific clinical symptoms with limited laboratory aid and investigations. Medications can vary, from steroids, immunosuppressants, and biologics, including anti-tnf alpha antagonist drugs. METHOD Information on updated etiology, clinical symptoms, diagnosis, and treatment of rpc has been obtained via extensive research of electronic literature published between 1976 and 2019 using PubMed and medline databases. English was the language of use. Search inputs included 'relapsing polychondritis,' 'polychondritis,' 'relapsing polychondritis symptoms,' and 'treatment of relapsing polychondritis.' Published articles in English that outlined and reported rpc's clinical manifestations and treatment ultimately met the inclusion criteria. Articles that failed to report the above and reported on other cartilaginous diseases met the exclusion criteria. RESULT Utilizing an extensive overview of work undertaken in critical areas of RPC research, this review intends to further explore and educate the approach to this disease in all dimensions from pathophysiology, diagnosis, and management. CONCLUSION RPC is a rare multi-systemic autoimmune disease and possibly fatal. The management remains empiric and is identified based on the severity of the disease per case. The optimal way to advance is to continue sharing data on RPC from reference centers; furthermore, clinical trials in randomized control groups must provide evidence-based treatment and management. Acquiring such information will refine the current knowledge of RPC, which will improve not only treatment but also diagnostic methods, including imaging and biological markers.
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Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Hamza Tariq
- Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacob Mitchell
- Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Azad Mohammed
- Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Włodzimierz Samborski
- Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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23
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Talarico R, Marinello D, Bombardieri S, Burmester G, Fonseca J, Frank C, Galetti I, Hachulla E, Houssiau F, Mueller-Ladner U, Schneider M, Smith V, Turchetti G, van Laar JM, Vieira A, Cutolo M, Mosca M. Clinical practice guidelines adherence, knowledge and awareness in rare and complex connective tissue diseases across Europe: results from the first ERN ReCONNET survey. RMD Open 2021; 6:0. [PMID: 32868449 PMCID: PMC7507993 DOI: 10.1136/rmdopen-2020-001344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/26/2020] [Accepted: 08/10/2020] [Indexed: 11/08/2022] Open
Abstract
Introduction The European Reference Network (ERN) ReCONNET is the ERN aimed at improving the management of rare and complex connective tissue and musculoskeletal diseases (rCTDs) across the European Union (EU). In the mission of ERN ReCONNET, clinical practice guidelines (CPGs) play a crucial role, representing a valid tool towards the harmonisation of the management of rCTDs while improving effectiveness and quality of care delivered to patients. Methods ERN ReCONNET developed two surveys to map the adherence to rCTDs CPGs among healthcare providers and to assess the knowledge and awareness of CPGs for their diseases among patients, family members and caregivers. Results The results of the surveys highlighted that healthcare professionals find it useful to apply CPGs in clinical practice (93%), while 62% of them experience difficulties and barriers in the application in their centres. Healthcare professionals also highlighted the need to develop CPGs for all rCTDs and to implement the use of the existing CPGs in clinical practice. On the other hand, patients, families and caregivers are relatively aware of the purpose of CPGs (51%) and 62% of them were aware of the existence of CPGs for their disease. Patient-friendly versions of CPGs and patients’ lifestyle guidelines should be systematically developed contributing to the empowerment of patients in the disease management. Conclusion ERN ReCONNET is addressing the main issues identified in the results of the survey, promoting practical actions for the local adaptation of CPGs across Europe, improving their routine clinical use and increasing the awareness on CPGs among rCTDs patients, family members and caregivers.
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Affiliation(s)
- Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joao Fonseca
- Serviço De Reumatologia E Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte E.P.E, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Charissa Frank
- Flemish Association for Hereditary Connective Tissue Disorders in Belgium, Koersel, Belgium
| | - Ilaria Galetti
- FESCA, Federation of European Scleroderma Associations, Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Frederic Houssiau
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique De Louvain, Louvain-la-Neuve, Belgium
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany.,Justus Liebig Universitat Giessen, Giessen, Germany
| | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ana Vieira
- Núcleo Síndrome De Sjögren, Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | - Maurizio Cutolo
- Department of Internal Medicine, University of Genoa, Genova, Italy.,Research Laboratory and Academic Division of Clinical Rheumatology, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Rheumatology Unit, University of Pisa, Pisa, Italy
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24
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CT findings of non-neoplastic central airways diseases. Jpn J Radiol 2021; 40:107-119. [PMID: 34398372 DOI: 10.1007/s11604-021-01190-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023]
Abstract
Non-neoplastic lesions of central airways are uncommon entities with different etiologies, with either focal or diffuse involvement of the tracheobronchial tree. Clinical symptoms of non-neoplastic tracheobronchial diseases are non-specific, and diagnosis is difficult, especially in the early stages. Three-dimensional computed tomography (3D-CT) is an evaluable tool as it allows to assess and characterize tracheobronchial wall lesions and meanwhile it enables the evaluation of airways surrounding structures. Multiplanar reconstructions (MPR), minimum intensity projections (MinIP), and 3D Volume Rendering (VR) (in particular, virtual bronchoscopy) also provide information on the site and of the length of airway alterations. This review will be discussed about (1) primary airway disorders, such as relapsing polychondritis, tracheobronchophathia osteochondroplastica, and tracheobronchomegaly, (2) airway diseases, related to granulomatosis with polyangiitis, Chron's disease, Behcet's disease, sarcoidosis, amyloidosis, infections, intubation and transplantation, (3) tracheobronchial malacia, and (4) acute tracheobronchial injury. 3D-CT findings, especially with MPR and 3D VR reconstructions, allows us to evaluate tracheobronchial disease morphologically in detail.
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25
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Kothari T, Valsamakis T, Sridhar AV, Ahmed MI. Case of paediatric relapsing polychondritis with severe airway involvement: the challenges of long-term airway and respiratory management. BMJ Case Rep 2021; 14:e239774. [PMID: 34380670 PMCID: PMC8359488 DOI: 10.1136/bcr-2020-239774] [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] [Accepted: 08/01/2021] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 15-year-old girl diagnosed with relapsing polychondritis (RP) with involvement of the tracheobronchial tree, resulting in an increased difficulty in breathing, hoarseness of voice and stridor.Her case required the input of multiple specialities including ear, nose and throat, rheumatology, respiratory team and intensive care. Airway assessment and imaging showed glottic and subglottic stenosis and left bronchomalacia. Despite the use of steroids, cyclophosphamide and rituximab, her symptoms progressed and she was started on overnight non-invasive ventilation.She had further relapses of her airway RP-she was started on adalimumab and methotrexate and underwent monthly balloon dilatations which helped with her symptoms and facilitated a safe discharge home. However, she had further relapses and intensive care admissions and following further discussions, a tracheostomy was inserted. She is now stable on her tracheostomy and is off any respiratory support.
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Chen N, Zheng Y. Characteristics and Clinical Outcomes of 295 Patients With Relapsing Polychondritis. J Rheumatol 2021; 48:1876-1882. [PMID: 34334365 DOI: 10.3899/jrheum.210062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study analyzes the clinical features of Chinese patients with relapsing polychondritis (RP). METHODS The clinical data of 295 patients with RP at Beijing Tongren Hospital were retrospectively analyzed. RESULTS The mean age of onset was 41.0 ± 15.0 years. The sex ratio was 1:1. Up to 70.5% of the patients had airway involvement during the disease course; among them, the larynx was most commonly affected (82.2%). One-quarter (25.7%) of the patients with laryngeal involvement underwent tracheotomy as a result of progressive dyspnea or acute laryngeal obstruction. Younger age at onset and respiratory symptoms at initial presentation were independent risk factors for tracheotomy in patients with RP with laryngeal involvement. The risk of tracheotomy in patients who presented with respiratory symptoms was 2.35 times higher than that of patients who presented with other symptoms (HR 2.35, 95% CI 1.23-4.50, P = 0.01). The risk of tracheotomy increased by 4.8% for every 1-year decrease in the age at onset (HR 0.95, 95% CI 0.93-0.97, P < 0.001). The incidence of lower respiratory tract infection was much higher in patients with airway involvement than in those without airway involvement. The main cause of death was respiratory failure as a result of airway obstruction. CONCLUSION There is a high prevalence of airway involvement in Chinese patients with RP. Laryngeal involvement is associated with a high risk of death. More attention should be paid to patients with RP with laryngeal involvement who are young at disease onset and present with respiratory symptoms.
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Affiliation(s)
- Nan Chen
- N. Chen, MD, Department of Rheumatology and Immunology, Beijing Tongren Hospital, Capital Medical University; Y. Zheng, MD, Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Zheng, Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China. . Accepted for publication July 16, 2021
| | - Yi Zheng
- N. Chen, MD, Department of Rheumatology and Immunology, Beijing Tongren Hospital, Capital Medical University; Y. Zheng, MD, Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Zheng, Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China. . Accepted for publication July 16, 2021
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Ritschl V, Ferreira RJO, Santos EJF, Fernandes R, Juutila E, Mosor E, Santos-Costa P, Fligelstone K, Schraven L, Stummvoll G, Salvador M, Poole JL, van den Ende C, Boström C, Stamm TA. Suitability for e-health of non-pharmacological interventions in connective tissue diseases: scoping review with a descriptive analysis. RMD Open 2021; 7:rmdopen-2021-001710. [PMID: 34326205 PMCID: PMC8323400 DOI: 10.1136/rmdopen-2021-001710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Non-pharmacological interventions support patients with connective tissue diseases to better cope with and self-manage their diseases. This study aimed to map existing evidence on non-pharmacological interventions in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and mixed connective tissue diseases regarding content, feasibility and potential suitability in an e-health setting. Methods A literature search was performed in eight different databases in July 2020. The intervention’s content was extracted using the ‘Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide’. A Sankey diagram and descriptive statistics were used to analyse the data and illustrate the relationships between the interventions. Results Of 8198 identified records, 119 papers were eligible. One hundred and four of them (87.4%) were conducted between 2000 and 2020, mainly in the USA (SLE n=24 (21.2%), SSc n=16 (14.2%)), Brazil (SLE n=8 (7.1%), SSc n=5 (4.4%)) and Italy (SLE n=0 (0%), SSc n=12 (10.6%)). Fifty-two studies (SLE n=24 (21.2%), SSc n=28 (24.8%)) used multicomponent interventions. The single interventions were physical exercises (SLE n=16 (14.2%), SSc n=17 (15.0%)), coaching/counselling (SLE n=11 (18.0%), SSc n=0 (0%)) and education (SLE n=2 (1.8%), SSc n=3 (2.7%)). Primary outcomes focused on physical function (SLE n=1 (0.9%), SSc n=15 (13.3%)), mouth opening in SSc (n=4 (5.9%)) and physical capacity (SLE n=2 (1.8%), SSc n=1 (0.9%)). No interventions for mixed connective tissue disease were found. Conclusion There was a great variety in the intervention’s content due to differences in body structure, activity limitations and participation restrictions in SLE and SSc. These results highlight the need for personalised, multicomponent, non-pharmacological interventions, which could be delivered as e-health interventions.
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Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo José Ferreira Santos
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Rúben Fernandes
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Essi Juutila
- Metropolia University of Applied Sciences, Helsinki, Finland
| | - Erika Mosor
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | | | - Linda Schraven
- Federation of European Scleroderma Associations, Amsterdam, The Netherlands
| | | | - Maria Salvador
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria .,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
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Three new inflammatory markers C reactive protein to albumin ratio, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio correlated with relapsing polychondritis disease activity index. Clin Rheumatol 2021; 40:4685-4691. [PMID: 34160712 DOI: 10.1007/s10067-021-05827-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The novel inflammatory markers C-reactive protein to albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were associated with the disease activity of many autoimmune diseases. The aim of this study was to evaluate the association of these new inflammatory indexes with relapsing polychondritis disease activity index (RPDAI). METHODS The data of relapsing polychondritis (RP) patients hospitalized between 2004 and 2020 at Peking Union Medical College Hospital were collected. One of the exclusive criteria was that RP patients overlapped with other diseases. Another was the RP patients with incomplete data. A total of 170 RP patients and 170 healthy controls (HCs) were included. The association of new inflammatory makers with RPDAI was assessed by Spearman's correlation analysis. RESULTS Compared to HCs, the CAR, NLR, and PLR were significantly higher in RP patients (both p < 0.001). The CAR, NLR, PLR, erythrocyte sedimentation rate and neutrophil counts in peripheral blood positively correlated with RPDAI. Blood albumin, lymphocyte count, hemoglobin (Hb) negatively correlated with RPDAI. The association of CAR, NLR, and PLR with RPDAI was demonstrated by Spearman's correlation analysis. CONCLUSION The novel inflammatory markers CAR, NLR and PLR were associated with RPDAI. Key Points • This is the first research to explore the association of CAR, NLR, and PLR with disease activity in patients with RP • CAR, NLR, and PLR are positively correlated with RPDAI • CAR, NLR, and PLR might be the potential predictors of disease activity in RP.
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Zhang L, Yun S, Wu T, He Y, Guo J, Han L, Lu J, Liu X, Yang R, Zhang S, Li T, Liu S. Clinical patterns and the evolution of relapsing polychondritis based on organ involvement: a Chinese retrospective cohort study. Orphanet J Rare Dis 2021; 16:225. [PMID: 34001193 PMCID: PMC8130285 DOI: 10.1186/s13023-021-01861-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Relapsing polychondritis (RPC) is a rare autoimmune disease and its early diagnosis remains challenging. Defining the clinical patterns and disease course may help early recognition of RPC. Results Sixty-six males and 60 females were included in this study. The average age at onset were 47.1 ± 13.8 years and the median follow-up period was 18 months. Correlation analysis revealed a strong negative correlation between airway involvement and auricular chondritis (r = − 0.75, P < 0.001). Four distinct clinical patterns were identified: Ear pattern (50.8%), Airway pattern (38.9%), Overlap pattern (4.8%) and Airway-Ear negative pattern (5.6%), and patients with Ear pattern and Airway pattern were further divided into limited and systemic form of RPC (27.8% with limited form of Ear pattern and 24.6% with limited form of Airway pattern initially). During follow-up, a minority of patients with Ear pattern and Airway pattern progressed into Overlap pattern, and some Airway-Ear negative pattern patients progressed into Ear pattern. While a large majority of limited RPC patients remained limited form during follow-up, a minority of limited RPC patients progressed into systemic form. Patients with Ear pattern had the highest survival rate and relatively lower inflammatory status. Conclusions RPC patients can be categorized as 4 different clinical patterns and 2 distinct presenting forms (limited and systemic) based on organ involvement. The clinical patterns and presenting forms may evolve during follow-up. Our findings may facilitate early recognition of this rare disease.
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Affiliation(s)
- Lei Zhang
- Rheumatology Department, The First Affiliated Hospital of Zhengzhou University, E1 Jianshe Road, Zhengzhou, 450052, Henan, China.
| | - Shuang Yun
- Ophthalmology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Tiange Wu
- Rheumatology Department, The First Affiliated Hospital of Zhengzhou University, E1 Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yujie He
- Rheumatology Department, The First Affiliated Hospital of Zhengzhou University, E1 Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Jinyan Guo
- Rheumatology Department, The First Affiliated Hospital of Zhengzhou University, E1 Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Lishuai Han
- Rheumatology Department, The First Affiliated Hospital of Zhengzhou University, E1 Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Jiameng Lu
- Rheumatology Department, The First Affiliated Hospital of Zhengzhou University, E1 Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Xiaojun Liu
- Rheumatology Department, The First Affiliated Hospital of Zhengzhou University, E1 Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Rui Yang
- Pulmonology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shitao Zhang
- Otolaryngology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Tianfang Li
- Rheumatology Department, The First Affiliated Hospital of Zhengzhou University, E1 Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Shengyun Liu
- Rheumatology Department, The First Affiliated Hospital of Zhengzhou University, E1 Jianshe Road, Zhengzhou, 450052, Henan, China
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Rose E, Ferrada MA, Quinn KA, Goodspeed W, Arnaud L, Sharma A, Yoshifuji H, Kim J, Allen C, Sirajuddin A, Chen M, Grayson PC. Physician Global Assessment as a Disease Activity Measure for Relapsing Polychondritis. Arthritis Care Res (Hoboken) 2021; 74:1269-1276. [PMID: 33544969 PMCID: PMC8339175 DOI: 10.1002/acr.24574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/17/2020] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Relapsing polychondritis (RP) is a systemic inflammatory disorder of cartilage that lacks validated disease activity measures. Physician global assessment (PhGA), a measure of disease activity commonly used in rheumatologic diseases, has not been tested in a cohort of patients with RP. METHODS Adult patients in an observational cohort of RP underwent standardized, comprehensive evaluation at approximately 6-month intervals. PhGA was scored by three physicians from the evaluating institution on a scale of 0 to 10 for each visit. A random subset of twenty visits was scored by three, independent physicians not affiliated with the evaluating institution. Treatment change between consecutive visits was categorized as increased, decreased or unchanged. RESULTS 78 patients were evaluated over 164 visits. The interclass correlation coefficient (ICC) (2, 1) for the three raters from the evaluating institution was excellent (0.79, 95% CI: 0.73-0.84) but was poor in the subset of cases scored by the additional raters (ICC (2,1) = 0.27, 95% CI: -0.01-0.53). Median PhGA was 3 (range 0-7). PhGA weakly correlated with CRP (rs = 0.30, p< 0.01). In response to increased treatment, median PhGA decreased from 3 (IQR: 2-4) to 2 (IQR: 2-3) (p< 0.01) but rarely went to 0. CONCLUSION Within a single-center, PhGA can be used to quantify disease activity and monitor disease response in RP. Persistent disease activity despite treatment, rather than a relapsing-remitting pattern, is observed for most patients with RP. Reliability of PhGA may not generalize across different institutions. A validated disease-specific activity index is needed in RP.
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Affiliation(s)
- Emily Rose
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Marcela A Ferrada
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Kaitlin A Quinn
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Wendy Goodspeed
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Autoimmune Diseases (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aman Sharma
- Clinical Immunology and Rheumatology Wing, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Japan
| | - Jeff Kim
- Office of Clinical Director, National Institutes on Deafness and Other Communication Disorder, National Institutes of Health, Bethesda, Maryland, USA
| | - Clint Allen
- Otolaryngology, National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland, USA
| | - Arlene Sirajuddin
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus Chen
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
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Mira C, Montalvão P, Fonseca I, Borges A. Localised laryngotracheal amyloidosis: a differential diagnosis not to forget. BMJ Case Rep 2021; 14:e237954. [PMID: 33526525 PMCID: PMC7853032 DOI: 10.1136/bcr-2020-237954] [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] [Accepted: 12/13/2020] [Indexed: 02/03/2023] Open
Abstract
We present a case of multifocal laryngotracheal amyloidosis (LTA) in a 43-year-old man with persistent and progressive dysphonia and dyspnoea, and a first inconclusive histology. Although laryngeal amyloidosis accounts for fewer than 1% of all benign laryngeal tumours, it is in fact the most common site of amyloid deposition in the head, neck and respiratory tract. The clinical scenario is non-specific and diagnosis depends on a high degree of suspicion and on histology. Imaging is useful in mapping lesions, which are often more extensive than they appear during laryngoscopy. Despite being a benign entity, the prognosis is variable with a high-rate and long-latency recurrences, requiring long-term follow-up.
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Affiliation(s)
- Catarina Mira
- Radiology Department, Hospital Beatriz Angelo, Loures, Portugal
| | - Pedro Montalvão
- Otorhinolaryngology Deparment, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisbon, Portugal
| | - Isabel Fonseca
- Pathology, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisboa, Portugal
| | - Alexandra Borges
- Radiology Department, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisboa, Portugal
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D'Cruz DP, Ferrada MA. Relapsing Polychondritis and Large-vessel Vasculitis. J Rheumatol 2020; 47:1732-1733. [PMID: 33262286 DOI: 10.3899/jrheum.200083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- David P D'Cruz
- D.P. D'Cruz, MD, FRCP, Louise Coote Lupus Unit, Guy's Hospital, London, UK;
| | - Marcela A Ferrada
- M.A. Ferrada, MD, US National Institutes of Health, Bethesda, Maryland, USA
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Ruaro B, Casabella A, Molfetta L, Salton F, Confalonieri P, Confalonieri M, Baratella E, De Tanti A, Bruni C. What Role Does Trabecular Bone Score Play in Chronic Inflammatory Rheumatic Diseases? Front Med (Lausanne) 2020; 7:600697. [PMID: 33425947 PMCID: PMC7793927 DOI: 10.3389/fmed.2020.600697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Patients suffering from rheumatic inflammatory diseases, e.g., systemic sclerosis, rheumatoid arthritis, and ankylosing spondylitis, are at risk of low bone mass. Dual-energy X-ray Absorptiometry (DXA) is the traditional radiological measurement technique for bone mineral density (BMD). The recently developed trabecular bone score (TBS) enhances the skeletal information provided by standard BMD. It re-analyzes the spatial dynamics of pixel intensity changes in lumbar spine DXA images, defining a quantitative index, characterizing trabecular bone microarchitecture. It has been demonstrated that low TBS values are associated with an increased incidence of fractures in patients with rheumatic diseases. These methods used together for bone damage evaluation can be of value to identify individuals who will potentially fracture. The main scientific literature on the clinical aspects of osteoporosis, including the use of TBS in evaluating this pathology, are herein reported aimed at shedding light on the role trabecular bone score plays in chronic inflammatory rheumatic diseases.
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Affiliation(s)
| | - Andrea Casabella
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
- Department of Internal Medicine Di.M.I, Osteoporosis, Bone and Joint Disease Research Center, CROPO, University of Genoa, Genoa, Italy
| | - Luigi Molfetta
- Department of Integrated Surgical and Diagnostic Sciences, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
| | | | | | | | - Elisa Baratella
- Department of Radiology, Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - Antonio De Tanti
- Cardinal Ferrari Centre, S. Stefano Rheabilitation, Fontanellato, Italy
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
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Yang C, Tang S, Zhu D, Ding Y, Qiao J. Classical Disease-Specific Autoantibodies in Systemic Sclerosis: Clinical Features, Gene Susceptibility, and Disease Stratification. Front Med (Lausanne) 2020; 7:587773. [PMID: 33330547 PMCID: PMC7710911 DOI: 10.3389/fmed.2020.587773] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterized by abnormalities in microcirculation, extracellular matrix accumulation, and immune activation. Autoantibodies are markers of immune abnormalities and provide diagnostic and predictive value in SSc. Anti-topoisomerase antibodies (ATAs), anticentromere antibodies (ACAs), and anti-RNA polymerase antibodies (ARAs) are the three classical specific antibodies with the highest availability and stability. In this review, we provide an overview of the recent progress in SSc research with respect to ATAs, ACAs, and ARAs, focusing on their application in distinguishing clinical phenotypes, such as malignancy and organ involvement, identifying genetic background in human leukocyte antigen (HLA) or non-HLA alleles, and their potential roles in disease pathogenesis based on the effects of antigen-antibody binding. We finally summarized the novel analysis using ATAs, ACAs, and ARAs on more detailed disease clusters. Considering these advantages, this review emphasizes that classical SSc-specific autoantibodies are still practical and have the potential for patient and risk stratification with applications in precise medicine for SSc.
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Affiliation(s)
- Changyi Yang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shunli Tang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dingxian Zhu
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yingguo Ding
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Guiot J, Henket M, Andre B, Herzog M, Hardat N, Njock MS, Moermans C, Malaise M, Louis R. A new nucleosomic-based model to identify and diagnose SSc-ILD. Clin Epigenetics 2020; 12:124. [PMID: 32807242 PMCID: PMC7430109 DOI: 10.1186/s13148-020-00915-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/30/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is a rare connective tissue disease associated with rapid evolving interstitial lung disease (SSc-ILD), driving its mortality. Specific biomarkers associated with the evolution of the lung disease are highly needed. We aimed to identify specific biomarkers of SSc-ILD to predict the evolution of the disease. Nucleosomes are stable DNA/protein complexes that are shed into the blood stream making them ideal candidates for biomarkers. METHODS We studied circulating cell-free nucleosomes (cf-nucleosomes) in SSc patients, 31 with ILD (SSc-ILD) and 67 without ILD. We analyzed plasma levels for cf-nucleosomes and investigated whether global circulating nucleosome levels in association with or without other biomarkers of interest for systemic sclerosis or lung fibrosis (e.g., serum growth factors: IGFBP-1 and the MMP enzyme: MMP-9), could be suitable potential biomarkers for the correct identification of SSc-ILD disease. RESULTS We found that H3.1 nucleosome levels were significantly higher in patients with SSc-ILD compared SSc patients without ILD (p < 0.05) and levels of MMP-9 were significantly increased in patients with SSc-ILD compared to SSc patients without ILD (p < 0.05). Conversely, IGFBP-1 was significantly reduced in patients with SSc-ILD compared to SSc without ILD (p < 0.001). The combination of cf-nucleosomes H3.1 coupled to MMP-9 and IGFBP-1 increased the sensitivity for the differential detection of SSc-ILD. High levels of accuracy were reached with this combined model: its performances are strong with 68.4% of positive predictive value and 77.2% of negative predictive value for 90% of specificity. With our model, we identified a significant negative correlation with FVC % pred (r = -0.22) and TLC % pred (r = -0.31). The value of our model at T1 (baseline) has a predictive power over the Rodnan score at T2 (after 6-18 months), showed by a significant linear regression with R2 = 19% (p = 0.013). We identified in the sole group of SSc-ILD patients a significant linear regression with a R2 = 54.4% with the variation of DLCO between T1 and T2 (p < 0.05). CONCLUSION In our study, we identified a new blood-based model with nucleosomic biomarker in order to diagnose SSc-ILD in a SSc cohort. This model is correlated with TLC and FVC at baseline and predictive of the skin evolution and the DLCO. Further longitudinal exploration studies should be performed in order to evaluate the potential of such diagnostic and predictive model.
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Affiliation(s)
- Julien Guiot
- Pneumology Department, CHU Liège, Domaine Universitaire du Sart-Tilman, B35, B4000, Liège, Belgium.
| | - Monique Henket
- Pneumology Department, CHU Liège, Domaine Universitaire du Sart-Tilman, B35, B4000, Liège, Belgium
| | - Béatrice Andre
- Rheumatology Department, CHU Liège, Domaine Universitaire du Sart-Tilman, B35, B4000, Liège, Belgium
| | - Marielle Herzog
- Belgian Volition SPRL, Parc Scientifique Créalys, 22 rue Phocas lejeune, B5032, Isnes, Belgium
| | - Nathalie Hardat
- Belgian Volition SPRL, Parc Scientifique Créalys, 22 rue Phocas lejeune, B5032, Isnes, Belgium
| | - Makon-Sebastien Njock
- Pneumology Department, CHU Liège, Domaine Universitaire du Sart-Tilman, B35, B4000, Liège, Belgium
- Rheumatology Department, CHU Liège, Domaine Universitaire du Sart-Tilman, B35, B4000, Liège, Belgium
| | - Catherine Moermans
- Pneumology Department, CHU Liège, Domaine Universitaire du Sart-Tilman, B35, B4000, Liège, Belgium
| | - Michel Malaise
- Rheumatology Department, CHU Liège, Domaine Universitaire du Sart-Tilman, B35, B4000, Liège, Belgium
| | - Renaud Louis
- Pneumology Department, CHU Liège, Domaine Universitaire du Sart-Tilman, B35, B4000, Liège, Belgium
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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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Ren F, Tang L. Aortarctia: a rare manifestation of relapsing polychondritis. Rheumatology (Oxford) 2020; 59:1764. [PMID: 31642903 DOI: 10.1093/rheumatology/kez496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Feifeng Ren
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Tang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Schwartz MN, Rimland CA, Quinn KA, Ferrada MA, Gribbons KB, Rosenblum JS, Goodspeed W, Novakovich E, Grayson PC. Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis. J Rheumatol 2020; 47:1785-1792. [PMID: 32238516 DOI: 10.3899/jrheum.190828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the validity and clinical utility of the Brief Illness Perception Questionnaire (BIPQ) to measure illness perceptions in multiple forms of vasculitis. METHODS Patients with giant cell arteritis (GCA), Takayasu arteritis (TA), antineutrophil cytoplasmic antibody-associated vasculitis (AAV), and relapsing polychondritis (RP) were recruited into a prospective, observational cohort. Patients independently completed the BIPQ, Multidimensional Fatigue Inventory (MFI), Medical Outcomes Study 36-item Short Form survey (SF-36), and a patient global assessment (PtGA) at successive study visits. Physicians concurrently completed a physician global assessment (PGA) form. Illness perceptions, as assessed by the BIPQ, were compared to responses from the full-length Revised Illness Perception Questionnaire (IPQ-R) and to other clinical outcome measures. RESULTS There were 196 patients (GCA = 47, TA = 47, RP = 56, AAV = 46) evaluated over 454 visits. Illness perception scores in each domain were comparable between the BIPQ and IPQ-R (3.28 vs 3.47, P = 0.22). Illness perceptions differed by type of vasculitis, with the highest perceived psychological burden of disease in RP. The BIPQ was significantly associated with all other patient-reported outcome measures (rho = |0.50-0.70|, P < 0.0001), but did not correlate with PGA (rho = 0.13, P = 0.13). A change in the BIPQ composite score of ≥ 7 over successive visits was associated with concomitant change in the PtGA. Change in the MFI and BIPQ scores significantly correlated over time (rho = 0.38, P = 0.0008). CONCLUSION The BIPQ is an accurate and valid assessment tool to measure and monitor illness perceptions in patients with vasculitis. Use of the BIPQ as an outcome measure in clinical trials may provide complementary information to physician-based assessments.
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Affiliation(s)
- Mollie N Schwartz
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Casey A Rimland
- C.A. Rimland, PhD, Systemic Autoimmunity Branch, NIH, NIAMS, Bethesda, Maryland, and University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina
| | - Kaitlin A Quinn
- K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, Bethesda, Maryland, and Division of Rheumatology, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Marcela A Ferrada
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - K Bates Gribbons
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Joel S Rosenblum
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Wendy Goodspeed
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Elaine Novakovich
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Peter C Grayson
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland;
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Abstract
Relapsing polychondritis (RP) is a rare auto-immune disease that causes progressive destruction of cartilaginous structures. Most cases of pediatric-onset RP were published as a single case report or hand-full case series although the prevalence of RP is unknown. This review aimed to describe the characteristics of pediatric-onset RP in order to provide a comparison between childhood and adulthood features of the disease and to review the experiences of biological agents used in children with RP. In children, the diagnosis of RP is either delayed or overlooked due to low incidence and variability in clinical features. Treatment of RP is challenging due to the recurrent episodic nature of the disease. Different immunosuppressive medications, including steroid and steroid-sparing disease-modifying antirheumatic drugs (DMARDs), such as methotrexate or azathioprine, are used to treat RP. There is no rigorous clinical research to support the use of new therapeutic modalities, including biological agents. It is challenging to protocolize the treatment of pediatric-onset RP due to the rarity of the disease. Corticosteroids are the primary form of therapy. However, DMARDs and biological agents may have a role in treating patients with sustained or refractory disease.
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Affiliation(s)
- Jubran T Alqanatish
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
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Relapsing polychondritis - analysis of symptoms and criteria. Reumatologia 2019; 57:8-18. [PMID: 30858626 PMCID: PMC6409832 DOI: 10.5114/reum.2019.83234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 01/26/2023] Open
Abstract
Objectives Relapsing polychondritis (RP) is a rare disease characterised by recurrent inflammation of the cartilaginous structures and proteoglycan-rich organs. The aim of this case series study is to share the 10-year clinical experience of our department in diagnosing RP patients in the context of data from available published studies. Material and methods A retrospective case analysis of 10 patients with symptoms of RP, hospitalised at the Department of Rheumatology and Internal Diseases of Wrocław University Hospital between January 2008 and December 2018. Results Nine out of 10 patients fulfilled at least one of the three sets of the diagnostic criteria. The mean age (±standard deviation) at diagnosis was 54.4 ±13.3 years and ranged from 32 to 73 years. The symptoms suggestive of the RP diagnosis were mainly inflammation of the pinna (in 80% of patients) and laryngeal stenosis (in 20% of patients). The mean age at which initial symptoms were observed was 52.3 ±12.0 years and ranged from 31 to 69 years. Auricular chondritis was the first manifestation of the disease in 40% of cases (two women and two men) laryngeal chondritis in 20%, nasal chondritis in 10%, and bronchial stenosis in 10%. Other initial symptoms were polyarthritis, which was present in 10% of cases (male) and general symptoms observed in 10%. Conclusions A thorough analysis of the entire medical history with specific questions about the occurrence of the manifestations of the disease in the past leads to the diagnosis of RP. The RP also should be considered in differential diagnosis of respiratory track narrowings. It is very useful to apply the three sets of criteria simultaneously in the diagnostic process.
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