Background/Purpose: In patients with atypical clinical symptoms or imaging findings, because there are no specific and easily measurable markers for RP serologically, it is often difficult to diagnose RP and detect RP flare earlier. Although previous studies have reported the usefulness of imaging tests such as contrast-enhanced CT, MRI, FDG-PET/CT and bone scintigraphy for diagnosis and assessment of disease activity, performing these imaging tests frequently is not realistic without careful consideration of cost, convenience, invasiveness and radiation exposure. Therefore, it is necessary to establish a more convenient and less invasive imaging modality that can be repeatedly used for diagnosis and evaluation of disease activity.

Objective: To assess the clinical utility of ultrasonography (US) in the diagnosis and monitoring of disease activity in relapsing polychondritis (RP).

Methods: Auricular and nasal chondritis of patients with RP (n = 6) were assessed by US before treatment initiation. Changes in the US findings as well as clinical findings and serum inflammatory markers were longitudinally assessed. We also performed US in patients with repeated ear trauma (n = 6), auricular cellulitis (n = 2), and healthy subjects (n = 6) and compared among groups.

Results: In all cases of RP, US finding before treatment showed low-echoic swollen auricular and nasal cartilage with increased Power Doppler signals (PDS), corresponding to biopsy findings. After treatment with prednisolone (PSL) combined with methotrexate, the clinical and serum inflammatory markers were completely resolved. Although perichondrial swelling and PDS on auricular US were also significantly improved, PDS remained in 2 of 6 cases, and these cases showed flare early after tapering PSL. Finally, US findings of RP were substantially differentiated from patients with repeated trauma and cellulitis and healthy subjects due to the thickness of soft tissue around the cartilage, PDS and subperichondrial serous effusion.

Conclusion: Assessment of RP lesions by US was useful for the evaluation of cartilaginous lesions and monitoring of disease activity, especially when considering the treatment response and the timing of drug tapering.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonography-of-auricular-cartilage-is-a-useful-tool-for-diagnosing-and-monitoring-disease-activity-in-relapsing-polychondritis/