Background/Purpose: MAGIC syndrome, a rare overlap of relapsing polychondritis (RP) and Behçet’s disease manifestations, remains poorly characterized compared to isolated RP. Behçet’s-associated features such as recurrent mucosal ulcerations and ocular inflammation may amplify systemic inflammatory burden. Given its hybrid nature involving vascular, mucosal, and cartilaginous inflammation, MAGIC may carry heightened risk for both airway and systemic complications. We aimed to compare clinical outcomes between patients with MAGIC syndrome and those with RP alone.

Methods: Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study identifying adults (≥18 years) diagnosed with RP. Cohort 1 (n=374) included patients with RP and concomitant features of Behçet’s disease, identified using ICD-10 codes for iridocyclitis or uveitis, recurrent oral ulcers, and genital ulcers (MAGIC syndrome). Cohort 2 (n=3,313) included patients with RP without these features. After 1:1 propensity score matching for demographics and comorbidities, 361 patients per cohort were analyzed. Outcomes over three years included thrombosis, vision loss, stroke, tracheal stenosis, gastrointestinal (GI) bleeding, inflammatory markers (CRP, ESR), and immunosuppressive or biologic therapy utilization. Risk analyses and Kaplan-Meier survival curves were performed.

Results: Following matching, baseline characteristics were well-balanced. Rates of thrombosis (3.3% vs 3.3%; p=0.994), vision loss (2.9% vs 2.9%; p=0.953), stroke (3.4% vs 4.3%; p=0.571), and GI bleeding (3.9% vs 3.1%; p=0.539) were similar between MAGIC and RP groups. Tracheal stenosis occurred more frequently in MAGIC (3.9% vs 3.0%) and was associated with a significantly increased hazard ratio (HR 4.18, 95% CI 1.19–14.66; p=0.015). Median CRP levels trended higher in MAGIC (31.3 vs 19.1 mg/L; p=0.055), while ESR was similar (24.6 vs 22.5 mm/hr; p=0.501). Use of non-biologic immunosuppressants (e.g., mycophenolate mofetil, azathioprine) was more common in RP, whereas biologic therapy (e.g., infliximab, tocilizumab) use was higher in MAGIC, though neither difference reached statistical significance.

Conclusion: Patients with MAGIC syndrome demonstrated similar risks of thrombosis, stroke, vision loss, and GI bleeding compared to matched RP patients. However, the significantly increased incidence of tracheal stenosis in MAGIC highlights a possible pathophysiologic overlap involving vasculitis, mucosal inflammation, and cartilaginous involvement—potentially accounting for increased airway compromise. These findings support vigilant airway surveillance and raise the possibility that MAGIC represents a more aggressive RP phenotype with unique clinical considerations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparative-outcomes-in-magic-syndrome-versus-relapsing-polychondritis-alone-a-propensity-matched-analysis/