Background/Purpose: Relapsing polychondritis (RP) is an autoimmune disorder that can present with airway inflammation, leading to dyspnea, cough, and fatigue. These respiratory symptoms are frequently misattributed to difficult-to-control asthma, often resulting in delayed or missed RP diagnoses. In our single-center prospective cohort, we aimed to evaluate the prevalence of prior asthma diagnoses and characterize airway findings on imaging among patients ultimately diagnosed with RP.

Methods: All patients had with confirmed diagnosis of RP based were enrolled in a prospective cohort study. A presumptive diagnosis of asthma was defined as either a chart-documented asthma diagnosis or a prescription for a rescue or maintenance inhaler prior to the RP diagnosis. All patients were evaluated for disease activity and organ damage at the time of clinical assessment. Patients with respiratory symptoms underwent dynamic expiratory CT imaging to evaluate for airway involvement. Statistical analysis was performed using t-tests for categorical variables to assess associations

Results: A total of 40 patients with confirmed relapsing polychondritis (RP) underwent dynamic expiratory CT imaging at our institution. Of these, 15 (38%) had a prior diagnosis of asthma, and 7 (18%) were diagnosed with tracheomalacia (TM). Overall, 6 patients were male; of those, 4 had TM. Males were more likely to have TM in this cohort. All patients were tested for VEXAS, and none of the male patients tested positive.Air trapping, indicative of small airway involvement, was identified in 13 patients (33%). TM strongly correlated with air trapping: all 7 patients with TM had air trapping, while none of the patients without TM did (100% vs. 19%, p < 0.001). Of the 13 patients with air trapping, 7 (54%) had TM.Despite frequent respiratory symptoms, only 5 patients underwent pulmonary function testing (PFTs), and none demonstrated improvement with bronchodilators. Only 3 patients had been evaluated by a pulmonologist. Most were treated empirically with short-acting beta agonists, without objective testing or confirmation of the underlying cause.There were no significant differences between patients with and without TM in inflammatory markers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), or Factor VIII. Muscle weakness was also not significantly different between groups

Conclusion: This study demonstrates that patients with relapsing polychondritis often have airway involvement, which is frequently misdiagnosed as asthma. The overlap in symptoms can lead to delayed recognition of RP-related airway disease and inappropriate treatment. These findings highlight an urgent need for better diagnostic tools to identify early airway involvement and prevent long-term damage. Future research should focus on characterizing the full spectrum of RP-related airway disease and developing reliable, noninvasive tests to support early diagnosis and targeted intervention.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relapsing-polychondritis-mimicking-asthma-while-airways-get-damaged/