Background/Purpose: Relapsing polychondritis (RP) is a relatively rare, but progressive disease with predilection for cartilage, with few data available regarding the arthritis in this setting. Purpose: To assess the type of articular involvement and its clinical associations of RP.

Methods: Systematic retrospective analysis of all patients diagnosed with RP in the Rheumatology Department, a tertiary care facility,  over a 12-year period (2000 to 2012) using the hospital and outpatient databases. The McAdam diagnostic criteria for RP were employed. The patients were interviewed by the rheumatologist using a standard protocol. Patients self-taking pictures of the ear, eye or other involved organs during the painful episodes was encouraged.

Results:

We identified 34 patients (67% women),  age of onset 44.8 ± 16.9 years. The mean time  to diagnosis was 36 months (1-168), after consultations of 4 other specialists (1-8). Most frequent autoimmune disease associated were vasculitis (10 cases, 2 with  Behcet’s /MAGIC syndrome), SLE (5), Sjogren’s syndrome (2) and psoriatic arthritis (2). Hematological malignancies were seen in 5 cases. The arthritis was present in 30/34 (88%) cases and was intermittent, but symmetric in 17 (56%) cases and asymmetric in 13 (43%), mimicking microcristalline arthritis in 9/30 (30%) cases. Mutilating arthritis was seen in 3 patients (2 with dissecting osteochondritis) and avascular necrosis in 3.  Chondrosternal and manubriosternal arthritis were noted in 61%  (21/34)  and 44% (15/34) cases, respectively; when inaugural, pointed to a diagnosis of Tietze or SAPHO syndrome. In 3 patients signs of vertebral chondritis were present, mimicking ankylosing spondylitis or vertebral chondrocalcinosis. Three patients diagnosed with Lyme disease  had acute intermittent arthritis attributed initially to borreliosis, before the appearance of chondrosternal arthritis and later of the ENT involvement. The symmetric arthritis was associated with a shorter  time  from onset to diagnosis (2.43 vs 4.3 yr, p=0.03) than the asymmetric one.  Symmetric arthritis was also correlated with more serious ENT involvement , auricular deformities (p=0.028) and also with ocular inflammation (p=0.03), pericarditis (p= 0.02), leukopenia (p=0.02) and glomerulonephritis (p=0.02). Rheumatoid factor was  present in only 4 cases, rather reflecting the presence of cryoglobulinemia or hematological malignancies.

Conclusion: Even in the presence of auricular or nasal chondritis, RP could still be a tricky diagnosis, several consultants being seen before diagnosis. In our series symmetric arthritis was associated with a more complicated disease course, possibly reflecting the underlying pathology.  The diagnosis of RP should be considered in recurrent paroxistic chest pain and also in vertebral acute relapsing pain. The instruction of patients to self-report and to document by pictures an evanescent inflammation could add to a better recognition of disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/articular-involvement-in-relapsing-polychondritis-a-case-series/