Clinical observation of relapsing polychondritis: a report of 23 patients

Abstract

To explore the clinical characteristics of relapsing polychondritis (RP) for its early diagnosis and treatment. A retrospective analysis was performed for the clinical data and prognoses for 23 RP patients from April 1996 to October 2011 at Departments of Respiratory Medicine, Rheumatism and Otorhinolaryngology, First Affiliated Hospital, Zhengzhou University. Lesion locations included auricle (n = 19), joints (n = 17), nose (n = 14), respiratory tract (n = 10), eyes (n = 6), inner ear (n = 4), costal cartilage (n = 3) and kidney (n = 1). Laboratory examinations revealed elevated erythrocyte sedimentation rate (ESR) (n = 18), elevated C-reactive protein (CRP) (n = 16) and positive rheumatoid factor (n = 2). Laryngeal mucosa was edematous and the vocal cords were paralyzed in the cases with airway involvement under laryngofiberscopy. Tracheal mucosa was highly edematous and tracheal lumen narrowed in the cases examined under bronchofibroscope. Laryngeal mucosa was swollen, glottic chink narrowed, laryngeal cartilage partially absorbed and deformed in the cases examined with neck computed tomography (CT). Tracheal mucosa was thickened, tracheal lumen narrowed and tracheal cartilage was deformed and calcified in the cases on chest CT. Pathological examination on tracheal cartilage showed that cartilage tissue was degenerative and fibrotic. And the proliferation of granulation tissue and the infiltration of inflammatory cells were present around cartilage tissue. Twenty-three RP patients received the therapies of antibiotics, glucocorticosteroid, immunosuppressive agent, tracheotomy or tracheal stent implantation. Two cases died of asphyxia. One case died of myocardial infarct. The symptoms of other 20 cases improved in different degrees. The clinical manifestations are diverse in RP patients. The prognoses of patients with airway involvement are worse and may be improved by an early diagnosis and correct treatment.