Relapsing polychondritis (RP) is a rare, chronic autoimmune disorder characterized by recurrent inflammation of cartilage and other connective tissues throughout the body. Cartilage is a firm yet flexible type of connective tissue that provides structure and support to various parts of the body.

The areas most commonly affected by relapsing polychondritis include the ears, nose, eyes, joints, and respiratory tract.

Although RP is a long-term condition, its course is often unpredictable, with episodes of inflammation (flares) alternating with periods of improvement or remission. Some individuals may experience prolonged periods with few or no symptoms.

In many cases, the disease is relatively mild and can be effectively managed with appropriate medical care. However, if inflammation is left uncontrolled, repeated episodes can lead to permanent damage and destruction of cartilage. This damage may result in lasting changes to the affected structures and cannot always be reversed.

Relapsing polychondritis can also occur alongside other serious autoimmune and inflammatory conditions, including vasculitis and connective tissue diseases. When these associated conditions are present, they require appropriate investigation, monitoring, and treatment to prevent further complications.

The name relapsing polychondritis describes the characteristic pattern of the disease. The prefix “poly” means many, while “chondritis” refers to inflammation of cartilage. Together, the term describes a condition involving recurrent episodes of inflammation affecting cartilage in multiple parts of the body.

Diagnosing relapsing polychondritis (RP) can be challenging because there is no single laboratory test that definitively confirms the disease. Its symptoms can also resemble those of other autoimmune, inflammatory, and infectious conditions.

A rheumatologist, a specialist in arthritis and autoimmune diseases, is typically involved in evaluating and diagnosing relapsing polychondritis.

The diagnostic process generally begins with a detailed medical history and a comprehensive physical examination. The rheumatologist will assess symptoms, identify areas of cartilage inflammation, review previous episodes, and look for evidence of involvement in other organs. Blood tests, imaging studies, and other investigations may then be requested to support the diagnosis and rule out alternative conditions.

Blood tests can help identify systemic inflammation, assess general health, and investigate other possible causes of the symptoms. However, no blood test alone can establish a diagnosis of relapsing polychondritis.

Common investigations include:

• Complete Blood Count (CBC): Measures red blood cells, white blood cells, and platelets. Abnormalities may provide evidence of inflammation, infection, or an associated blood disorder.
• Erythrocyte Sedimentation Rate (ESR): Measures how quickly red blood cells settle in a test tube. An elevated result may indicate inflammation somewhere in the body.
• C-Reactive Protein (CRP): Measures a protein produced by the liver in response to inflammation. Elevated levels can indicate active inflammatory disease.
• Creatinine and Urinalysis: Assess kidney function and look for abnormalities, such as blood or protein in the urine, which may suggest kidney involvement or an associated vasculitis.
• Rheumatoid Factor (RF) and Antinuclear Antibodies (ANA): Help investigate other autoimmune conditions, including rheumatoid arthritis and lupus, which can produce overlapping symptoms.
• Additional Autoimmune Testing: Depending on the clinical presentation, tests such as antineutrophil cytoplasmic antibodies (ANCA) may be requested to investigate possible associated vasculitis.

When the body’s immune system is “activated” and busy attacking the spine and joints, it can make a person feel very tired, similar to when they have the flu.

Causes and Risk Factors of Relapsing Polychondritis

Relapsing polychondritis (RP) is a rare immune-mediated inflammatory disease in which the immune system mistakenly attacks the body’s own cartilage and, in some cases, other connective tissues. The exact cause of this abnormal immune response remains unknown. Researchers have not yet established why some individuals develop the condition while others do not.

Relapsing polychondritis can occur on its own or alongside other autoimmune, inflammatory, and malignant conditions. Approximately one-third of people with RP have an associated medical condition, while the remaining two-thirds have no identified underlying disorder.

Associated conditions may include:

• Systemic vasculitis.
• Connective tissue diseases.
• Rheumatoid arthritis.
• Thyroid disorders.
• Inflammatory bowel disease.
• Myelodysplastic syndromes and other blood disorders.
• Certain malignancies.

In some individuals, relapsing polychondritis may develop before another associated condition becomes apparent. This means that ongoing medical monitoring may be important, particularly when new or unexplained symptoms develop.

Who Develops Relapsing Polychondritis?

Relapsing polychondritis is extremely rare and can affect individuals of any age, sex, or ethnic background. However, certain demographic patterns have been observed.

• Age: The condition most commonly develops between the ages of 40 and 60, although it can occur in children and older adults.
• Ethnicity: RP has historically been reported more frequently among people of European ancestry, although it occurs worldwide.
• Sex: Men and women can both develop the disease, with some studies suggesting a slight predominance in women.

Because relapsing polychondritis is uncommon and its underlying cause is not fully understood, there are currently no established ways to predict who will develop the condition or reliably prevent its onset.

Treatment and Management of Relapsing Polychondritis

Relapsing polychondritis (RP) is a very rare, chronic inflammatory disease. Although there is currently no cure, several effective treatments are available to control inflammation, reduce symptoms, prevent permanent cartilage damage, and improve quality of life.

The course of the disease varies considerably from person to person. Some individuals experience relatively mild symptoms, while others develop more serious complications involving the eyes, respiratory tract, cardiovascular system, or other organs.

Treatment is therefore individualized according to the severity of the disease, the organs involved, the symptoms experienced, and whether other autoimmune or inflammatory conditions are present.

Living with Relapsing Polychondritis

People with relapsing polychondritis can lead active, fulfilling, and productive lives with appropriate treatment and regular medical care.

The following recommendations can help with long-term disease management:

• Learn about the condition: Understanding relapsing polychondritis, its symptoms, potential complications, and treatment options can help you make informed decisions about your healthcare.
• Attend regular medical appointments: Ongoing monitoring allows your healthcare team to assess disease activity, evaluate treatment effectiveness, and identify complications early.
• Manage associated conditions: If RP occurs alongside vasculitis, connective tissue disease, or another inflammatory condition, these disorders should also be appropriately treated.
• Understand your medications: Learn about the medications prescribed to you, including their benefits, potential side effects, and required monitoring.
• Recognize disease flares: Being aware of changes in your symptoms can help you seek medical attention promptly when inflammation becomes active.

A multidisciplinary healthcare team, often involving a rheumatologist and other specialists depending on organ involvement, can help coordinate treatment and long-term care.

Medications for Relapsing Polychondritis

Several medications can be used to manage relapsing polychondritis. The choice of treatment depends on disease severity, the tissues and organs affected, and the individual’s response to previous therapies.

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are sometimes used as initial treatment for mild disease, particularly when inflammation affects the ears, nose, or joints.

These medications help reduce inflammation, pain, and swelling. However, they may not provide sufficient control when the disease is more active or involves vital organs.

2. Corticosteroids (Prednisone)

Prednisone is commonly used to control inflammation when symptoms are more significant or when NSAIDs are insufficient.

It works by suppressing the immune system and reducing inflammatory activity. Higher doses may be necessary when RP affects important organs such as the eyes, respiratory tract, or cardiovascular system.

Long-term corticosteroid use can cause significant side effects, so physicians generally aim to use the lowest effective dose and gradually reduce treatment when disease activity allows.

3. Dapsone

Dapsone is an anti-inflammatory medication that may be considered in selected patients, particularly those with milder disease or certain skin and cartilage manifestations.

It requires appropriate blood monitoring because of potential adverse effects, including haemolytic anaemia and other blood abnormalities.

4. Disease-Modifying Antirheumatic Drugs (DMARDs)

When inflammation persists despite initial treatment, or when patients require prolonged corticosteroid therapy, disease-modifying medications may be introduced.

These medications help control abnormal immune activity and reduce the frequency and severity of inflammatory episodes.

Commonly used medications include:

• Methotrexate: Suppresses immune activity and is frequently used as a steroid-sparing treatment.
• Azathioprine (Imuran): Reduces immune-system activity and may be used for more persistent or systemic disease.
• Cyclophosphamide (Cytoxan): A stronger immunosuppressive medication that may be considered in severe, organ-threatening disease, particularly when associated vasculitis is present.

Other immunosuppressive and biologic therapies may be considered by specialists when conventional treatments are ineffective.

5. Treatment of Severe Organ Involvement

When relapsing polychondritis affects vital organs, more intensive treatment may be necessary.

For example:

• Eye involvement: Higher-dose corticosteroids and additional immunosuppressive medications may be required to control serious inflammation and protect vision.
• Respiratory involvement: Significant airway inflammation may require systemic immunosuppression and specialized respiratory care.
• Cardiovascular involvement: Treatment may involve corticosteroids, immunosuppressive medications, and cardiovascular specialist assessment.
• Associated vasculitis: More aggressive immunosuppressive treatment may be necessary when the kidneys, nerves, or other organs are affected.

The treatment approach should be determined by the specialists managing the affected organs.

Living with Relapsing Polychondritis Education can affect mental health in several ways. Research consistently shows that people with Relapsing Polychondritis Education have higher rates of anxiety and depression than the general population, although not everyone with Relapsing Polychondritis Education experiences these challenges.

Some of the reasons include:

• Chronic pain: Ongoing pain can increase stress, irritability, and emotional exhaustion.
• Fatigue: Persistent fatigue can make it harder to work, socialize, or enjoy activities, contributing to low mood.
• Sleep disruption: Pain and stiffness often interfere with sleep, which can worsen anxiety and depression.
• Reduced mobility: Difficulty with movement or physical limitations may lead to frustration or loss of independence.
• Uncertainty about the future: Concerns about disease progression, work, or relationships can increase emotional distress.
• Inflammation: Some evidence suggests that inflammation itself may contribute to changes in mood, although this relationship is still being studied.

Signs and Symptoms of Relapsing Polychondritis

Inflammation of cartilage is the hallmark feature of relapsing polychondritis (RP). The severity, frequency, and duration of inflammatory episodes vary from person to person. Although the disease most commonly affects the ears, nose, eyes, respiratory tract, and joints, it can also involve the heart and other organs.

Ears

The ears are the most frequently affected area in relapsing polychondritis. Inflammation typically involves the cartilage of the outer ear while sparing the earlobe, which contains no cartilage.

One or both ears may become red, hot, swollen, and extremely tender. The pain can be severe enough to make sleeping on the affected side uncomfortable or even impossible.

Ear inflammation is sometimes mistaken for cellulitis, a bacterial infection of the skin and underlying tissues. However, when symptoms persist or recur despite appropriate antibiotic treatment, relapsing polychondritis should be considered as a possible alternative diagnosis.

Repeated episodes of inflammation can gradually damage the ear cartilage, potentially causing permanent deformity and a characteristic cauliflower-like appearance.

Nose

Relapsing polychondritis can affect the cartilage supporting the bridge of the nose. Recurrent inflammation may weaken and destroy this cartilage, resulting in a deformity known as a saddle nose. This causes the nasal bridge to collapse or develop a noticeable depression.

Other symptoms may include nasal tenderness, swelling, nosebleeds, crusting, and changes in the sense of smell.

Eyes

Eye involvement in relapsing polychondritis can take several forms, depending on which structures are affected.

• Episcleritis: Inflammation of the thin tissue covering the white of the eye, typically causing redness and mild discomfort.
• Scleritis: Inflammation of the deeper, more substantial outer layer of the eye, often associated with significant pain.
• Uveitis: Inflammation of the uvea, the middle layer of the eye.
• Iritis: Inflammation of the iris, the coloured part of the eye.

Eye involvement can range from relatively mild inflammation to more serious conditions that threaten vision, making prompt ophthalmological assessment important.

Respiratory Tract and Lungs

Cartilage plays an essential role in maintaining the structure and stability of the respiratory tract. The trachea (windpipe) and bronchi contain cartilage rings that help keep the airways open during breathing.

In relapsing polychondritis, inflammation can damage this supporting cartilage, causing the airways to become weakened and potentially collapse, particularly during exhalation. This can result in breathing difficulties and airway obstruction.

Other respiratory symptoms may include:

• Persistent, harsh, barking cough.
• Hoarseness or changes in the voice.
• Wheezing or noisy breathing.
• Shortness of breath.
• Recurrent respiratory infections.

Airway involvement is one of the most serious complications of relapsing polychondritis because progressive cartilage damage can lead to significant and potentially life-threatening respiratory impairment.

There is no specific diet proven to stop AS or reverse spinal changes. A Mediterranean-style pattern—vegetables and fruit, whole grains, legumes, nuts, fish, and unsaturated fats—is a reasonable approach for overall health. Foods such as tomatoes and bell peppers can be included, but they shouldn’t be considered treatments for AS.

Tomatoes and Relapsing Polychondritis Education

Tomatoes can be a nutritious addition to an arthritis-friendly diet, although they do not cure arthritis or directly reverse joint damage.

• Lycopene: Tomatoes are particularly rich in lycopene, an antioxidant that helps protect cells from oxidative stress. Cooked tomatoes and tomato products can provide especially well-absorbed lycopene.

• Vitamin C: Supports collagen formation and normal connective-tissue function.

• Antioxidants: Tomatoes contain vitamin C, carotenoids, and other plant compounds that contribute to overall antioxidant intake.

• Potential anti-inflammatory effects: Laboratory and observational research suggests that compounds in tomatoes may influence inflammatory pathways, but evidence that eating tomatoes significantly reduces arthritis pain or inflammation in people is still limited.

• Heart health: Tomatoes can contribute to a heart-healthy diet, which is particularly relevant for people with Relapsing Polychondritis Education, because RA is associated with increased cardiovascular risk.

Some people with arthritis report that tomatoes or other nightshade vegetables worsen their symptoms. There isn’t strong scientific evidence that tomatoes generally cause arthritis inflammation or should routinely be avoided. If you consistently notice symptoms after eating a particular food, discussing this pattern with a healthcare professional or dietitian can be more useful than eliminating foods unnecessarily.

For osteoarthritis, tomatoes are best viewed as part of an overall nutritious eating pattern. For rheumatoid arthritis, diet can complement medical treatment but shouldn’t replace disease-modifying medication when it is prescribed.

Medical note: Treatment recommendations are individualized. NSAIDs and dapsone are not appropriate for every patient, and airway or cardiovascular involvement requires specialist assessment. Biologic medications may also be considered in difficult-to-control disease.