Condition hub
Relapsing polychondritis
What this illness attacks, and why the airway comes first.
It inflames cartilage
Cartilage is the firm, bendy tissue in your ears, your nose and your airways, and this illness inflames it wherever it happens to be. That is why the symptoms range from a hot, swollen ear to trouble breathing in the same diagnosis.
The airway is what makes it urgent
Rings of cartilage hold your windpipe open, and when they swell or go weak the airway can close down or give way. Most rheumatic illnesses threaten how you work over years, and this one can threaten your breathing over days.
Anesthesia is its own risk
Putting in a breathing tube is harder and riskier when the airway cartilage is involved, and so is keeping the airway open while you are asleep for surgery. A doctor who doesn't know your diagnosis cannot plan around any of that.
There is no guideline at all
A search of two large medical databases went looking for care guidelines in this illness and found not one among the twenty papers it turned up. The reviewers listed eleven things the illness still needs, and care around surgery is one of them.1
The four-step plan, applied to relapsing polychondritis.
Get the right diagnosis
The pattern of inflamed cartilage over time, with scans and breathing tests for the airway from the start. No blood test makes this diagnosis, and most doctors will not have met it before.
Relapsing polychondritis and labs →Clean up your food
No diet trial has been done in this illness and no food advice for it has been tested on anybody. Eating well still does everything it does for anybody else, and a long steroid course makes that count for more.
Relapsing polychondritis and diet →Detox your daily life
Smoking, workplace exposure and air pollution have never been measured in this illness. What is worth attending to instead is anything that loads an airway already under strain, and what a long steroid course does to the rest of you.
Relapsing polychondritis and environment →Build a stronger body
No exercise trial exists here, so what is published is a handful of reports covering a few people each and this page quotes not one of them. Build from what you can do now, with somebody who knows the airway is involved.
Relapsing polychondritis and exercise →
Pro tip
Tell any surgeon or anesthetist that you have this diagnosis before any procedure, however small it looks, and have something in writing as well. An emergency room is where this fact is hardest to get across and where it counts most, and a card in your wallet does work that memory will not.
The airway, and why anesthesia is different here
Rings of cartilage hold your windpipe and larger airways open, and when that cartilage swells or goes weak, the airway can close down or give way. That's what makes relapsing polychondritis more dangerous, and faster, than most rheumatic illnesses. Most of those threaten how you work over years, and this one can threaten your breathing over days.
So if you have this diagnosis, tell the surgery team in advance, even for a procedure that looks small. Have something in writing too, because an emergency room is where this fact is hardest to get across and where it counts most. A card in your wallet does work that memory won't.
Why there is so little to read
What monitoring involves
No guideline exists, so plans differ from one center to the next, and which scan is best and how often to screen are themselves on the list of unsettled things. One thing does hold everywhere, which is that the airway comes first, checked with scans and breathing tests. How often that should happen is still an open question.
Your hearing and balance can be involved, through swelling in the structures of the inner ear. Some people get eye inflammation, trouble with a heart valve, or kidney disease, and those get watched for. Ask your team what their plan is and what each test is looking for, because in an illness with no protocol the thinking behind the plan is worth having.
When to see a rheumatologist.
See a rheumatologist if you have:
- New trouble breathing, noisy breathing, or a change in your voice
- A hot, swollen, painful ear that spares the soft lobe
- Inflammation of the nose or a saddle-shaped change in its bridge
- New eye inflammation, redness, or pain
- New hearing loss, dizziness, or trouble with balance
- Any planned surgery or anesthetic, so the airway can be planned for in advance
The first item is the one where speed changes the outcome, so new or noisy breathing and any change in your voice need a prompt look instead of a wait. Say the diagnosis first when you call, because most doctors will not have met it before and the name is what tells them the airway may be involved.
References.
- Rednic S; Damian L; Talarico R et al. Relapsing polychondritis: state of the art on clinical practice guidelines. RMD Open. 2018;4:e000788. 10.1136/rmdopen-2018-000788Systematic literature review for clinical practice guidelines in relapsing polychondritis
- Chen N; Zheng Y. Characteristics and Clinical Outcomes of 295 Patients With Relapsing Polychondritis. J Rheumatol. 2021;48:1876-1882. 10.3899/jrheum.210062Retrospective cohort of 295 patients with relapsing polychondritis at Beijing Tongren Hospital
- Yin R; Zhao M; Xu D et al. Relapsing polychondritis: focus on cardiac involvement. Front Immunol. 2023;14:1218475. 10.3389/fimmu.2023.1218475Screening of patients with relapsing polychondritis hospitalised between December 2005 and December 2021 at Peking Union Medical College Hospital
- Le Besnerais M; Arnaud L; Boutémy J et al. Aortic involvement in relapsing polychondritis. Joint Bone Spine. 2018;85:345-351. 10.1016/j.jbspin.2017.05.009Multicentre comparative study
- Moulis G; Pugnet G; Costedoat-Chalumeau N et al. Efficacy and safety of biologics in relapsing polychondritis: a French national multicentre study. Ann Rheum Dis. 2018;77:1172-1178. 10.1136/annrheumdis-2017-212705French national multicentre retrospective cohort of 41 patients with relapsing polychondritis exposed to 105 courses of biologic treatment: TNF inhibitors 60
This page gathers the published research on this subject into one place. The studies behind it were published between 1989 and 2026, and every figure links to the paper it came from. Those studies were peer reviewed. This summary of them was not. Dr. Sarah Luebker is reviewing these pages one at a time and has not reached this one yet, so it carries no medical review date and nothing here is her opinion or her advice to you. Each page gets updated as she reaches it. It is here in the meantime because the science is worth having in one organized place that is easy to find and easy to read. Talk to your own clinician before acting on any of it.