Relapsing Polychondritis — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseaseRelapsing PolychondritisSCE Rheumatology

A 35-year-old woman has an 18-month history of recurrent episodes of painful erythematous swelling affecting the cartilaginous parts of both pinnae while sparing the earlobes. She has also developed episodic nasal-bridge pain and an intermittent, non-erosive inflammatory oligoarthritis. During attacks, her C-reactive protein is elevated. Urinalysis and chest imaging are normal. What is the most likely diagnosis?

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Correct answer: B — Relapsing polychondritis

The diagnosis is relapsing polychondritis. The discriminating findings are recurrent auricular chondritis confined to the cartilaginous pinna, with characteristic sparing of the non-cartilaginous lobule, together with nasal chondritis and inflammatory, typically non-erosive arthritis. Diagnosis is primarily clinical; inflammatory markers may support active inflammation but are not specific. Granulomatosis with polyangiitis can cause destructive nasal disease and arthritis, but the recurrent cartilage-predominant auricular pattern and absence of pulmonary or renal features favour relapsing polychondritis. Cellulitis would not usually recur bilaterally with lobule sparing or cause nasal chondritis and arthritis. Auricular gout generally produces firm tophi rather than episodic diffuse chondritis. Psoriatic arthritis does not explain recurrent auricular and nasal cartilage inflammation.

Reference: Mertz P, et al. Relapsing polychondritis: Best Practice & Clinical Rheumatology. Best Practice & Research Clinical Rheumatology. 2023;37(1):101867. https://pubmed.ncbi.nlm.nih.gov/37839908/