DEAR DR. GOTT: What can you tell me about relapsing polychondritis? I can’t find much help on the Web. I’ve had flare-ups three times a year for years, affecting one ear and sometimes both at the same time. Surprisingly, my last episode was three years ago, and it lasted six weeks, but now I am dealing with it again. Two different specialists have been of no help. The condition gets painful before it gets better.
DEAR READER: Polychondritis is a chronic, progressive, inflammatory autoimmune reaction of cartilage in various tissues of the body, including the ears, nose, spine, trachea and joints. The eyes, blood vessels, skin and heart, while not formed by cartilage, have a similar makeup and can also be involved. The condition generally affects men and women in middle age. Symptoms typically begin with one or both ears becoming red, swollen and painful.
Diagnosis is made when a healthcare provider observes eye inflammation, hearing or balance problems, bilateral ear inflammation, painful swelling in more than one joint and damage to cartilage in the respiratory tract. Laboratory testing to include an ESR (erythrocyte sedimentation rate) can provide pertinent evidence when inflammation is present.
Exacerbation of symptoms can last a few weeks, subside and occur again. Over time, the supporting cartilage can become damaged, resulting in hearing, vision and balance difficulties, floppy ears and a sloping nose.
Mild relapsing polychronditis is commonly treated with NSAIDs (nonstereroidal anti-inflammatory drugs). As symptoms become more troublesome, they are treated with daily prednisone on a tapering basis. Severe cases are treated with prescription cyclosporine, azathioprine or cyclophosphamide, which will lessen symptoms but have not been shown to alter the course of the disorder.
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