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It has been estimated that 20–50% of cases involve airway involvement, which is the main cause of mortality.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 44-year-old man with a 4-year history of difficult-to-treat asthma who, despite adherence to a triple inhaled therapy regimen, had an average of 7 visits to the emergency department per year with an average of 3 admissions per year for episodes classified as “asthmatic exacerbation”. In the context of a new admission due to a metapneumovirus infection and associated respiratory exacerbation, a work-up was performed, which included: spirometry with data of severe obstructive pattern and negative bronchodilator test, a chest CT scan, which showed the presence of cartilaginous airway inflammation and, finally, a fibreoptic bronchoscopy, which showed an oedematous tracheal mucosa with a significant inflammatory component that reduced airway caliber.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In view of these findings, the Rheumatology Department was asked to collaborate in order to direct the diagnosis towards a connective tissue disease. Thus, when a thorough history taking was performed, the patient reported several episodes of local inflammation in the nasal and auricular areas, suggestive of chondritis, which had been present for years, even before the diagnosis of asthma. At the time of the examination there was no evidence of active chondritis in the pinna or nasal cartilage, and auscultation revealed global hypoventilation with some scattered wheezing.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The clinical and radiological signs strongly supported the diagnosis of RP as the most likely cause of the chronic respiratory condition. With all this in mind, once the acute respiratory infection had resolved, it was decided to start immunosuppressive treatment with methotrexate 15 mg subcutaneously/week, after which a period of 6 months of clinical stability without admissions or emergency department visits was achieved.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Difficult-to-recognise cases of RP mimicking severe asthma have been described in the medical literature, as they may have identical spirometry patterns, even with spirometry reversibility. The low prevalence of RP, as well as its poor clinical recognition by many specialists, contribute to this entity’s delayed diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The absence of early specific treatment has been linked to a worse prognosis, especially when end-stage fibrosis is reached. The drugs that have shown the best results are glucocorticoids, immunosuppressive agents such as methotrexate and anti-tumour necrosis factor agents.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, in a patient with severe asthma refractory to the usual treatment, the presence of data suggesting a systemic inflammatory process should be checked. History taking should focus on the presence of previous episodes of arthritis or chondritis. In these cases, our aim should be to act early in the course of the disease, in order to suppress airway cartilage inflammation, and thus prevent the development of irreversible lesions that could lead to a fatal or life-threatening prognosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This work was not funded by any organisation.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Ethical considerations</span><p id="par0035" class="elsevierStylePara elsevierViewall">This work was conducted with the approval of the centre and with the informed consent of the patient being studied.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors deny any conflict of interest of an economic or moral nature.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Ethical considerations" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory failure secondary to relapsing polychondritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Badireddi" 1 => "M.F. Siddiqui" 2 => "N.J. Boddu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.02381" "Revista" => array:7 [ "tituloSerie" => "Respir Care" "fecha" => "2014" "volumen" => "59" "numero" => "9" "paginaInicial" => "e140" "paginaFinal" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25053828" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differentiating tracheobronchial involvement in granulomatosis with polyangiitis and relapsing polychondritis on chest CT: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Jalaber" 1 => "X. Puéchal" 2 => "I. Saab" 3 => "E. Canniff" 4 => "B. Terrier" 5 => "L. Mouthon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13075-022-02935-2" "Revista" => array:6 [ "tituloSerie" => "Arthritis Res Ther." "fecha" => "2022" "volumen" => "24" "numero" => "1" "paginaInicial" => "241" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36307863" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relapsing polychondritis with initial presentations of recurrent negative-pressure pulmonary edema and acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.F. Wu" 1 => "Y.S. Li" 2 => "C.Y. Hung" 3 => "W.C. Chao" 4 => "Z.Y. Fu" 5 => "K.C. Kao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.03274" "Revista" => array:7 [ "tituloSerie" => "Respir Care" "fecha" => "2015" "volumen" => "60" "numero" => "5" "paginaInicial" => "e101" "paginaFinal" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25550527" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of TNF-α inhibitors in airway involvement of relapsing polychondritis: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Biya" 1 => "S. Dury" 2 => "J.M. Perotin" 3 => "C. Launois" 4 => "M. Dewolf" 5 => "G. 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Journal Information
Vol. 163. Issue 5.
Pages 267-268 (September 2024)
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Vol. 163. Issue 5.
Pages 267-268 (September 2024)
Letter to the Editor
Recurrent Polychondritis as a mimicker of challenging-to-manage allergic asthma
Policondritis recidivante como simuladora de asma alérgica de difícil abordaje
Elena Oliver García
, Elena Cañadillas Sánchez, Eva Palero Díaz
Corresponding author
Servicio de Reumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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