No controlled therapeutic trials have been published. The objective of treatment is to abate current symptoms and preserve the integrity of cartilaginous structures.
TEAM APPROACH TO CARE
Relapsing Polychondritis is a complex systemic disease that requires a team approach in treating it effectively:
Internist: Monitors medications, take care of day-to-day medical needs and coordinate with specialists.
Rheumatologist: Take the lead in controlling the disease's activity and should be involved early in patient care. Referring to other medical specialists when disease activity is involved out of their area of medicine.
The mainstay of treatment is systemic corticosteroids. Those patients with serious disease including ocular, laryngotracheal, bronchial, cardiovascular, renal, and neurological involvement require aggressive immunosuppressive-anti-inflammatory therapy. Prednisone at 20-60 mg/d administered in the acute phase is tapered to 5-25 mg/d for maintenance. Severe flares may require 80-100 mg/d. Many persons require a low daily dose of prednisone for maintenance; however, some persons can be successfully treated with intermittent administration of high doses during flares. McAdam and coworkers found that continuous prednisone decreased the severity, frequency, and duration of relapses.
Other medications reported to control symptoms include methotrexate, azathioprine, cyclophosphamide, and cyclosporin. These medications also may help control the disease progression. In conjunction with steroid therapy, methotrexate has been found to significantly decrease corticosteroid requirements while helping control symptoms. (other medications)
Oral administration of Non-Steroidal anti-inflammatory drugs (NSAIDs) is effective in some patients with mild disease, particularly at the time of an acute flare. NSAIDs can be used effectively with prednisone and/or DMARDs in controlling inflammation.
Medical care must include assessment and treatment for other confounding or concurrent autoimmune and or rheumatic connective tissure disorders.
Surgical Care:
Surgical therapy may include tracheotomy, permanent tracheotomy placement, aortic aneurysm repair, and cardiac valve replacement.
The benefits of any proposed surgery must be adequately weighed against the risk for infection, especially in the event of acute relapse, because persons are at an increased risk of infection regardless of corticosteroid administration.
Pulmonary/ Thoracic: Monitor respiratory conditions.
Otolaryngologists: consultation when inner ear and/or when ENT symptoms are present.
Ophthalmologists: Consulted early to diagnose, monitor, & treat potentially devastating ocular complications.
Dermatologist: RPC can also effect the skin in many different ways.
Endocrinologist: Oversee hormone levels and help over come the side effects of steroid usage.
Neurologists - Cardiologists - Nephrologists - Counselors
Other specialists as needed during the patients care and course of treatment.
