Relapsing polychondritis: Difference between revisions
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==Overview== | ==Overview== | ||
Relapsing polychondritis is an immune-mediated chronic disease which involves the cartilaginous structure of different parts of the body, most commonly those of the [[ears]], [[nose]], and laryngotracheobronchial tree. The term relapsing polychondritis was first coined by Pearson in 1960. The majority of patients with relapsing polychondritis remain asymptomatic for several years. Early clinical features include [[ear pain]], [[polyarthritis]] and other non-specific symptoms such as [[fever]], [[weight loss]] and [[skin rash]]. The pathogenesis of relapsing polychondritis is unknown, however several studies have suggested the role of both [[cellular immunity]] and abnormal [[autoantibody]] in the [[pathogenesis]] of relapsing polychondritis. There are two different criteria to diagnose relapsing polychondritis which include Mc Adam criteria and modified Damiani criteria. There are no specific laboratory findings associated with relapsing polychondritis but certain antibodies are raised such as anti-type II [[collagen]] [[antibodies]] and [[antineutrophil cytoplasmic antibodies]]. Other abnormal laboratory findings include low haemoglobin, [[leukocytosis]], [[eosinophilia]], increased [[Erythrocyte sedimentation rate|ESR]], [[C-reactive protein|CRP]], urinary [[glycosaminoglycans]] levels and urinary [[Collagen, type II, alpha 1|collagen]] type II neoepitope levels in active [[inflammation|inflammation.]] Imaging such as chest x-ray is helpful to find out tracheal stenosis, however, CT scan is more useful to diagnose subglottic stenosis. MRI is useful to see the difference between [[edema]], [[fibrosis]], and [[inflammation]]. The mainstay of therapy for relapsing polychondritis is medical therapy. [[NSAIDs]] are used as an initial treatment of relapsing polychondritis. If NSAIDs are contraindicated or resistant, then steroids or dapsone can be used. Prednisone is used in the treatment of relapse. Treatment of life-threatening organ damage include [[prednisone]] and [[cyclophosphamide]]. Various surgical options include [[tracheostomy]], cardiac [[valve replacement]], aortic aneurysm repair, and saddle-nose deformity repair. | |||
==Historical Perspective== | ==Historical Perspective== | ||
*In 1923, Jaksch-Wartenhorst | *In 1923, Jaksch-Wartenhorst used the term '''polychondropathia''' to describe his first case about relapsing polychondritis. | ||
*In 1960, the term relapsing polychondritis was first coined by Pearson. | *In 1960, the term relapsing polychondritis was first coined by Pearson. | ||
==Classification== | ==Classification== | ||
*There is no classification of relapsing polychondritis. | *There is no established classification of relapsing polychondritis. | ||
==Pathophysiology== | ==Pathophysiology== | ||
*The pathogenesis of relapsing polychondritis is unknown. | *The pathogenesis of relapsing polychondritis is unknown. | ||
*Several studies have suggested the role of both cellular immunity and abnormal autoantibody in the pathogenesis of relapsing polychondritis. | *Several studies have suggested the role of both [[cellular immunity]] and abnormal [[autoantibody]] in the [[pathogenesis]] of relapsing polychondritis. | ||
*The HLA class II has been associated with the development of relapsing polychondritis, there is increase susceptibility with HLA-DR4.<ref name="pmid8489544">{{cite journal |vauthors=Lang B, Rothenfusser A, Lanchbury JS, Rauh G, Breedveld FC, Urlacher A, Albert ED, Peter HH, Melchers I |title=Susceptibility to relapsing polychondritis is associated with HLA-DR4 |journal=Arthritis Rheum. |volume=36 |issue=5 |pages=660–4 |date=May 1993 |pmid=8489544 |doi= |url=}}</ref> | *The [[HLA]] class II has been associated with the development of relapsing polychondritis, there is increase susceptibility with [[HLA-DR4]].<ref name="pmid8489544">{{cite journal |vauthors=Lang B, Rothenfusser A, Lanchbury JS, Rauh G, Breedveld FC, Urlacher A, Albert ED, Peter HH, Melchers I |title=Susceptibility to relapsing polychondritis is associated with HLA-DR4 |journal=Arthritis Rheum. |volume=36 |issue=5 |pages=660–4 |date=May 1993 |pmid=8489544 |doi= |url=}}</ref> | ||
*On gross pathology, [ | *On gross pathology, thickening of [[cartilage]] of [[ear]], [[nose]], [[epiglottis]], and [[cricoid]] and tracheal rings are characteristic findings of relapsing polychondritis. | ||
*On microscopic histopathological analysis of relapsing polychondritis, following features are seen: | *On microscopic histopathological analysis of relapsing polychondritis, following features are seen: | ||
**Lymphocytes, plasma cells, neutrophils, and eosinophils are seen in the cartilage. | **[[Lymphocytes]], [[plasma cells]], [[neutrophils]], and [[eosinophils]] are seen in the cartilage. | ||
** | **[[Cartilage]] has lost the [[chondrocytes]] and normal architecture at the later stages of [[inflammation]]. | ||
**Cartilage is replaced by [[fibrous tissue]] in the end. | |||
==Differentiating Relapsing Polychondritis from other Diseases== | ==Differentiating Relapsing Polychondritis from other Diseases== | ||
* | * [[Chondritis]] | ||
* Chondromdermatitis | * Chondromdermatitis | ||
* Hansen's disease | * [[Hansen's disease]] | ||
* Nodularis helicis | * Nodularis helicis | ||
* Perichondritis | * Perichondritis | ||
* Rhinophyma | * [[Rhinophyma]] | ||
* Skin cancer | * Skin cancer | ||
* Syphilis | * [[Syphilis]] | ||
Also, Relapsing Polychondritis should be differenttieted form other causes of small-sized vessel vasculitis. | |||
<span style="font-size:85%">'''Abbreviations:''' | |||
ABG= [[Arterial blood gas]], ANA= [[Antinuclear antibody]], ANP= [[Atrial natriuretic peptide]], ASO= [[Antistreptolysin O|Antistreptolysin O antibody]], BNP= [[Brain natriuretic peptide]], CBC= [[Complete blood count]], COPD= [[Chronic obstructive pulmonary disease]], CRP= [[C-reactive protein]], CT= [[Computed tomography]], CXR= [[Chest X-ray]], DVT= [[Deep vein thrombosis]], ESR= [[Erythrocyte sedimentation rate]], HRCT= [[High Resolution CT]], IgE= [[Immunoglobulin E]], LDH= [[Lactate dehydrogenase]], PCWP= [[Pulmonary capillary wedge pressure]], PCR= [[Polymerase chain reaction]], PFT= [[Pulmonary function test]].</span> | |||
<small><small> | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! colspan="3" rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Diseases | |||
| colspan="8" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations''' | |||
! colspan="9" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Para-clinical findings | |||
| colspan="1" rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Gold standard''' | |||
! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Additional findings | |||
|- | |||
| colspan="5" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms''' | |||
! colspan="3" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" | Physical examination | |||
|- | |||
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Histopathology | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Headache | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Arthralgia | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Claudication | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bruit | |||
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |HTN | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Focal neurological disorder | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Biomarker | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |CBC | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |ESR | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Other | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |CT scan | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Angiography | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Ultrasound/ Echocardiography | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Other | |||
|- | |||
! rowspan="30" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small-Vessel Vasculitis | |||
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[ANCA-associated vasculitis]] | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Microscopic polyangiitis]]<ref name="pmid20688249">{{cite journal| author=Chung SA, Seo P| title=Microscopic polyangiitis. | journal=Rheum Dis Clin North Am | year= 2010 | volume= 36 | issue= 3 | pages= 545-58 | pmid=20688249 | doi=10.1016/j.rdc.2010.04.003 | pmc=2917831 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20688249 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[C-ANCA|Anti-PR3 antibody (C-ANCA)]] (40%), [[P-ANCA|Anti-MPO antibody (P-ANCA)]] (60%) | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], [[Normocytic anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Proteinuria]], [[RBC casts|Erythrocyte casts]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Suspected [[pancreatitis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Mesenteric]] [[angiography]] for differentiating from [[polyarteritis nodosa]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Bilateral nodular, and patchy [[Opacity|opacities]] in [[Chest X-ray|CXR]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Glomerulonephritis]] with focal [[necrosis]], crescent formation, and lack or paucity of [[immunoglobulin]] deposits | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Rash]], [[Hemoptysis]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Granulomatosis with polyangiitis|Granulomatosis with polyangiitis (Wegener’s)]]<ref name="pmid27195187">{{cite journal| author=Kubaisi B, Abu Samra K, Foster CS| title=Granulomatosis with polyangiitis (Wegener's disease): An updated review of ocular disease manifestations. | journal=Intractable Rare Dis Res | year= 2016 | volume= 5 | issue= 2 | pages= 61-9 | pmid=27195187 | doi=10.5582/irdr.2016.01014 | pmc=4869584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27195187 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[C-ANCA|Anti-PR3 antibody (C-ANCA)]] (90%), [[P-ANCA|Anti-MPO antibody (P-ANCA)]] (10%) | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], [[Normochromic anemia|Normochromic normocytic anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[Creatinine|Cr]] or [[Blood urea nitrogen|BUN]], [[Hypoalbuminemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Consolidation (medicine)|Consolidation]], Patchy or diffuse [[Ground glass opacification on CT|ground-glass opacities]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Occlusion]] or [[stenosis]] of [[LAD]] and [[RCA]] in [[coronary angiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Single or multiple [[nodules]] and [[Mass|masses]] with [[cavitation]] in [[CXR]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Parenchymal]] [[necrosis]], [[Granulomatous]] [[inflammation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Conjunctivitis]], | |||
[[Episcleritis]], | |||
[[Uveitis]], | |||
[[Optic nerve]] vasculitis | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Eosinophilic granulomatosis with polyangiitis|Eosinophilic granulomatosis with polyangiitis]] | |||
[[Eosinophilic granulomatosis with polyangiitis|(Churg-Strauss)]]<ref name="pmid16612766">{{cite journal |vauthors=Keogh KA, Specks U |title=Churg-Strauss syndrome |journal=Semin Respir Crit Care Med |volume=27 |issue=2 |pages=148–57 |date=April 2006 |pmid=16612766 |doi=10.1055/s-2006-939518 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[P-ANCA|Anti-MPO antibody (P-ANCA)]] (40%), Eotaxin-3 | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Eosinophilia]], [[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[Creatinine|Cr]] or [[Blood urea nitrogen|BUN]], [[Proteinuria]], [[RBC casts|Erythrocyte casts]], ↑[[Immunoglobulin E|IgE]] levels | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Significant enlargement of peripheral [[pulmonary arteries]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Myocardial ischemia]] and [[Myocardial infarction|infarction]] in [[coronary angiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Congestive heart failure|Congestive heart failure (CHF)]] in [[echocardiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Extensive air-space [[Opacity|opacities]] in [[CXR]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small [[necrotizing]] [[granulomas]] with [[eosinophilic]] core surrounded by [[macrophages]] and [[Epithelioid cell|epithelioid giant cells]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Allergic rhinitis]], [[Asthma]], [[Urticaria|Urticarial rash]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hydralazine]]-associated [[ANCA-associated vasculitis]]<ref name="pmid23316942">{{cite journal| author=Keasberry J, Frazier J, Isbel NM, Van Eps CL, Oliver K, Mudge DW| title=Hydralazine-induced anti-neutrophil cytoplasmic antibody-positive renal vasculitis presenting with a vasculitic syndrome, acute nephritis and a puzzling skin rash: a case report. | journal=J Med Case Rep | year= 2013 | volume= 7 | issue= | pages= 20 | pmid=23316942 | doi=10.1186/1752-1947-7-20 | pmc=3565908 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316942 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[P-ANCA|Anti-MPO antibody (P-ANCA)]], Anti-histone antibodies | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[Creatinine|Cr]] or [[Blood urea nitrogen|BUN]], [[Hypoalbuminemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Bilateral [[pulmonary]] infiltrates | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aneurysms]] or [[Occlusion|occlusions]] of the [[Visceral|visceral arteries]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Pauci-immune [[necrotizing]] and [[crescentic glomerulonephritis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Sinusitis]], [[Hemoptysis]] | |||
|- | |||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Immune complexes|Immune complex]] small-vessel vasculitis | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Goodpasture disease|Anti-glomerular basement membrane disease]]<ref name="pmid28515156">{{cite journal |vauthors=McAdoo SP, Pusey CD |title=Anti-Glomerular Basement Membrane Disease |journal=Clin J Am Soc Nephrol |volume=12 |issue=7 |pages=1162–1172 |date=July 2017 |pmid=28515156 |doi=10.2215/CJN.01380217 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anti-GBM antibody|Anti-GBM antibodies]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypochromic anemia|Hypochromic microcytic anemia]], [[Thrombocytopenia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓[[C3 (complement)|C3]] level | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary hemorrhage]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal [[kidneys]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Alveolar]] infiltrates spreading from the [[hilum]] in [[CXR]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Cellular crescents in the [[glomeruli]], [[Pulmonary hemorrhage|Intra-alveolar hemorrhages]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anti-GBM antibody|Anti-GBM antibodies]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hemoptysis]], [[Hematuria]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cryoglobulinemia|Cryoglobulinemic vasculitis]]<ref name="pmid16344620">{{cite journal |vauthors=Ferri C, Mascia MT |title=Cryoglobulinemic vasculitis |journal=Curr Opin Rheumatol |volume=18 |issue=1 |pages=54–63 |date=January 2006 |pmid=16344620 |doi= |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[C4A|C4 component]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], [[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Antinuclear antibodies|ANA]], [[hypocomplementemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |R/O underlying [[malignancy]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Stenosis]] or [[Occlusion|occlusions]] of the [[Visceral|visceral arteries]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Bacterial endocarditis]] in [[echocardiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Interstitial]] involvement or [[pleural effusions]] in [[CXR]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[HCV]]-associated [[proteins]] in [[vasculitic]] [[skin]], Intraluminal [[cryoglobulin]] deposits | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Acrocyanosis]], [[Retinal]] [[hemorrhage]], [[Purpura]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis C virus]]-associated [[Cryoglobulinemia|cryoglobulinemic vasculitis]]<ref name="pmid28810602">{{cite journal| author=Guo QY, Wu M, Wang YW, Sun GD| title=Hepatitis C virus-associated cryoglobulinemia with membrano-proliferative glomerulonephritis treated with prednisolone and interferon: A case report. | journal=Exp Ther Med | year= 2017 | volume= 14 | issue= 2 | pages= 1395-1398 | pmid=28810602 | doi=10.3892/etm.2017.4671 | pmc=5525644 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28810602 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hepatitis C|HCV RNA]], [[Cryoglobulins]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], [[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓[[C4A|Serum C4]], Positive [[RF]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Increased [[hepatic]] [[echogenicity]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hepatomegaly]], [[Splenomegaly]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Increased [[hepatic]] [[echogenicity]] in [[MRI]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Vasculitic]] skin, [[Antigen]] infilteration in [[lesions]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hepatitis C|HCV RNA]], [[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Palpable [[purpura]], [[Microscopic hematuria]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Henoch-Schönlein purpura|IgA vasculitis (Henoch-Schönlein purpura)]]<ref name="pmid26990342">{{cite journal |vauthors=Farhadian JA, Castilla C, Shvartsbeyn M, Meehan SA, Neimann A, Pomeranz MK |title=IgA vasculitis (Henoch-Schönlein purpura) |journal=Dermatol. Online J. |volume=21 |issue=12 |pages= |date=December 2015 |pmid=26990342 |doi= |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[IgA]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Normochromic anemia]], [[Leukocytosis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Occult blood|Stool OB]], ↓[[C3 (complement)|C3]], ↓[[C4A|C4]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Increased [[bowel]] wall thickness, [[Hematoma|hematomas]], [[peritoneal fluid]], and [[intussusception]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated loops of [[bowel]] consistent in [[abdominal X-ray]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytoclastic vasculitis]] in postcapillary [[venules]] with [[IgA]] deposition | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |History and [[physical examination]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]], [[Purpura|Palpable purpura]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hypocomplementemia|Hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)]]<ref name="pmid22328958">{{cite journal| author=Buck A, Christensen J, McCarty M| title=Hypocomplementemic urticarial vasculitis syndrome: a case report and literature review. | journal=J Clin Aesthet Dermatol | year= 2012 | volume= 5 | issue= 1 | pages= 36-46 | pmid=22328958 | doi= | pmc=3277093 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22328958 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[C11orf1|C1q]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mild [[anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Antinuclear antibodies|ANA]], ↓[[C10orf10|C1q]], ↓[[C3 (complement)|C3]], ↓[[C4A|C4]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hepatomegaly]], [[Splenomegaly]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Deposits of [[immunoglobulins]], [[complement]], or [[fibrin]] around [[blood vessels]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Urticaria]], | |||
[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Urticaria]], [[Hematuria]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gastrointestinal diseases|Gastrointestinal disease]] | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute mesenteric ischemia]]<ref name="pmid24267504">{{cite journal |vauthors=Sise MJ |title=Acute mesenteric ischemia |journal=Surg. Clin. North Am. |volume=94 |issue=1 |pages=165–81 |date=February 2014 |pmid=24267504 |doi=10.1016/j.suc.2013.10.012 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[FABP1|I-FABP]], [[GSTA1|Alpha-GST]], [[Ischemia-modified albumin (IMA)]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], ↑[[Hematocrit|HCT]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↑[[Amylase]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Bowel]] wall thickening, [[Pneumatosis intestinalis|Intestinal pneumatosis]], [[Mesenteric ischemia|Portomesenteric]] thrombosis | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Mesenteric vein thrombosis|Mesenteric venous thrombosis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Artery|Arterial]] [[stenosis]] or occlusion of the [[Celiac artery|celiac]] or [[superior mesenteric arteries]] in [[duplex ultrasound]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Ileus]] with distended loops of [[bowel]], [[Bowel]] wall thickening in [[abdominal X-ray]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Superficial [[Mucosal bleeding|mucosal hemorrhage]], [[edema]] and [[necrosis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |History and [[physical examination]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Abdominal pain]], [[Distension]], [[Absent bowel sounds]] | |||
|- | |||
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cardiovascular diseases|Cardiovascular disease]] | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infective Endocarditis]]<ref name="pmid19665088">{{cite journal| author=McDonald JR| title=Acute infective endocarditis. | journal=Infect Dis Clin North Am | year= 2009 | volume= 23 | issue= 3 | pages= 643-64 | pmid=19665088 | doi=10.1016/j.idc.2009.04.013 | pmc=2726828 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19665088 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[NT-proBNP]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Normochromic anemia|Normochromic-normocytic anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypergammaglobulinemia|Hyperglobulinemia]], [[Cryoglobulinemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Metastatic]] [[infections]], such as [[Splenic infarction|splenic infarct]], [[Renal infarct|renal infarcts]], or [[psoas abscess]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Vegetation (pathology)|Vegetation]], [[abscess]], or new dehiscence of a [[Prosthetic valves|prosthetic valve]]<nowiki/>in [[echocardiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Vertebral osteomyelitis]] in [[Magnetic resonance imaging|MRI]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Vegetation (pathology)|Vegetation]] or [[Abscess|intracardiac abscess]] demonstrating active [[endocarditis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Echocardiography]] ([[TTE]]) | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Janeway lesions]], [[Osler nodes]], [[Roth's spot|Roth spots]], [[Vertebral osteomyelitis]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Leukocytoclastic vasculitis|Leukocytoclastic Vasculitis]]<ref name="pmid26176572">{{cite journal| author=Einhorn J, Levis JT| title=Dermatologic Diagnosis: Leukocytoclastic Vasculitis. | journal=Perm J | year= 2015 | volume= 19 | issue= 3 | pages= 77-8 | pmid=26176572 | doi=10.7812/TPP/15-001 | pmc=4500485 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26176572 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[IgM]], [[IgA]], [[Immunoglobulin G|IgG]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], [[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypocomplementemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Vascular]] [[stenosis]] and [[obstruction]] in visceral [[Angiogram|angiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Perivascular [[inflammatory]] infiltrate of [[neutrophils]] with leukocytoclasia (releasing [[nuclear]] debris) | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Purpura|Palpable purpura]], [[Petechiae]] | |||
|- | |||
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary disease]] | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Langerhans Cell Histiocytosis]]<ref name="pmid18572052">{{cite journal |vauthors=Margo CE, Goldman DR |title=Langerhans cell histiocytosis |journal=Surv Ophthalmol |volume=53 |issue=4 |pages=332–58 |date=2008 |pmid=18572052 |doi=10.1016/j.survophthal.2008.04.007 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[CD1a]], CD207,[[BRAF (gene)|BRAF-V600E]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypercalcemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary cystic lymphangiectasis|Pulmonary cysts]] and [[Pulmonary nodule|nodules]], [[Lytic|Bone lytic lesions]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hepatomegaly]], [[Splenomegaly]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cerebellum]] and [[pons]] hyperintensity in [[MRI]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Birbeck granules]] by [[electron microscopy]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Brown to purplish [[papules]], [[Eczematous Scaling|Eczematous rash]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Non small cell lung cancer|Non-Small Cell Lung Cancer]]<ref name="pmid18452692">{{cite journal| author=Molina JR, Yang P, Cassivi SD, Schild SE, Adjei AA| title=Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship. | journal=Mayo Clin Proc | year= 2008 | volume= 83 | issue= 5 | pages= 584-94 | pmid=18452692 | doi=10.4065/83.5.584 | pmc=2718421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18452692 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[EGFR]], ''[[ROS1]],'' [[Anaplastic lymphoma kinase|EML4-''ALK'']], [[PD-L1]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], [[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypercalcemia]], [[Hyponatremia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary|Pulmonary lesion]] or [[mass]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary]] marginal [[lesions]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cancer staging|Staging]] and response to treatment in [[Positron emission tomography|PET-CT]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Adenocarcinoma of the lung pathophysiology|Adenocarcinoma]], [[Squamous cell carcinoma of the lung pathophysiology|Squamous cell carcinoma]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Computed tomography|High resolution CT-scan]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cough]], [[Hemoptysis]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Small cell lung cancer|Small Cell Lung Cancer]]<ref name="pmid16226617">{{cite journal |vauthors=Jackman DM, Johnson BE |title=Small-cell lung cancer |journal=Lancet |volume=366 |issue=9494 |pages=1385–96 |date=2005 |pmid=16226617 |doi=10.1016/S0140-6736(05)67569-1 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |''[[P53 (protein)|p53]],'' [[Thyroid transcription factor-1|Thyroid transcription factor-1 (TTF1)]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hyponatremia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Large [[hilar]] mass with bulky [[mediastinal]] [[adenopathy]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Endobronchial [[ultrasound]] (EBUS) | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Standard [[Staging (pathology)|staging]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Spindled cells with dark [[nuclei]], scant [[cytoplasm]], and fine, granular [[Chromatin|nuclear chromatin]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Computed tomography|High resolution CT-scan]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cough]], [[Hemoptysis]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pulmonary Infarction]]<ref name="pmid15821192">{{cite journal |vauthors=Parambil JG, Savci CD, Tazelaar HD, Ryu JH |title=Causes and presenting features of pulmonary infarctions in 43 cases identified by surgical lung biopsy |journal=Chest |volume=127 |issue=4 |pages=1178–83 |date=April 2005 |pmid=15821192 |doi=10.1378/chest.127.4.1178 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[D-dimer]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mild [[leukocytosis]], Mild [[anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypoxemia]], [[Hypocarbia]] or [[Hypercarbia]], [[Respiratory alkalosis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary embolism]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Low-[[density]] filling defect within the [[pulmonary artery]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pericardial effusion]] in [[echocardiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary]] infiltrates, [[atelectasis]], and [[pleural effusions]] in [[Chest X-ray|CXR]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Infarct]] induced [[apoptosis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pulmonary artery]] [[angiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cough]], [[Hemoptysis]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal disease]] | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Acute poststreptococcal glomerulonephritis|Acute Poststreptococcal Glomerulonephritis]]<ref name="pmid25554106">{{cite journal |vauthors=VanDeVoorde RG |title=Acute poststreptococcal glomerulonephritis: the most common acute glomerulonephritis |journal=Pediatr Rev |volume=36 |issue=1 |pages=3–12; quiz 13 |date=January 2015 |pmid=25554106 |doi=10.1542/pir.36-1-3 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Antistreptococcal antibodies|Antistreptolysin-O (ASO) titers]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypocomplementemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Normal to slightly enlarged [[kidneys]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Central venous pressure|Central venous]] congestion in a [[hilar]] pattern in [[Chest X-ray|CXR]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Hypercellularity of [[Endothelial cells|endothelial]] and [[mesangial cells]], Infiltration of the [[glomerular]] tuft with [[polymorphonuclear cells]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]] | |||
|- | |||
! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hematologic disease]] | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hemolytic-uremic syndrome|Hemolytic-Uremic Syndrome]]<ref name="pmid11691946">{{cite journal |vauthors=Corrigan JJ, Boineau FG |title=Hemolytic-uremic syndrome |journal=Pediatr Rev |volume=22 |issue=11 |pages=365–9 |date=November 2001 |pmid=11691946 |doi= |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[C5a|C5b-9]], [[ADAMTS13]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]], [[Thrombocytopenia]], [[Reticulocytosis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[Lactate dehydrogenase|Lactate dehydrogenase (LDH)]], [[Hypercalcemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Thalami]], [[brainstem]], or [[cerebellum]] abnormality | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cerebral]] [[microangiopathy]] or [[hypertension]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Hypoechoic [[kidney]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abnormal hyperintensity in the [[Brain|brain cisterns]] in [[MRI]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Thromboses|Microthromboses]] include [[Fibrin|fibrin thrombi]] that may occlude the [[glomerular]] tuft | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical findings coupled with [[Medical laboratory|laboratory abnormalities]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]], [[Proteinuria]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Chronic Lymphocytic Leukemia|Chronic Lymphocytic Leukemia (CLL)]]<ref name="pmid15561682">{{cite journal |vauthors=Byrd JC, Stilgenbauer S, Flinn IW |title=Chronic lymphocytic leukemia |journal=Hematology Am Soc Hematol Educ Program |volume= |issue= |pages=163–83 |date=2004 |pmid=15561682 |doi=10.1182/asheducation-2004.1.163 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[CD5]], [[CD19]], [[CD20]], IgV<sub>H</sub> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Absolute [[lymphocytosis]], Smudge cells | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Flow cytometry]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cancer staging|Staging]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Large atypical [[Cells (biology)|cells]], cleaved cells, and [[prolymphocytes]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Chromosomal]] and [[genetic testing]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Easy bruising]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Multiple myeloma|Multiple Myeloma]]<ref name="pmid28318212">{{cite journal |vauthors=Michels TC, Petersen KE |title=Multiple Myeloma: Diagnosis and Treatment |journal=Am Fam Physician |volume=95 |issue=6 |pages=373–383 |date=March 2017 |pmid=28318212 |doi= |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Light chain|Ig light chain]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]], [[Thrombocytopenia]], [[Leukopenia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Bone marrow aspiration]] and [[biopsy]], ↑[[Cr]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Osseous]] involvement and [[Lytic|lytic lesions]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Peripheral zone of increased [[vascularity]] in lesions | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Punched-out lesion in [[X-ray|skull X-ray]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clonal proliferation of [[plasma cells]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Protein electrophoresis]] plus conventional [[X-rays]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Constipation]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hypereosinophilic syndrome|Hypereosinophilic Syndrome]]<ref name="pmid19630574">{{cite journal |vauthors=Klion A |title=Hypereosinophilic syndrome: current approach to diagnosis and treatment |journal=Annu. Rev. Med. |volume=60 |issue= |pages=293–306 |date=2009 |pmid=19630574 |doi=10.1146/annurev.med.60.062107.090340 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[IgE]], [[CD117]] with [[CD2]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Eosinophilia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑Serum [[tryptase]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Lymphadenopathy]] and [[splenomegaly]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Intracardiac thrombus|Intracardiac thrombi]] in [[echocardiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Reticulin|Reticulin stain]] for [[myelofibrosis]] and [[tryptase]] staining for [[mast cells]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical findings coupled with [[Medical laboratory|laboratory abnormalities]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Splinter hemorrhages]], [[Raynaud phenomenon]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Non-Hodgkin lymphoma|Non-Hodgkin Lymphoma]]<ref name="pmid22835603">{{cite journal |vauthors=Shankland KR, Armitage JO, Hancock BW |title=Non-Hodgkin lymphoma |journal=Lancet |volume=380 |issue=9844 |pages=848–57 |date=September 2012 |pmid=22835603 |doi=10.1016/S0140-6736(12)60605-9 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[C-myc|MYC]], [[BCL2-like 1 (gene)|BCL2]], [[BCL6]], and [[TP53]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Lymphocytosis]], [[Anemia]], [[Thrombocytopenia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[Lactate dehydrogenase|Lactate dehydrogenase (LDH)]], [[Hypercalcemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Enlarged [[Lymph node|lymph nodes]], [[Hepatosplenomegaly]], Filling defects in the [[liver]] and [[spleen]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hepatosplenomegaly]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Mediastinal lymphadenopathy]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small cleaved or noncleaved, intermediate, or large cell with a follicular or diffuse pattern | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Surgically excised tissue [[biopsy]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Easy bruising]], [[Testicular mass]], [[Skin lesions|Skin lesion]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Serum sickness|Serum Sickness]]<ref name="pmid2867672">{{cite journal |vauthors=Lin RY |title=Serum sickness syndrome |journal=Am Fam Physician |volume=33 |issue=1 |pages=157–62 |date=January 1986 |pmid=2867672 |doi= |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[IL-1]], [[IL-6]], [[TNF]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukopenia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Gammopathy|Polyclonal gammopathy]], ↑[[Cr]], [[Cryoglobulinemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Arteritic lesions are focal, [[necrotizing]], and [[inflammatory]] involving all layers of the [[artery]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical findings coupled with [[Medical laboratory|laboratory abnormalities]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]], [[Skin rash]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Disseminated intravascular coagulation|Disseminated Intravascular Coagulation]]<ref name="pmid25535423">{{cite journal| author=Venugopal A| title=Disseminated intravascular coagulation. | journal=Indian J Anaesth | year= 2014 | volume= 58 | issue= 5 | pages= 603-8 | pmid=25535423 | doi=10.4103/0019-5049.144666 | pmc=4260307 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25535423 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fibrin degradation product|Fibrin degradation product (FDP)]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Thrombocytopenia]], [[Schistocytes]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[D-dimer]], [[aPTT]] and [[PT]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Intracranial hemorrhage]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Ischemia]] and [[necrosis]] due to [[Fibrin|fibrin deposition]] in small and medium-sized [[vessels]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical findings coupled with [[Medical laboratory|laboratory abnormalities]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Cyanosis|Acral cyanosis]], [[Hemorrhagic]] skin [[Infarction|infarctions]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Idiopathic thrombocytopenic purpura|Idiopathic Thrombocytopenic Purpura]]<ref name="pmid27441004">{{cite journal| author=Nomura S| title=Advances in Diagnosis and Treatments for Immune Thrombocytopenia. | journal=Clin Med Insights Blood Disord | year= 2016 | volume= 9 | issue= | pages= 15-22 | pmid=27441004 | doi=10.4137/CMBD.S39643 | pmc=4948655 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27441004 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[FCGR2B|FC gamma receptors (FCGR) IIb]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]], [[Thrombocytopenia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[HIV]], [[ANA]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |R/O other causes | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |R/O [[splenomegaly]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Increased number of normal morphologic [[megakaryocytes]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical findings coupled with [[thrombocytopenia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Easy bruising]], [[Purpura]] | |||
|- | |||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic disease]] | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Sarcoidosis]]<ref name="pmid27454074">{{cite journal| author=Chiarchiaro J, Chen BB, Gibson KF| title=New molecular targets for the treatment of sarcoidosis. | journal=Curr Opin Pulm Med | year= 2016 | volume= 22 | issue= 5 | pages= 515-21 | pmid=27454074 | doi=10.1097/MCP.0000000000000304 | pmc=5152532 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27454074 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[IL-2]] and [[Interferon gamma|IFN-γ]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mild [[anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[Angiotensin-converting enzyme|ACE]], ↑[[Vitamin D|1, 25-dihydroxyvitamin D]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Active [[alveolitis]] or [[fibrosis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hepatosplenomegaly]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Bilateral [[Adenopathy|hilar adenopathy]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Granuloma|Noncaseating granulomas (NCGs)]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Histopathology|Histological confirmation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Heart block]], [[Ocular disease|Ocular lesion]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Legionella Infections|Legionella Infection]]<ref name="pmid12491204">{{cite journal |vauthors=Murdoch DR |title=Diagnosis of Legionella infection |journal=Clin. Infect. Dis. |volume=36 |issue=1 |pages=64–9 |date=January 2003 |pmid=12491204 |doi=10.1086/345529 |url=}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cytokine|Inflammatory cytokines]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]] with [[left shift]], [[Thrombocytosis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[D-dimer]], [[Fibrin degradation product|FDP]], [[Hyponatremia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pleural effusion]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nonspecific and indistinguishable [[CXR]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Intra-[[alveolar]] [[inflammation]], [[Abscesses|Microabscesses]] in the [[parenchyma]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Sputum culture]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cough]], [[Diarrhea]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic lupus erythematosus]]<ref name="Tsokos2011">{{cite journal|last1=Tsokos|first1=George C.|title=Systemic Lupus Erythematosus|journal=New England Journal of Medicine|volume=365|issue=22|year=2011|pages=2110–2121|issn=0028-4793|doi=10.1056/NEJMra1100359}}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anti-dsDNA antibody|Anti dsDNA]], [[ANA]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[Leukopenia]], [[Lymphopenia]], [[Anemia]], [[Thrombocytopenia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[Creatinine|Cr]] or [[Blood urea nitrogen|BUN]], | |||
↑[[ALT]] or [[AST]], [[Proteinuria]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Interstitial lung disease, [[Pneumonitis]], [[Pulmonary emboli]], [[Hemorrhage|Alveolar hemorrhage]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aneurysms]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Pericardial effusion]], [[pulmonary hypertension]], or verrucous [[Libman-Sacks endocarditis]] in [[echocardiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Central nervous system|Central nervous system (CNS)]] [[Systemic lupus erythematosus|lupus]] white-matter changes in [[MRI]] | |||
! align="center" style="padding: 5px 5px; background: #F5F5F5;" |Staging [[lupus nephritis]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anti-dsDNA antibody|Anti-dsDNA antibody test]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Skin rashes]] or [[photosensitivity]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Rheumatoid arthritis]]<ref name="pmid16824912">{{cite journal| author=Scott JT| title=The gold standard in rheumatoid arthritis. | journal=J R Soc Med | year= 1991 | volume= 84 | issue= 9 | pages= 513-4 | pmid=1682491 | doi= | pmc=1293405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1682491 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RF]], [[Anti-citrullinated protein antibody|Anti-CCP antibody]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑[[Creatinine|Cr]] or [[Blood urea nitrogen|BUN]], | |||
↑[[ALT]] or [[AST]], [[ANA]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Fractures|Microfractures]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aneurysms]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Joint (anatomy)|Effusions in joints]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Basilar invagination with [[cranial]] migration of an eroded [[Odontoid process|odontoid]] peg in [[MRI]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Influx of [[inflammatory cells]] into the [[synovial membrane]], with [[angiogenesis]], proliferation of chronic [[inflammatory cells]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical findings coupled [[Anti-citrullinated protein antibody|anti-CCP antibody]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Rheumatoid nodules]] | |||
|- | |||
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Relapsing polychondritis]]<ref name="pmid27708954">{{cite journal| author=Emmungil H, Aydın SZ| title=Relapsing polychondritis. | journal=Eur J Rheumatol | year= 2015 | volume= 2 | issue= 4 | pages= 155-159 | pmid=27708954 | doi=10.5152/eurjrheum.2015.0036 | pmc=5047229 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27708954 }}</ref> | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+/- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |+ | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]], [[Anemia]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cryoglobulins]], [[ANA]], [[C-ANCA]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Calcification]] of [[Cartilaginous|cartilaginous structures]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aortic root|Aortic root dilatation]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aortic root|Aortic root dilatation]] and degree of [[aortic regurgitation]] in [[echocardiography]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Tracheal stenosis]] in [[CXR]] | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Chondrolysis, [[Chondritis]], Perichondritis | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical findings coupled with imaging | |||
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Ear pain]] and redness, [[Polyarthritis]] | |||
|- | |||
|} | |||
</small></small> | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
* The | *The incidence of relapsing polychondritis is approximately 4 per 100,000 individuals in Minnesota. | ||
===Age=== | ===Age=== | ||
*Relapsing polychondritis is more commonly observed among patients | *Relapsing polychondritis is more commonly observed among patients aged 40 to 60 years but it can also occur in [[childhood]].<ref name="pmid11063294">{{cite journal |vauthors=Knipp S, Bier H, Horneff G, Specker C, Schuster A, Schroten H, Lenard HG, Niehues T |title=Relapsing polychondritis in childhood--case report and short review |journal=Rheumatol. Int. |volume=19 |issue=6 |pages=231–4 |date=2000 |pmid=11063294 |doi= |url=}}</ref><ref name="pmid19880136">{{cite journal |vauthors=Belot A, Duquesne A, Job-Deslandre C, Costedoat-Chalumeau N, Boudjemaa S, Wechsler B, Cochat P, Piette JC, Cimaz R |title=Pediatric-onset relapsing polychondritis: case series and systematic review |journal=J. Pediatr. |volume=156 |issue=3 |pages=484–9 |date=March 2010 |pmid=19880136 |doi=10.1016/j.jpeds.2009.09.045 |url=}}</ref> | ||
===Gender=== | ===Gender=== | ||
*Relapsing polychondritis affects men and women equally. | *Relapsing polychondritis affects men and women equally. | ||
===Race=== | ===Race=== | ||
* | *Relapsing polychondritis usually affects Caucasian. | ||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors in the development of relapsing polychondritis include: | |||
*Genetic susceptibility: | |||
**Increased risk with HLA DR4 | |||
*History of other [[connective tissue disorders]] | |||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
*The majority of patients with relapsing polychondritis remain asymptomatic for several years. | |||
*Early clinical features include [[ear pain]], [[polyarthritis]] and other non-specific symptoms such as [[fever]], [[weight loss]] and [[skin rash]]. | |||
*Common complications of relapsing polychondritis include collapsing of cartilage which causes facial abnormalities, deformities of the ear, eye, and destruction of the thyroid gland. | |||
*Relapsing polychondritis has the relapsing and remitting course, Prognosis depends upon the type of organ involvement, stage of the disease. | |||
==Diagnosis== | ==Diagnosis== | ||
==Diagnostic Criteria== | ===Diagnostic Criteria=== | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan=" | ! colspan="2" |Mc Adam diagnostic criteria for relapsing polychondritis<ref name="pmid775252">{{cite journal |vauthors=McAdam LP, O'Hanlan MA, Bluestone R, Pearson CM |title=Relapsing polychondritis: prospective study of 23 patients and a review of the literature |journal=Medicine (Baltimore) |volume=55 |issue=3 |pages=193–215 |date=May 1976 |pmid=775252 |doi= |url=}}</ref> | ||
|- | |- | ||
|Criteria | |Criteria | ||
|Requirement | |Requirement | ||
|- | |- | ||
|Recurrent [[chondritis]] of both auricles | |||
|Recurrent chondritis of both auricles | | rowspan="6" |3 out of 6 features | ||
| | |||
are required for definitive | |||
diagnosis of relapsing | |||
polychondritis | |||
|- | |- | ||
|Non-erosive [[inflammatory]] [[polyarthritis]] | |||
|Non-erosive inflammatory polyarthritis | |||
|- | |- | ||
| | |Nasal [[chondritis]] | ||
|- | |- | ||
| | |[[Inflammation]] of auricular structures | ||
|- | |- | ||
| | |[[Chondritis]] of the respiratory tract | ||
|- | |- | ||
| | |[[Cochlear division|Cochlear]] and/or [[Vestibular system|vestibular]] damage | ||
| | |||
| | |||
|} | |} | ||
==Symptoms== | According to modified Damiani criteria, there should be one of the following findings to diagnose relapsing polychondritis:<ref name="pmid449538">{{cite journal |vauthors=Damiani JM, Levine HL |title=Relapsing polychondritis--report of ten cases |journal=Laryngoscope |volume=89 |issue=6 Pt 1 |pages=929–46 |date=June 1979 |pmid=449538 |doi= |url=}}</ref> | ||
* Decreased | *There should be three of McAdam's diagnostic criteria. | ||
* | *One or more of the clinical findings of McAdam's diagnostic criteria and positive histologic confirmation. | ||
* | *Chondritis at two or more separate anatomic locations with a response to [[glucocorticoids]] or [[dapsone]]. | ||
* | |||
* Pain on movement of joint | ===Symptoms=== | ||
Symptoms of relapsing polychondritis may include the following:<ref name="pmid1539895">{{cite journal |vauthors=Coppola M, Yealy DM |title=Relapsing polychondritis: an unusual cause of painful auricular swelling |journal=Ann Emerg Med |volume=21 |issue=1 |pages=81–5 |date=January 1992 |pmid=1539895 |doi= |url=}}</ref><ref name="pmid14673390">{{cite journal |vauthors=Kent PD, Michet CJ, Luthra HS |title=Relapsing polychondritis |journal=Curr Opin Rheumatol |volume=16 |issue=1 |pages=56–61 |date=January 2004 |pmid=14673390 |doi= |url=}}</ref><ref name="pmid1259793">{{cite journal |vauthors=O'Hanlan M, McAdam LP, Bluestone R, Pearson CM |title=The arthropathy of relapsing polychrondritis |journal=Arthritis Rheum. |volume=19 |issue=2 |pages=191–4 |date=1976 |pmid=1259793 |doi= |url=}}</ref><ref name="pmid7586772">{{cite journal |vauthors=Balsa A, Expinosa A, Cuesta M, MacLeod TI, Gijón-Baños J, Maddison PJ |title=Joint symptoms in relapsing polychondritis |journal=Clin. Exp. Rheumatol. |volume=13 |issue=4 |pages=425–30 |date=1995 |pmid=7586772 |doi= |url=}}</ref> | |||
*[[Ear pain]] | |||
*[[Eye pain]], [[redness]], and increased [[lacrimation]] | |||
*Decreased [[visual acuity]] | |||
*[[Proptosis]] | |||
*[[Rhinorrhea]] | |||
*[[Epistaxis]] | |||
*Pain on the movement of joint | |||
*[[Joint swelling]] | |||
*[[Cough]] | |||
*[[Shortness of breath]] | |||
*[[Dysphagia]] | |||
*[[Chest pain]] | |||
*[[Headache]] | |||
*[[Confusion]] | |||
===Physical Examination=== | ===Physical Examination=== | ||
*Patients with relapsing polychondritis usually appear [[lethargic]]. | |||
*Physical examination may be remarkable for: | |||
*Ear examination: | |||
**On inspection, there is [[inflammation]] and [[swelling]] | |||
**On palpation, there is [[tenderness]] | |||
*Eye examination: | |||
**On inspection, lid [[retraction]], [[redness]] of the eye, [[ptosis]], and [[proptosis]] | |||
**[[Visual acuity]] is decreased | |||
*Lung examination: | |||
**On auscultation, [[wheezing]] and expiratory [[stridor]] is found | |||
*Heart examination: | |||
**S1, S2 is normal, the [[Heart murmur|murmur]] can be heard depending on the involvement of valve | |||
*Joint examination: | |||
**On inspection, there is [[redness]] and [[swelling]] | |||
**On palpation, there is [[tenderness]] | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Line 107: | Line 814: | ||
*Abnormal laboratory findings consistent with the diagnosis of relapsing polychondritis include: | *Abnormal laboratory findings consistent with the diagnosis of relapsing polychondritis include: | ||
**CBC with differentials | **CBC with differentials | ||
***Low hemoglobin | ***Low [[hemoglobin]] | ||
***Leukocytosis | ***[[Leukocytosis]] | ||
***Eosinophilia | ***[[Eosinophilia]] | ||
**ESR and CRP are usually raised | **[[Erythrocyte sedimentation rate|ESR]] and [[CRP]] are usually raised | ||
**Antibody testing | **Antibody testing | ||
***Anti-type II collagen antibodies is usually raised in early phase of disease<ref name="pmid714080">{{cite journal |vauthors=Foidart JM, Abe S, Martin GR, Zizic TM, Barnett EV, Lawley TJ, Katz SI |title=Antibodies to type II collagen in relapsing polychondritis |journal=N. Engl. J. Med. |volume=299 |issue=22 |pages=1203–7 |date=November 1978 |pmid=714080 |doi=10.1056/NEJM197811302992202 |url=}}</ref><ref name="pmid7030234">{{cite journal |vauthors=Ebringer R, Rook G, Swana GT, Bottazzo GF, Doniach D |title=Autoantibodies to cartilage and type II collagen in relapsing polychondritis and other rheumatic diseases |journal=Ann. Rheum. Dis. |volume=40 |issue=5 |pages=473–9 |date=October 1981 |pmid=7030234 |pmc=1000784 |doi= |url=}}</ref> | ***Anti-type II [[collagen]] [[antibodies]] is usually raised in early phase of disease<ref name="pmid714080">{{cite journal |vauthors=Foidart JM, Abe S, Martin GR, Zizic TM, Barnett EV, Lawley TJ, Katz SI |title=Antibodies to type II collagen in relapsing polychondritis |journal=N. Engl. J. Med. |volume=299 |issue=22 |pages=1203–7 |date=November 1978 |pmid=714080 |doi=10.1056/NEJM197811302992202 |url=}}</ref><ref name="pmid7030234">{{cite journal |vauthors=Ebringer R, Rook G, Swana GT, Bottazzo GF, Doniach D |title=Autoantibodies to cartilage and type II collagen in relapsing polychondritis and other rheumatic diseases |journal=Ann. Rheum. Dis. |volume=40 |issue=5 |pages=473–9 |date=October 1981 |pmid=7030234 |pmc=1000784 |doi= |url=}}</ref> | ||
***Antineutrophil cytoplasmic antibodies is found in patients who has vasculitis<ref name="pmid8323388">{{cite journal |vauthors=Papo T, Piette JC, Le Thi Huong Du, Godeau P, Meyer O, Kahn MF, Bourgeois P |title=Antineutrophil cytoplasmic antibodies in polychondritis |journal=Ann. Rheum. Dis. |volume=52 |issue=5 |pages=384–5 |date=May 1993 |pmid=8323388 |pmc=1005055 |doi= |url=}}</ref> | ***[[Antineutrophil cytoplasmic antibodies]] is found in patients who has [[vasculitis]]<ref name="pmid8323388">{{cite journal |vauthors=Papo T, Piette JC, Le Thi Huong Du, Godeau P, Meyer O, Kahn MF, Bourgeois P |title=Antineutrophil cytoplasmic antibodies in polychondritis |journal=Ann. Rheum. Dis. |volume=52 |issue=5 |pages=384–5 |date=May 1993 |pmid=8323388 |pmc=1005055 |doi= |url=}}</ref> | ||
**Urinary glycosaminoglycans levels may be elevated | **Urinary [[glycosaminoglycans]] levels may be elevated | ||
**Urinary collagen type II neoepitope levels is elevated in active inflammation | **Urinary [[Collagen, type II, alpha 1|collagen]] type II neoepitope levels is elevated in active [[inflammation]]<ref name="pmid12270767">{{cite journal |vauthors=Passos CO, Onofre GR, Martins RC, Graff DL, Pagani EA, Sodré CT, Silva LC |title=Composition of urinary glycosaminoglycans in a patient with relapsing polychondritis |journal=Clin. Biochem. |volume=35 |issue=5 |pages=377–81 |date=July 2002 |pmid=12270767 |doi= |url=}}</ref> | ||
***Levels of urinary collagen type II neoepitope is used to assess response to treatment | ***Levels of urinary collagen type II neoepitope is used to assess response to treatment<ref name="pmid14558101">{{cite journal |vauthors=Kraus VB, Stabler T, Le ET, Saltarelli M, Allen NB |title=Urinary type II collagen neoepitope as an outcome measure for relapsing polychondritis |journal=Arthritis Rheum. |volume=48 |issue=10 |pages=2942–8 |date=October 2003 |pmid=14558101 |doi=10.1002/art.11281 |url=}}</ref> | ||
**Serum levels of cartilage oligomeric matrix protein is elevated and used as a marker of disease activity | **Serum levels of [[cartilage]] oligomeric matrix protein is elevated and used as a marker of disease activity<ref name="pmid20810035">{{cite journal |vauthors=Kempta Lekpa F, Piette JC, Bastuji-Garin S, Kraus VB, Stabler TV, Poole AR, Marini-Portugal A, Chevalier X |title=Serum cartilage oligomeric matrix protein (COMP) level is a marker of disease activity in relapsing polychondritis |journal=Clin. Exp. Rheumatol. |volume=28 |issue=4 |pages=553–5 |date=2010 |pmid=20810035 |doi= |url=}}</ref> | ||
===Imaging Findings=== | ===Imaging Findings=== | ||
=== | *X-ray of the chest shows [[tracheal stenosis]]. | ||
*CT scan of the chest shows following findings:<ref name="pmid16801364">{{cite journal |vauthors=Lee KS, Ernst A, Trentham DE, Lunn W, Feller-Kopman DJ, Boiselle PM |title=Relapsing polychondritis: prevalence of expiratory CT airway abnormalities |journal=Radiology |volume=240 |issue=2 |pages=565–73 |date=August 2006 |pmid=16801364 |doi=10.1148/radiol.2401050562 |url=}}</ref> | |||
**[[Subglottic stenosis]] | |||
**Thickening of anterior and lateral [[Tracheal disease|tracheal]] wall with sparing of the posterior membranous wall | |||
[[Image:Relapsing-polychondritis-1.jpg|200px|centre|thumbnail|Relapsing polychondritis<br> Source: Case courtesy of Dr Charlie Chia-Tsong Hsu<ref>href="https://radiopaedia.org/">Radiopaedia.org</ref><ref>href="https://radiopaedia.org/cases/31793">rID: 31793</ref>]] | |||
*MRI is better than CT scanning to see the difference between [[edema]], [[fibrosis]], and [[inflammation]] | |||
== | ==Other Diagnostic studies== | ||
*[[ECG]] and [[Echocardiography]] are done in the patient who has cardiac involvement. | |||
*[[Bronchoscopy]] used to visualize extensive disease involving the lungs. | |||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
*The mainstay of therapy for relapsing polychondritis is medical therapy. | |||
*[[NSAIDs]] are used as an initial treatment of relapsing polychondritis.<ref name="pmid21958172">{{cite journal |vauthors=Yoo JH, Chodosh J, Dana R |title=Relapsing polychondritis: systemic and ocular manifestations, differential diagnosis, management, and prognosis |journal=Semin Ophthalmol |volume=26 |issue=4-5 |pages=261–9 |date=2011 |pmid=21958172 |doi=10.3109/08820538.2011.588653 |url=}}</ref> | |||
*Preferred regimen: [[Naproxen]] 500 mg PO q12h or [[ibuprofen]] 800 mg PO q6h x 7 to 10 days. | |||
*If NSAIDs are contraindicated or resistant then following regimens are used: | |||
**Preferred regimen: [[Dapsone]] 50 to 100 mg PO q24h x 4 months depending on the severity of the disease. | |||
**Preferred regimen: [[Prednisone]] 30 to 60 mg PO q24h in divided dose. | |||
'''Treatment of relapse''': | |||
*Preferred regimen: [[Prednisone]] 5 to 7.5 mg PO q24h | |||
'''Treatment of life-threatening organ damage''': | |||
*Preferred regimen: Initial therapy is the combination of [[prednisone]] 1 mg/kg PO q24h and [[cyclophosphamide]] 2 mg/kg PO q24h. | |||
*Maintenance therapy depends on the renal function of a patient. | |||
*Patient without nephritis, Preferred regimen: [[Methotrexate]] 15mg PO once weekly. | |||
*Patient with nephritis, Preferred regimen: [[Azathioprine]] - dose is adjused according to GFR. | |||
===Surgery=== | ===Surgery=== | ||
Medical therapy is the mainstay of therapy for relapsing polychondritis, however various surgical options include: | |||
*[[Tracheostomy]] | |||
*Cardiac [[valve replacement]] | |||
*Aortic aneurysm repair | |||
*Saddle-nose deformity repair | |||
===Prevention=== | ===Prevention=== | ||
There are no primary preventive measures available for relapsing polychondritis. | |||
==References== | ==References== |
Latest revision as of 13:30, 13 May 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ,Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Relapsing polychondritis is an immune-mediated chronic disease which involves the cartilaginous structure of different parts of the body, most commonly those of the ears, nose, and laryngotracheobronchial tree. The term relapsing polychondritis was first coined by Pearson in 1960. The majority of patients with relapsing polychondritis remain asymptomatic for several years. Early clinical features include ear pain, polyarthritis and other non-specific symptoms such as fever, weight loss and skin rash. The pathogenesis of relapsing polychondritis is unknown, however several studies have suggested the role of both cellular immunity and abnormal autoantibody in the pathogenesis of relapsing polychondritis. There are two different criteria to diagnose relapsing polychondritis which include Mc Adam criteria and modified Damiani criteria. There are no specific laboratory findings associated with relapsing polychondritis but certain antibodies are raised such as anti-type II collagen antibodies and antineutrophil cytoplasmic antibodies. Other abnormal laboratory findings include low haemoglobin, leukocytosis, eosinophilia, increased ESR, CRP, urinary glycosaminoglycans levels and urinary collagen type II neoepitope levels in active inflammation. Imaging such as chest x-ray is helpful to find out tracheal stenosis, however, CT scan is more useful to diagnose subglottic stenosis. MRI is useful to see the difference between edema, fibrosis, and inflammation. The mainstay of therapy for relapsing polychondritis is medical therapy. NSAIDs are used as an initial treatment of relapsing polychondritis. If NSAIDs are contraindicated or resistant, then steroids or dapsone can be used. Prednisone is used in the treatment of relapse. Treatment of life-threatening organ damage include prednisone and cyclophosphamide. Various surgical options include tracheostomy, cardiac valve replacement, aortic aneurysm repair, and saddle-nose deformity repair.
Historical Perspective
- In 1923, Jaksch-Wartenhorst used the term polychondropathia to describe his first case about relapsing polychondritis.
- In 1960, the term relapsing polychondritis was first coined by Pearson.
Classification
- There is no established classification of relapsing polychondritis.
Pathophysiology
- The pathogenesis of relapsing polychondritis is unknown.
- Several studies have suggested the role of both cellular immunity and abnormal autoantibody in the pathogenesis of relapsing polychondritis.
- The HLA class II has been associated with the development of relapsing polychondritis, there is increase susceptibility with HLA-DR4.[1]
- On gross pathology, thickening of cartilage of ear, nose, epiglottis, and cricoid and tracheal rings are characteristic findings of relapsing polychondritis.
- On microscopic histopathological analysis of relapsing polychondritis, following features are seen:
- Lymphocytes, plasma cells, neutrophils, and eosinophils are seen in the cartilage.
- Cartilage has lost the chondrocytes and normal architecture at the later stages of inflammation.
- Cartilage is replaced by fibrous tissue in the end.
Differentiating Relapsing Polychondritis from other Diseases
- Chondritis
- Chondromdermatitis
- Hansen's disease
- Nodularis helicis
- Perichondritis
- Rhinophyma
- Skin cancer
- Syphilis
Also, Relapsing Polychondritis should be differenttieted form other causes of small-sized vessel vasculitis. Abbreviations: ABG= Arterial blood gas, ANA= Antinuclear antibody, ANP= Atrial natriuretic peptide, ASO= Antistreptolysin O antibody, BNP= Brain natriuretic peptide, CBC= Complete blood count, COPD= Chronic obstructive pulmonary disease, CRP= C-reactive protein, CT= Computed tomography, CXR= Chest X-ray, DVT= Deep vein thrombosis, ESR= Erythrocyte sedimentation rate, HRCT= High Resolution CT, IgE= Immunoglobulin E, LDH= Lactate dehydrogenase, PCWP= Pulmonary capillary wedge pressure, PCR= Polymerase chain reaction, PFT= Pulmonary function test.
Epidemiology and Demographics
- The incidence of relapsing polychondritis is approximately 4 per 100,000 individuals in Minnesota.
Age
- Relapsing polychondritis is more commonly observed among patients aged 40 to 60 years but it can also occur in childhood.[32][33]
Gender
- Relapsing polychondritis affects men and women equally.
Race
- Relapsing polychondritis usually affects Caucasian.
Risk Factors
Common risk factors in the development of relapsing polychondritis include:
- Genetic susceptibility:
- Increased risk with HLA DR4
- History of other connective tissue disorders
Natural History, Complications and Prognosis
- The majority of patients with relapsing polychondritis remain asymptomatic for several years.
- Early clinical features include ear pain, polyarthritis and other non-specific symptoms such as fever, weight loss and skin rash.
- Common complications of relapsing polychondritis include collapsing of cartilage which causes facial abnormalities, deformities of the ear, eye, and destruction of the thyroid gland.
- Relapsing polychondritis has the relapsing and remitting course, Prognosis depends upon the type of organ involvement, stage of the disease.
Diagnosis
Diagnostic Criteria
Mc Adam diagnostic criteria for relapsing polychondritis[34] | |
---|---|
Criteria | Requirement |
Recurrent chondritis of both auricles | 3 out of 6 features
are required for definitive diagnosis of relapsing polychondritis |
Non-erosive inflammatory polyarthritis | |
Nasal chondritis | |
Inflammation of auricular structures | |
Chondritis of the respiratory tract | |
Cochlear and/or vestibular damage |
According to modified Damiani criteria, there should be one of the following findings to diagnose relapsing polychondritis:[35]
- There should be three of McAdam's diagnostic criteria.
- One or more of the clinical findings of McAdam's diagnostic criteria and positive histologic confirmation.
- Chondritis at two or more separate anatomic locations with a response to glucocorticoids or dapsone.
Symptoms
Symptoms of relapsing polychondritis may include the following:[36][37][38][39]
- Ear pain
- Eye pain, redness, and increased lacrimation
- Decreased visual acuity
- Proptosis
- Rhinorrhea
- Epistaxis
- Pain on the movement of joint
- Joint swelling
- Cough
- Shortness of breath
- Dysphagia
- Chest pain
- Headache
- Confusion
Physical Examination
- Patients with relapsing polychondritis usually appear lethargic.
- Physical examination may be remarkable for:
- Ear examination:
- On inspection, there is inflammation and swelling
- On palpation, there is tenderness
- Eye examination:
- On inspection, lid retraction, redness of the eye, ptosis, and proptosis
- Visual acuity is decreased
- Lung examination:
- Heart examination:
- S1, S2 is normal, the murmur can be heard depending on the involvement of valve
- Joint examination:
- On inspection, there is redness and swelling
- On palpation, there is tenderness
Laboratory Findings
- There are no specific laboratory findings associated with relapsing polychondritis.
- Abnormal laboratory findings consistent with the diagnosis of relapsing polychondritis include:
- CBC with differentials
- ESR and CRP are usually raised
- Antibody testing
- Anti-type II collagen antibodies is usually raised in early phase of disease[40][41]
- Antineutrophil cytoplasmic antibodies is found in patients who has vasculitis[42]
- Urinary glycosaminoglycans levels may be elevated
- Urinary collagen type II neoepitope levels is elevated in active inflammation[43]
- Levels of urinary collagen type II neoepitope is used to assess response to treatment[44]
- Serum levels of cartilage oligomeric matrix protein is elevated and used as a marker of disease activity[45]
Imaging Findings
- X-ray of the chest shows tracheal stenosis.
- CT scan of the chest shows following findings:[46]
- Subglottic stenosis
- Thickening of anterior and lateral tracheal wall with sparing of the posterior membranous wall
![](/images/a/aa/Relapsing-polychondritis-1.jpg)
Source: Case courtesy of Dr Charlie Chia-Tsong Hsu[47][48]
- MRI is better than CT scanning to see the difference between edema, fibrosis, and inflammation
Other Diagnostic studies
- ECG and Echocardiography are done in the patient who has cardiac involvement.
- Bronchoscopy used to visualize extensive disease involving the lungs.
Treatment
Medical Therapy
- The mainstay of therapy for relapsing polychondritis is medical therapy.
- NSAIDs are used as an initial treatment of relapsing polychondritis.[49]
- Preferred regimen: Naproxen 500 mg PO q12h or ibuprofen 800 mg PO q6h x 7 to 10 days.
- If NSAIDs are contraindicated or resistant then following regimens are used:
- Preferred regimen: Dapsone 50 to 100 mg PO q24h x 4 months depending on the severity of the disease.
- Preferred regimen: Prednisone 30 to 60 mg PO q24h in divided dose.
Treatment of relapse:
- Preferred regimen: Prednisone 5 to 7.5 mg PO q24h
Treatment of life-threatening organ damage:
- Preferred regimen: Initial therapy is the combination of prednisone 1 mg/kg PO q24h and cyclophosphamide 2 mg/kg PO q24h.
- Maintenance therapy depends on the renal function of a patient.
- Patient without nephritis, Preferred regimen: Methotrexate 15mg PO once weekly.
- Patient with nephritis, Preferred regimen: Azathioprine - dose is adjused according to GFR.
Surgery
Medical therapy is the mainstay of therapy for relapsing polychondritis, however various surgical options include:
- Tracheostomy
- Cardiac valve replacement
- Aortic aneurysm repair
- Saddle-nose deformity repair
Prevention
There are no primary preventive measures available for relapsing polychondritis.
References
- ↑ Lang B, Rothenfusser A, Lanchbury JS, Rauh G, Breedveld FC, Urlacher A, Albert ED, Peter HH, Melchers I (May 1993). "Susceptibility to relapsing polychondritis is associated with HLA-DR4". Arthritis Rheum. 36 (5): 660–4. PMID 8489544.
- ↑ Chung SA, Seo P (2010). "Microscopic polyangiitis". Rheum Dis Clin North Am. 36 (3): 545–58. doi:10.1016/j.rdc.2010.04.003. PMC 2917831. PMID 20688249.
- ↑ Kubaisi B, Abu Samra K, Foster CS (2016). "Granulomatosis with polyangiitis (Wegener's disease): An updated review of ocular disease manifestations". Intractable Rare Dis Res. 5 (2): 61–9. doi:10.5582/irdr.2016.01014. PMC 4869584. PMID 27195187.
- ↑ Keogh KA, Specks U (April 2006). "Churg-Strauss syndrome". Semin Respir Crit Care Med. 27 (2): 148–57. doi:10.1055/s-2006-939518. PMID 16612766.
- ↑ Keasberry J, Frazier J, Isbel NM, Van Eps CL, Oliver K, Mudge DW (2013). "Hydralazine-induced anti-neutrophil cytoplasmic antibody-positive renal vasculitis presenting with a vasculitic syndrome, acute nephritis and a puzzling skin rash: a case report". J Med Case Rep. 7: 20. doi:10.1186/1752-1947-7-20. PMC 3565908. PMID 23316942.
- ↑ McAdoo SP, Pusey CD (July 2017). "Anti-Glomerular Basement Membrane Disease". Clin J Am Soc Nephrol. 12 (7): 1162–1172. doi:10.2215/CJN.01380217. PMID 28515156.
- ↑ Ferri C, Mascia MT (January 2006). "Cryoglobulinemic vasculitis". Curr Opin Rheumatol. 18 (1): 54–63. PMID 16344620.
- ↑ Guo QY, Wu M, Wang YW, Sun GD (2017). "Hepatitis C virus-associated cryoglobulinemia with membrano-proliferative glomerulonephritis treated with prednisolone and interferon: A case report". Exp Ther Med. 14 (2): 1395–1398. doi:10.3892/etm.2017.4671. PMC 5525644. PMID 28810602.
- ↑ Farhadian JA, Castilla C, Shvartsbeyn M, Meehan SA, Neimann A, Pomeranz MK (December 2015). "IgA vasculitis (Henoch-Schönlein purpura)". Dermatol. Online J. 21 (12). PMID 26990342.
- ↑ Buck A, Christensen J, McCarty M (2012). "Hypocomplementemic urticarial vasculitis syndrome: a case report and literature review". J Clin Aesthet Dermatol. 5 (1): 36–46. PMC 3277093. PMID 22328958.
- ↑ Sise MJ (February 2014). "Acute mesenteric ischemia". Surg. Clin. North Am. 94 (1): 165–81. doi:10.1016/j.suc.2013.10.012. PMID 24267504.
- ↑ McDonald JR (2009). "Acute infective endocarditis". Infect Dis Clin North Am. 23 (3): 643–64. doi:10.1016/j.idc.2009.04.013. PMC 2726828. PMID 19665088.
- ↑ Einhorn J, Levis JT (2015). "Dermatologic Diagnosis: Leukocytoclastic Vasculitis". Perm J. 19 (3): 77–8. doi:10.7812/TPP/15-001. PMC 4500485. PMID 26176572.
- ↑ Margo CE, Goldman DR (2008). "Langerhans cell histiocytosis". Surv Ophthalmol. 53 (4): 332–58. doi:10.1016/j.survophthal.2008.04.007. PMID 18572052.
- ↑ Molina JR, Yang P, Cassivi SD, Schild SE, Adjei AA (2008). "Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship". Mayo Clin Proc. 83 (5): 584–94. doi:10.4065/83.5.584. PMC 2718421. PMID 18452692.
- ↑ Jackman DM, Johnson BE (2005). "Small-cell lung cancer". Lancet. 366 (9494): 1385–96. doi:10.1016/S0140-6736(05)67569-1. PMID 16226617.
- ↑ Parambil JG, Savci CD, Tazelaar HD, Ryu JH (April 2005). "Causes and presenting features of pulmonary infarctions in 43 cases identified by surgical lung biopsy". Chest. 127 (4): 1178–83. doi:10.1378/chest.127.4.1178. PMID 15821192.
- ↑ VanDeVoorde RG (January 2015). "Acute poststreptococcal glomerulonephritis: the most common acute glomerulonephritis". Pediatr Rev. 36 (1): 3–12, quiz 13. doi:10.1542/pir.36-1-3. PMID 25554106.
- ↑ Corrigan JJ, Boineau FG (November 2001). "Hemolytic-uremic syndrome". Pediatr Rev. 22 (11): 365–9. PMID 11691946.
- ↑ Byrd JC, Stilgenbauer S, Flinn IW (2004). "Chronic lymphocytic leukemia". Hematology Am Soc Hematol Educ Program: 163–83. doi:10.1182/asheducation-2004.1.163. PMID 15561682.
- ↑ Michels TC, Petersen KE (March 2017). "Multiple Myeloma: Diagnosis and Treatment". Am Fam Physician. 95 (6): 373–383. PMID 28318212.
- ↑ Klion A (2009). "Hypereosinophilic syndrome: current approach to diagnosis and treatment". Annu. Rev. Med. 60: 293–306. doi:10.1146/annurev.med.60.062107.090340. PMID 19630574.
- ↑ Shankland KR, Armitage JO, Hancock BW (September 2012). "Non-Hodgkin lymphoma". Lancet. 380 (9844): 848–57. doi:10.1016/S0140-6736(12)60605-9. PMID 22835603.
- ↑ Lin RY (January 1986). "Serum sickness syndrome". Am Fam Physician. 33 (1): 157–62. PMID 2867672.
- ↑ Venugopal A (2014). "Disseminated intravascular coagulation". Indian J Anaesth. 58 (5): 603–8. doi:10.4103/0019-5049.144666. PMC 4260307. PMID 25535423.
- ↑ Nomura S (2016). "Advances in Diagnosis and Treatments for Immune Thrombocytopenia". Clin Med Insights Blood Disord. 9: 15–22. doi:10.4137/CMBD.S39643. PMC 4948655. PMID 27441004.
- ↑ Chiarchiaro J, Chen BB, Gibson KF (2016). "New molecular targets for the treatment of sarcoidosis". Curr Opin Pulm Med. 22 (5): 515–21. doi:10.1097/MCP.0000000000000304. PMC 5152532. PMID 27454074.
- ↑ Murdoch DR (January 2003). "Diagnosis of Legionella infection". Clin. Infect. Dis. 36 (1): 64–9. doi:10.1086/345529. PMID 12491204.
- ↑ Tsokos, George C. (2011). "Systemic Lupus Erythematosus". New England Journal of Medicine. 365 (22): 2110–2121. doi:10.1056/NEJMra1100359. ISSN 0028-4793.
- ↑ Scott JT (1991). "The gold standard in rheumatoid arthritis". J R Soc Med. 84 (9): 513–4. PMC 1293405. PMID 1682491.
- ↑ Emmungil H, Aydın SZ (2015). "Relapsing polychondritis". Eur J Rheumatol. 2 (4): 155–159. doi:10.5152/eurjrheum.2015.0036. PMC 5047229. PMID 27708954.
- ↑ Knipp S, Bier H, Horneff G, Specker C, Schuster A, Schroten H, Lenard HG, Niehues T (2000). "Relapsing polychondritis in childhood--case report and short review". Rheumatol. Int. 19 (6): 231–4. PMID 11063294.
- ↑ Belot A, Duquesne A, Job-Deslandre C, Costedoat-Chalumeau N, Boudjemaa S, Wechsler B, Cochat P, Piette JC, Cimaz R (March 2010). "Pediatric-onset relapsing polychondritis: case series and systematic review". J. Pediatr. 156 (3): 484–9. doi:10.1016/j.jpeds.2009.09.045. PMID 19880136.
- ↑ McAdam LP, O'Hanlan MA, Bluestone R, Pearson CM (May 1976). "Relapsing polychondritis: prospective study of 23 patients and a review of the literature". Medicine (Baltimore). 55 (3): 193–215. PMID 775252.
- ↑ Damiani JM, Levine HL (June 1979). "Relapsing polychondritis--report of ten cases". Laryngoscope. 89 (6 Pt 1): 929–46. PMID 449538.
- ↑ Coppola M, Yealy DM (January 1992). "Relapsing polychondritis: an unusual cause of painful auricular swelling". Ann Emerg Med. 21 (1): 81–5. PMID 1539895.
- ↑ Kent PD, Michet CJ, Luthra HS (January 2004). "Relapsing polychondritis". Curr Opin Rheumatol. 16 (1): 56–61. PMID 14673390.
- ↑ O'Hanlan M, McAdam LP, Bluestone R, Pearson CM (1976). "The arthropathy of relapsing polychrondritis". Arthritis Rheum. 19 (2): 191–4. PMID 1259793.
- ↑ Balsa A, Expinosa A, Cuesta M, MacLeod TI, Gijón-Baños J, Maddison PJ (1995). "Joint symptoms in relapsing polychondritis". Clin. Exp. Rheumatol. 13 (4): 425–30. PMID 7586772.
- ↑ Foidart JM, Abe S, Martin GR, Zizic TM, Barnett EV, Lawley TJ, Katz SI (November 1978). "Antibodies to type II collagen in relapsing polychondritis". N. Engl. J. Med. 299 (22): 1203–7. doi:10.1056/NEJM197811302992202. PMID 714080.
- ↑ Ebringer R, Rook G, Swana GT, Bottazzo GF, Doniach D (October 1981). "Autoantibodies to cartilage and type II collagen in relapsing polychondritis and other rheumatic diseases". Ann. Rheum. Dis. 40 (5): 473–9. PMC 1000784. PMID 7030234.
- ↑ Papo T, Piette JC, Le Thi Huong D, Godeau P, Meyer O, Kahn MF, Bourgeois P (May 1993). "Antineutrophil cytoplasmic antibodies in polychondritis". Ann. Rheum. Dis. 52 (5): 384–5. PMC 1005055. PMID 8323388. Vancouver style error: initials (help)
- ↑ Passos CO, Onofre GR, Martins RC, Graff DL, Pagani EA, Sodré CT, Silva LC (July 2002). "Composition of urinary glycosaminoglycans in a patient with relapsing polychondritis". Clin. Biochem. 35 (5): 377–81. PMID 12270767.
- ↑ Kraus VB, Stabler T, Le ET, Saltarelli M, Allen NB (October 2003). "Urinary type II collagen neoepitope as an outcome measure for relapsing polychondritis". Arthritis Rheum. 48 (10): 2942–8. doi:10.1002/art.11281. PMID 14558101.
- ↑ Kempta Lekpa F, Piette JC, Bastuji-Garin S, Kraus VB, Stabler TV, Poole AR, Marini-Portugal A, Chevalier X (2010). "Serum cartilage oligomeric matrix protein (COMP) level is a marker of disease activity in relapsing polychondritis". Clin. Exp. Rheumatol. 28 (4): 553–5. PMID 20810035.
- ↑ Lee KS, Ernst A, Trentham DE, Lunn W, Feller-Kopman DJ, Boiselle PM (August 2006). "Relapsing polychondritis: prevalence of expiratory CT airway abnormalities". Radiology. 240 (2): 565–73. doi:10.1148/radiol.2401050562. PMID 16801364.
- ↑ href="https://radiopaedia.org/">Radiopaedia.org
- ↑ href="https://radiopaedia.org/cases/31793">rID: 31793
- ↑ Yoo JH, Chodosh J, Dana R (2011). "Relapsing polychondritis: systemic and ocular manifestations, differential diagnosis, management, and prognosis". Semin Ophthalmol. 26 (4–5): 261–9. doi:10.3109/08820538.2011.588653. PMID 21958172.
External links
- Polychondritis Educational Society, Ltd. (PES)
- Dr. D. E. Trentham research paper
- MedicineNet.com
- The Polychondritis Group - Support Group
Template:Osteochondropathy
Template:Diseases of the musculoskeletal system and connective tissue