Date:
Patient:
Reason for Visit:
Follow-up for relapsing polychondritis (RP)
Assessment of current disease activity (joint pain, inflammation, extra-articular involvement)
Evaluation of response to treatment and potential complications
History:
Presenting Illness:
Current symptoms and their duration (joint pain, stiffness, swelling, redness)
Comparison to previous relapses (severity, location)
Presence of extra-articular manifestations (e.g., ear involvement – chondritis, ocular involvement – scleritis, respiratory involvement – laryngeal stenosis)
Past Medical History (PMH):
Date of initial RP diagnosis
Prior disease course (frequency and severity of relapses)
Medications used to treat previous relapses
Underlying medical conditions (e.g., autoimmune disorders)
Social History:
Physical Exam:
General: Assess for signs of systemic inflammation (fever, fatigue).
Musculoskeletal:
Evaluate for joint tenderness, swelling, warmth, and range of motion limitations in affected joints.
Look for signs of enthesitis (inflammation at tendon or ligament attachments).
Ear, Nose, and Throat (ENT):
Examine ears for tenderness, swelling, or deformity suggestive of chondritis.
Assess for nasal bridge tenderness or saddle-nose deformity.
Evaluate for hoarseness, stridor (noisy breathing), or signs of upper airway obstruction.
Eyes: Look for scleral redness, inflammation, or signs of scleritis.
Diagnostic Tests (may be ordered depending on clinical presentation):
Laboratory Tests:
Complete blood count (CBC) – may show elevated white blood cells suggestive of inflammation.
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) – elevated levels indicate inflammation, but not specific for RP.
Antinuclear antibody (ANA) testing – often positive in RP, but not diagnostic.
Rheumatoid factor (RF) testing – usually negative in RP.
Consider specialized antibody testing for cartilage antigens (e.g., anti-type II collagen antibodies) in some cases.
Imaging Tests (may be used to assess joint damage or complications):
X-rays – may show joint space narrowing or erosions in later stages of RP.
MRI – can detect early joint inflammation and bone marrow edema.
CT scan (chest or sinuses) – may be used to assess airway involvement or complications.
Assessment:
Disease activity: Based on clinical presentation, laboratory findings, and imaging studies.
Presence of extra-articular involvement: Ear, eye, respiratory, or other organ involvement.
Severity of relapse: Impact on daily activities and overall well-being.
Response to previous treatments.
Risk of complications: Secondary amyloidosis (protein build-up in organs) can occur in long-standing cases.
Plan:
Acute treatment for relapse:
Corticosteroids (oral or intravenous) to suppress inflammation.
Immunosuppressive medications (e.g., methotrexate, azathioprine, mycophenolate) may be used in severe cases or to maintain remission.
Management of extra-articular involvement: May require additional medications or specialist consultations (e.g., ophthalmologist for scleritis, otolaryngologist for airway involvement).
Referral to a rheumatologist: For complex cases, treatment decisions, and long-term management.
Patient education: Provide information about RP, the relapsing-remitting course, importance of early recognition of flares, and treatment options.
Discuss potential complications and the importance of adherence to medication regimens.
Address emotional aspects of chronic illness and offer support resources.
Follow-up:
Schedule for follow-up appointments based on disease activity:
More frequent visits during active relapses to monitor response to treatment.
Less frequent visits during remission for disease monitoring and medication adjustments as needed.
Educate the patient on recognizing signs of flares and the importance of reporting worsening symptoms promptly.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of relapsing polychondritis