Weight Loss with Relapsing Polychondritis in South Africa

Imagine an immune system that attacks cartilage — the structural material of your ears, nose, larynx, trachea, ribs, and joints. That is what relapsing polychondritis (RP) does. A rare and often misdiagnosed autoimmune condition, RP is characterised by episodes of intense inflammation in cartilage-rich structures, followed by partial resolution, and then relapse — sometimes in the same sites, sometimes in new ones.

The condition's rarity (estimated at 3–4 cases per million people) means that most South Africans with RP face a long diagnostic journey before finally getting the right diagnosis from an experienced rheumatologist. By that point, there is often already some degree of permanent structural damage — particularly to the nose (saddle-nose deformity), ears, and in the most severe cases, the airways.

Weight management with RP requires navigating the familiar tension of autoimmune conditions: anti-inflammatory nutrition during active disease, corticosteroid weight management during treatment, airway-aware food choices when laryngeal involvement is present, and rebuilding during remission.

This article is for informational purposes only. Always consult your rheumatologist and a registered dietitian before making dietary or lifestyle changes.

Understanding Relapsing Polychondritis

Relapsing polychondritis is an autoimmune condition in which autoantibodies and T cells target type II collagen — the primary structural protein of cartilage. This triggers episodes of intense inflammation characterised by pain, redness, swelling, and warmth in affected cartilaginous structures.

Classic Manifestations

• Auricular chondritis: Inflammation of the cartilage of the outer ear — the ear becomes red, hot, swollen, and extremely tender. Critically, the earlobe (which has no cartilage) is spared — a diagnostic clue. This is the most common RP manifestation (85–90% of patients)
• Nasal chondritis: Inflammation of the nasal bridge cartilage; repeated episodes lead to collapse of the nasal bridge — saddle-nose deformity
• Laryngotracheal involvement: The most dangerous manifestation — inflammation and eventual fibrosis of the laryngeal and tracheal cartilage rings can lead to airway narrowing and collapse (see emergency section below)
• Arthritis: A non-erosive, migratory polyarthritis affecting large and small joints
• Costochondritis: Chest wall pain from inflammation of the cartilage joining ribs to the sternum
• Ocular involvement: Episcleritis, scleritis, uveitis — painful eye inflammation requiring specialist treatment
• Cardiovascular involvement: Aortic regurgitation and other valvular changes in severe long-standing disease

Airway Involvement: What Every RP Patient Needs to Know

Approximately 50% of RP patients develop some degree of laryngotracheal involvement over the course of their disease. This ranges from mild hoarseness and throat tenderness to severe subglottic stenosis (narrowing below the vocal cords) and tracheal collapse — a potentially fatal emergency.

Warning signs of laryngotracheal involvement:

• Hoarseness or change in voice quality
• Throat tenderness (especially over the larynx)
• A dry, barking cough
• Stridor — a high-pitched sound during breathing in, like a whistle
• Dyspnoea (breathlessness) on minimal exertion or at rest
• Difficulty or pain on swallowing (dysphagia)

Any new hoarseness, stridor, or breathing difficulty in a known RP patient is a potential emergency. Seek immediate medical assessment. In South Africa, proceed to the nearest emergency unit with airway management capability.

Dietary Implications of Laryngeal RP

When the larynx is inflamed or narrowed, swallowing can become difficult or painful. Aspiration risk increases when swallowing mechanics are impaired. Dietary modifications for laryngeal involvement:

• Switch to soft, moist, smooth-textured foods during acute laryngeal flares
• Blended soups (butternut, lentil, sweet potato) — nutritious and easy to swallow
• Soft pap (maize porridge made to a very smooth consistency) — a traditional SA option
• Smooth yoghurt and amasi (fermented milk) — protein-rich and easy to swallow
• Avocado — soft, calorie-dense, anti-inflammatory
• Mashed potato or sweet potato with a little olive oil or low-fat milk
• Avoid dry, hard, or crumbly textures: rusks, biltong, nuts, popcorn, tough meat
• If dysphagia is significant, a speech therapist or swallowing specialist assessment is warranted

Anti-Inflammatory Diet for Cartilage Protection

While no diet can replace medical treatment for RP, an anti-inflammatory eating pattern supports cartilage health by:

• Reducing systemic inflammatory cytokine load (reducing IL-1, IL-6, TNF-alpha)
• Providing collagen precursors to support cartilage matrix maintenance
• Reducing oxidative stress that worsens chondrocyte (cartilage cell) damage

Key Anti-Inflammatory Foods in a SA Context

• Oily fish: Pilchards (canned in tomato sauce R20–R35), sardines, snoek, and mackerel deliver omega-3 fatty acids (EPA and DHA) that reduce cartilage-damaging cytokine production. Target 3 servings per week
• Turmeric: Curcumin has demonstrated anti-inflammatory effects on chondrocytes in laboratory and clinical studies. Use liberally in curries, lentil dishes, and golden milk (turmeric + ginger + rooibos + small amount of black pepper to enhance absorption)
• Colourful vegetables: Red, orange, yellow, and green vegetables at every meal provide antioxidants (vitamin C, beta-carotene, lycopene) that reduce oxidative cartilage damage
• Vitamin C-rich foods: Guava (the highest natural vitamin C source widely available in SA), citrus, peppers, strawberries — vitamin C is essential for collagen synthesis and cartilage matrix integrity
• Rooibos tea: South Africa's finest anti-inflammatory beverage — rich in aspalathin and quercetin; safe to drink freely throughout the day
• Legumes: Lentils, chickpeas, kidney beans — plant protein plus anti-inflammatory polyphenols; affordable on a South African budget
• Olive oil: Oleocanthal has NSAID-like properties; use as primary cooking and dressing fat
• Ginger: Anti-inflammatory and has anti-nausea properties helpful for medication side effects; fresh ginger in rooibos tea or stir-fries

Managing Corticosteroid Weight Gain

Like most inflammatory rheumatic conditions, RP frequently requires prolonged corticosteroid treatment. Prednisolone at doses of 0.5–1 mg/kg/day during flares, tapering over weeks to months, is standard. Strategies to minimise steroid-driven weight gain:

• Low-sodium diet: Corticosteroids cause sodium and water retention; limit added salt, processed meats (biltong, Vienna sausages, canned goods), and take-away food; target under 1,500 mg/day during high-dose phases
• Low-GI carbohydrates: Oats, sweet potato, brown rice, lentils — prevent the sharp insulin spikes that drive steroid-related fat storage
• High protein: 1.2–1.5 g/kg body weight/day; prioritise lean sources (eggs, fish, chicken, legumes, low-fat dairy) to counter corticosteroid muscle catabolism
• Calcium and vitamin D: Corticosteroids rob bones of calcium; ensure adequate intake through low-fat dairy, fortified plant milks, and canned fish with bones (pilchards, sardines); consider supplementation as guided by your doctor
• Potassium top-up: Bananas, sweet potato, avocado, and legumes restore potassium depleted by corticosteroids
• Limit alcohol: Interacts with corticosteroids, worsens immune suppression, and adds empty calories

Weight Management Goals During Remission

When RP is well controlled and corticosteroids are at low doses or discontinued, a gradual, sustainable weight loss programme is appropriate if steroid-driven weight gain has occurred:

• Target 0.3–0.5 kg per week through a 300–500 kcal/day calorie deficit
• Prioritise protein and vegetables; moderate low-GI carbohydrates; limit saturated fat
• Combine dietary changes with progressive exercise (see below)
• Avoid crash diets or extreme calorie restriction which may stress the immune system

Exercise with Relapsing Polychondritis

Exercise provides critical benefits in RP — countering corticosteroid effects, maintaining joint function, supporting mood, and enabling sustained healthy weight — but must be tailored to the distribution and severity of disease.

Clearances Needed

• Laryngotracheal involvement: Get explicit clearance from your pulmonologist or ENT for any exercise that substantially increases breathing demand; moderate-intensity walking and cycling are often safe, but high-intensity interval training may not be
• Costochondritis: Avoid loaded chest exercises (bench press, press-ups) during active rib cartilage flares; focus on lower body and core stability instead
• Cardiovascular involvement: Echocardiogram assessment before intensive exercise if aortic or valvular disease is known

Recommended Exercise Modalities

• Swimming and pool walking — low impact, good aerobic conditioning, avoids rib cartilage loading
• Walking (30–45 minutes, 5 days per week) — the SA outdoor walking culture suits RP well during remission
• Stationary cycling — controlled intensity, easy to stop if symptoms develop
• Yoga and Pilates — excellent for flexibility, core strength, and stress management; many classes available across SA at R80–R150 per session
• Resistance training with light to moderate weights — critical for rebuilding muscle wasted by steroids and inflammation

Treatment Costs in South Africa

• NSAIDs (naproxen, ibuprofen): First-line for mild auricular or joint involvement; R50–R150/month
• Dapsone: Used specifically for milder RP, particularly ear and joint involvement; R200–R400/month
• Colchicine: Sometimes used for mild-moderate disease; R300–R600/month
• Prednisolone: Standard for moderate-severe flares; R50–R150/month; long-term effects require monitoring
• Methotrexate: Steroid-sparing; R150–R300/month; weekly dosing
• Azathioprine: Steroid-sparing; R200–R400/month
• Mycophenolate mofetil (CellCept): Steroid-sparing alternative; R800–R1,500/month
• Tocilizumab (Actemra): IL-6 inhibitor for severe refractory disease; R10,000–R25,000/infusion; requires specialist motivation
• Rituximab: Used in refractory or overlap disease; R25,000–R50,000 per infusion cycle
• Tracheal stenting: Available at academic hospitals for severe subglottic stenosis; procedural cost varies widely

RP is a PMB condition — medical aids are obliged to fund treatment. Work with your rheumatologist and specialist to ensure proper medical aid coding and authorisation.

SA Resources and Support

• SARAA (South African Rheumatism and Arthritis Association): arthritis.org.za — specialist referral for RP; can assist with finding rheumatologists experienced in rare autoimmune conditions
• ADSA (Association for Dietetics in South Africa): adsa.org.za — find a dietitian for anti-inflammatory dietary planning and dysphagia management
• Rare Diseases South Africa: rarediseases.co.za — community and advocacy for rare autoimmune conditions
• SADAG: sadag.org — 0800 21 22 23; mental health support for chronic illness

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