Objective <p>This retrospective study aims to investigate the risk factors for relapse in relapsing polychondritis (RP).</p> Methods <p>Patients diagnosed with RP and treated at Shanxi Bethune Hospital from October 2011 to December 2024 were considered. Those who met the 1979 Damiani classification criteria were selected and categorized into relapse and non-relapse groups. The Cox proportional hazards model and Kaplan–Meier survival curve analysis were used to identify the risk factors associated with RP relapse.</p> Results <p>The study enrolled a total of 28 patients with RP. Airway and nasal involvement were more common in the relapse group (<i>n</i> = 13) than in the non-relapse group (<i>n</i> = 15) (75.0% vs 25.0%, <i>p</i> = 0.020; 53.8% vs 13.3%, <i>p</i> = 0.042, respectively). Pre-treatment RPDAI scores, C-reactive protein (CRP) levels, and IgG levels were higher in the relapse group (30.3 ± 11.9 vs 20.5 ± 9.9, <i>p</i> = 0.024; 96.3 ± 81.9 vs 22.8 ± 15.8&#xa0;mg/L, <i>p</i> = 0.007; 15.9 ± 6.6 vs 11.0 ± 2.5 g/L, <i>p</i> = 0.020, respectively). Univariate analysis of the Cox proportional hazards model suggests that airway involvement, CRP levels and IgG levels before treatment are significantly associated with the risk of relapse (HR 3.787, 95% CI 1.160 − 12.359, <i>p</i> = 0.027; HR 9.707, 95% CI 2.575 − 36.594, <i>p</i> = 0.001; HR 5.515, 95% CI 1.780 − 17.084, <i>p</i> = 0.003; respectively). When compared to non-airway involvement group (<i>n</i> = 15), airway involvement group (<i>n</i> = 13) showed higher RPDAI scores, CRP levels, and initial prednisolone dosage before treatment (30[22.5-33.0]&#xa0;vs 20[9-30], <i>p</i> = 0.030; 60[34.5-128.9] vs 28[6-46] mg/L, <i>p</i> = 0.020; 60[40-60]vs 30[15-50] mg/d, <i>p</i> = 0.020, respectively).</p> Conclusions <p>Airway involvement, CRP levels and IgG levels before treatment may be risk factors for relapse in RP patients, and patients with airway involvement often require higher doses of corticosteroids.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> <p><b>Key Points</b></p> <p>• <i>The study indicates that airway involvement, CRP levels and IgG levels before treatment are risk&#xa0;factors for recurrence in relapsing polychondritis, and when airway involvement is present, higher initial doses of corticosteroids are used</i>.</p> </entry> </row> </tbody> </tgroup> </Table></p>