Relapsing polychondritis (RP) is a rare autoimmune disorder characterized by recurrent inflammation of cartilaginous structures. Effective steroid-sparing therapies for recurrent or refractory RP remain limited. This case report describes the clinical presentation, diagnosis, and treatment outcome of a patient with classic RP using combination therapy with a Janus kinase (JAK) inhibitor（Upadacitinib）.

Case Presentation: A 48-year-old woman presented with a 2-week history of painful swelling and erythema of the left pinna (with lobule sparing), mild hearing loss, and bilateral elbow arthritis. She had a 7-year history of recurrent bilateral auricular chondritis and two episodes of nasal bridge chondritis with scleritis. Physical examination showed a swollen, tender, and floppy left ear and tender swollen elbows. Laboratory findings included an erythrocyte sedimentation rate (ESR) >120 mm/h (reference range, 0–21). The diagnosis of RP was made clinically based on recurrent auricular chondritis, nasal chondritis, nonerosive seronegative polyarthritis, and ocular inflammation, fulfilling modified McAdam criteria. Pathogenesis involves autoantibodies against type II collagen and T-cell–mediated cartilage destruction.

Treatment and Outcome: The patient was treated with upadacitinib 15 mg once daily plus methotrexate 10 mg once weekly. Symptoms of auricular inflammation, arthritis, and associated pain resolved rapidly. Inflammatory markers (ESR and C-reactive protein) normalized. The patient achieved clinical remission without glucocorticoids, with stabilization of ear deformity and improvement in hearing. The regimen was well tolerated.

Following initiation of upadacitinib and methotrexate, the patient experienced rapid resolution of auricular swelling, erythema, pain, elbow arthritis, and hearing impairment. Inflammatory markers, including ESR and C-reactive protein (CRP), normalized. The floppy ear deformity stabilized without further progression, and the patient achieved sustained clinical remission. The combination regimen was well tolerated with no reported adverse effects during follow-up.

Combination therapy with upadacitinib 15 mg daily and low-dose methotrexate effectively controlled disease activity and normalized inflammatory markers in this patient with relapsing polychondritis. This case suggests that JAK inhibitors combined with methotrexate may serve as a promising steroid-sparing treatment option for RP. Larger studies are warranted to confirm the efficacy and safety of this approach.