Biologic therapy in relapsing polychondritis: navigating between options

Relapsing Polychondritis Associated With Thyroid Carcinoma: A First Malagasy Case

Relapsing polychondritis (RP) is a rare disease characterized by recurrent systemic inflammation affecting cartilaginous tissues and proteoglycan-rich tissues. The disease may present in several clinical variants, which can delay diagnosis. Corticosteroids are the treatment of choice for RP. In rare cases, RP can be paraneoplastic. The association of RP with thyroid cancer is unusual. We report the first Malagasy case of a 48-year-old man with RP type one diagnosed within less than a year, presenting with recurrent chondritis of the auricular cartilage, tracheobronchial chondritis, and recurrent episcleritis. The disease was associated with papillary thyroid carcinoma.

JAK inhibitors (JAKi): Mechanisms of action and perspectives in systemic and autoimmune diseases

Janus kinase (JAK) molecules are involved in important cellular activation pathways. Over the past decade, many targeted therapies have emerged, including the increasingly promising role of JAK inhibitors (JAKi) in the treatment of inflammatory and autoimmune diseases. The spectrum of use of these small molecules is increasingly broader. JAKi have been approved in several autoimmune diseases. Currently, four molecules (tofacitinib, baricitinib, upadacitinib and filgotinib) have been labeled for moderate to severe rheumatoid arthritis (RA) with failure or poor tolerance of one or more conventional disease-modifying antirheumatic drug (csDMARDS), or biologics (bDMARDS). JAKi are now also commonly used in other diseases such as psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis. They have also shown promising results in clinical trials for the treatment of other autoimmune conditions. We present here their mechanisms of action, and the main data about JAKi use on systemic and autoimmune diseases.

Hiding in Plain Sight-Relapsing Polychondritis Disguised as Hip Arthritis: A Case Report and Literature Review

BACKGROUND

Relapsing polychondritis (RP) is a rare autoimmune disorder characterized by episodic inflammation of cartilaginous tissues. Its diverse clinical manifestations frequently pose diagnostic challenges and lead to misdiagnosis.

METHODS

We present a 59-year-old female initially diagnosed with refractory hip osteoarthritis based on persistent left hip pain unresponsive to conventional anti-inflammatory therapy. Subsequent development of stridor and dyspnea prompted comprehensive evaluation, including laryngotracheal imaging, autoimmune serology, and multidisciplinary consultation. Diagnostic criteria for RP were applied in accordance with revised Michet criteria.

RESULTS

Tracheal stenosis secondary to tracheal chondritis and iritis were identified, confirming the diagnosis of RP. Following initiation of corticosteroid therapy, the patient exhibited marked clinical improvement.

CONCLUSION

This case underscores the importance of enhanced clinical awareness regarding atypical presentations of RP, particularly when accompanied by evolving systemic symptoms. A multidisciplinary diagnostic approach is advocated to facilitate early detection and improve patient outcomes.