Relapsing polychondritis in a patient with ankylosing spondylitis using etanercept

IL-17 Inhibitor Secukinumab Achieves Remission in Relapsing Polychondritis: A Case Report

BACKGROUND Relapsing polychondritis is a rare autoimmune disease of unknown etiology. There are no defined protocols for treatment, and its management depends on the physician's knowledge and empirical experience. Various reports often highlight the insufficient efficacy of conventional disease-modifying anti-rheumatic drugs, and report controversial results associated with the use of different biologic agents. CASE REPORT The patient was a 32-year-old woman, previously diagnosed with ankylosing spondylitis. Four years after the initial diagnosis and following her second delivery, the patient presented with a refractory and aggressive relapsing polychondritis, which posed a significant challenge for treatment. Two months prior to the onset of the chondritis, the patient exhibited high disease activity of ankylosing spondylitis, with ASDAS-CRP 3.5 and BASDAI 6.0. After treatment failure using a combination of an anti-TNFalpha inhibitor and methotrexate, we achieved remission of both co-existing autoimmune diseases using an IL-17 inhibitor (secukinumab). CONCLUSIONS Further investigations are needed to better understand the pathogenesis of this rare condition. The existence of various reports on the controversial effects of treatment with different biologic agents, including IL-17 antagonists, raises several questions, including whether the onset of relapsing polychondritis is a side effect of the use of biologics or if it is an autoimmune disease that occurs independently of the treatment. This is the first time that the use of an anti-IL-17 agent is reported to have successfully suppressed an aggressive, progressive form of this disease, without any symptom-free period before the initiation of secukinumab.

A Rare Case of Ankylosing Spondylitis Coexisting with Relapsing Polychondritis, Antiphospholipid Syndrome, and Myelodysplastic Syndrome

Ankylosing spondylitis (AS) is rarely accompanied by other autoimmune diseases and/or hematologic disorders. We herein report a 46-year-old man with AS coexisting with relapsing polychondritis (RP), antiphospholipid syndrome (APS) and myelodysplastic syndrome (MDS). While receiving anti-TNF therapy for AS, the patient developed anemia and was diagnosed with MDS. After six months, he developed swelling and redness of the nose and both auricles. RP was diagnosed by an ear biopsy. Afterward, during the evaluation of a repeated fever, APS was diagnosed. This case of AS with multiple autoimmune diseases and hematologic malignancy successfully responded to a Janus kinase inhibitor (baricitinib).

Unusual Presentation of Relapsing Polychondritis in a Patient with Human Immunodeficiency Virus and Reactive Arthritis

Patient: Female, 58-year-old

Final Diagnosis: Relapsing polychondritis

Symptoms: Ear pain • eye pain

Medication: —

Clinical Procedure: —

Specialty: Rheumatology

Relapsing Polychondritis following Treatment with Secukinumab for Ankylosing Spondylitis: Case Report and Review of the Literature

Relapsing polychondritis (RP) is an autoimmune disorder that often occurs concomitantly with other autoimmune diseases, though RP has been infrequently associated with ankylosing spondylitis (AS). There is a small, but growing, body of the literature demonstrating case reports describing RP secondary to AS in patients treated with tumor necrosis alpha inhibitors (TNFi's). We present the first case in which RP developed in AS while treated with an interleukin 17A inhibitor (IL-17Ai), secukinumab. With this case report, we hope to raise physician awareness of the possible autoimmune disorders that may arise subsequent to novel immunomodulation therapies, particularly that RP may develop subsequent to inhibition of IL-17A.

Refractory relapsing polychondritis: challenges and solutions

Relapsing polychondritis is a severe systemic immune-mediated disease characterized by an episodic and progressive inflammatory condition with progressive destruction of cartilaginous structures. This disease has for nearly a century kept secrets not yet explained. The real incidence and prevalence of this rare disease are unknown. The multiple clinical presentations and episodic nature of relapsing polychondritis cause a significant diagnosis delay. No guidelines for the management of patients with relapsing polychondritis have been validated to date. The challenges remain, both in the understanding of its pathophysiology and diagnosis, evaluation of its activity and prognosis, and its treatment. Possible solutions involve the sharing of data for relapsing polychondritis from worldwide reference centers. Thus, we would be able to evolve toward a better knowledge of its pathophysiology, the publication of new diagnosis criteria, which will include biological markers and imaging findings, the prediction of life-threatening or organ-threatening situations, and the publication of therapeutic evidence-based guidelines after performing at randomized controlled trials.