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

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.

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.

The ocular manifestations of relapsing polychondritis

PURPOSE

Relapsing polychondritis (RPC) is a rare, multi-system, inflammatory disorder. Ocular disease is estimated to occur in 14-67% of patients with RPC, and any ocular structure can be affected. Published case reports and series of RPC were analysed to determine the frequency and nature of the ocular manifestations of RPC, including the age and gender distribution.

METHODS

A literature search of the MEDLINE database for case reports and series on RPC was conducted in October 2021 using search terms [relapsing polychondritis (MeSH Major Topic)] OR [relapsing polychondritis (Title/Abstract)]. Articles were included if the diagnosis of RPC was confirmed using established diagnostic criteria and if the paper described the clinical features of patients with RPC.

RESULTS

546 articles (454 case reports and 92 case series) described the clinical features in a total of 2414 patients with RPC. 49% of patients with RPC had ocular involvement, and this was a presenting feature in 21%. The most common ocular manifestations were scleritis (32%), episcleritis (31%) and uveitis (23%).

CONCLUSION

Many patients with RPC will be seen by an ophthalmologist during the course of their disease. Knowledge and awareness of RPC and its ocular manifestations is therefore essential to enable the ophthalmologist to make the diagnosis.

Biologic therapy in relapsing polychondritis: navigating between options

INTRODUCTION

Relapsing polychondritis (RP) is a rare systemic inflammatory disease of unknown etiology, primarily affecting cartilaginous tissue and proteoglycan-rich structures. Clinical manifestations vary from mild symptoms to occasional organ or life-threatening complications. Treatment can be challenging and is mostly based on experience or case reports/series.

AREAS COVERED

There is growing literature investigating the role of biologics in the management of RP. TNFα antagonists, abatacept, tocilizumab, rituximab, anakinra and tofacitinib have been prescribed in several RP patients, mainly as second-line treatment, after conventional immunosuppressive agents' failure.

EXPERT OPINION

: Glucocorticoids represent the gold standard treatment of RP. Conventional immunosuppressants should be administered in refractory patients or when a glucocorticoid-sparing effect is needed. Biologic therapy should be used after failure of conventional treatments or in severe manifestations. TNFα inhibitors are the most prescribed biologic agent, with partial or complete response in several cases; but loss of efficacy may occur over time. Infliximab and adalimumab should be preferred among TNFα antagonists. Abatacept and tocilizumab proved to be effective as second-line biologic agents, but frequent infections are reported with the former. Data on anakinra and rituximab are controversial, therefore they are not recommended as first-line biologic drugs. The use of JAK inhibitors is still anecdotal.