Relapsing Polychondritis in a Patient with Ankylosing Spondylitis Using Etanercept

Abstract

Relapsing polychondritis (RP) is an autoimmune disease characterized by recurrent episodes of inflammation and progressive destruction of cartilaginous tissues, especially of the ears, nose, joints, and tracheobronchial tree. Its etiology is not well understood, but some studies have linked its pathophysiology with autoimmune disease and autoantibody production. We described a case of a 46-year-old male patient with ankylosing spondylitis who developed RP after the use of etanercept. Few similar cases have been described in the literature. However, they show a possible association between the use of biological inhibitors of tumor necrosis factor (anti-TNFα), which potentially produces autoantibodies, and the development of RP. The treatment was based on data in the literature and included the cessation of biological therapy and the addition of corticosteroids with substantial improvement.

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

“…The patient was HLA-B27 positive and was diagnosed based upon clinical suspicion two months after initiating etanercept therapy. This patient was taken off the TNF-alpha inhibitor and with the addition of corticosteroids saw improvement in his RP within five months [14]. Two similar cases were described by Hernández et al in 2011, in which two HLA-B27 were diagnosed with newly developed RP as consequence of TNA-alpha inhibitor therapy [15].…”

“…Steroids were started in each patient in combination with TNFi cessation, with resolution of symptoms after five to six months. TNFi's were successfully restarted without documented recurrence of RP [14, 15]. …”

Case report of mixed-type autoimmune hemolytic anemia in a patient with relapsing polychondritis

“…[ 14 ] Triggering factors for RP include mechanical stimuli, such as local cartilage traumas [ 15 ] and ear piercing [ 16 ] that may expose cryptogenic antigens of the cartilaginous matrix. Glucosamine chondroitin supplement [ 17 ] and anti-TNF-α drugs [ 18 , 19 ] were considered to potentially initiate RP. Furthermore, infectious agents such as Mycobacterium tuberculosis and Myxoma virus , which share structural homology with cartilaginous autoantigens, may cross-react with autoantigens related to the disease.…”

Relapsing Polychondritis Possibly Caused by Chronic Infection with Borrelia Burgdorferi – Case Report

“…There have been cases cited of RP association with other autoimmune or inflammatory disease such as ulcerative colitis, ankylosing spondylitis, Behcet's disease, myelodysplastic syndromes [13,14,15,16]. There are reported cases of central nervous system affection translated by encephalitis, meningitis, meningoencephalitis [17,18].…”