Relapsing Polychondritis: Problems and Solutions

Abstract

The purpose of this study is to evaluate the clinical course and effectiveness of pharmacological therapy in a patient with recurrent polychondritis. Material and methods. Retrospective and prospective analyses of the diagnosis, course and treatment of recurrent polychondritis in the patient were performed. The patient was diagnosed based on the McAdam classification criteria. The patient was assigned laboratory tests: general, biochemical and immunological blood analyses; instrumental methods: X-ray and ultrasound examinations of the vessels, spirometry. The results of the study. The patient was first diagnosed with recurrent polychondritis at the age of 58. The patient complained of pain, swelling and hyperemia of the auricles, a change in the shape of the nose; attacks of suffocation, which were stopped by inhalations of salbutamol, hoarseness of voice; prolonged subfebrility (37.5–38°C), arthralgia. In September 2022, he was examined by an otolaryngologist, then sent to a rheumatologist to determine therapeutic and diagnostic tactics. According to the results of laboratory data: erythrocyte sedimentation rate – 48 mm/hour, C-reactive protein – 30.1 mg/l, rheumatoid factor – 10 units/l, antibodies to cyclic citrulline peptide- 7.0 units, the result of immunoblot is negative; antibodies to myeloperoxidase – 4.15 RU/ml, antibodies to proteinase – 32.2 RU/ml. During spirometry, there was a violation of the function of external respiration of an obstructive type. Ultrasound of the joints: signs of synovitis of the proximal interphalangeal joints of both hands. Based on the McAdam classification criteria, a clinical diagnosis was made: recurrent polychondritis with systemic manifestations: chondritis of the auricles and nasal congestion, seronegative arthritis, bronchoobstructive syndrome, constitutional symptom (fever). The patient was prescribed therapy: prednisone 20 mg/day, methotrexate 25 mg/week. Clinical and laboratory remission was achieved, but subsequently relapses of the disease and the appearance of a herpes infection were observed (antiviral therapy was prescribed). In July 2023, he was sent for examination and treatment at the Nasonova Research Institute of Rheumatology. The patient was submitted to the commission on therapy with genetically engineered biological drugs. Taking into account the often recurrent herpetic infection, the appointment of genetically engineered biological drugs was postponed. It is recommended to continue taking prednisolone at a dose of 20 mg/day, antiviral therapy (valciclovir). Dapsone 100 mg per day was added to the treatment, but his patient independently canceled the drug due to the appearance of severe nausea and insomnia. Subsequently, a rheumatologist with an immunosuppressive purpose prescribed azathiroprine 150 mg/day, continued taking prednisone 20 mg/day, however, exacerbations of the disease were registered. The lack of effect of the therapy was the basis for the patient's re-hospitalization at the V.A. Nasonova Research Institute of Rheumatology. Conclusions. Recurrent polychondritis is a rapidly progressive disease, and in the absence of timely diagnosis and treatment, it has a risk of developing life-threatening conditions.