abstract from Rheumatology conference and Polychondritis

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Infliximab in the Treatment of Polychondritis

Category: 31 Miscellaneous rheumatic diseases

Glenn R EhresmannKeck School of Medicine, Los Angeles, CA

Presentation Number: 340

Poster Board Number: 340

Keywords: Infliximab, Polychondritis

Background: Infliximab, a monoclonal antibody that binds with high affinity and specificity to TNF alpha and neutralizes its biologic activity, is approved for the reduction of the signs and symptoms of rheumatoid arthritis and Crohn’s disease. We report on the use of infliximab to treat a patient with relapsing polychondritis, a condition characterized by recurring inflammation of cartilage.Results: The 35-year-old male patient has a 10 year duration of polychondritis that initially presented with autoimmune hearing loss characterized by sudden loss of balance, left-sided deafness, and left inner ear pain in 1992. Eight months later, similar symptoms presented in the right ear. During the following 3 years, the patient experienced several episodes of classic ear involvement requiring multiple courses of high dose corticosteroids. Deafness resulted in the placement of a cochlear ear implant in 1995. In April 2000, a severe flare of symptoms required high dose prednisone therapy and initiation of methotrexate (15mg/kweek). Steroids were tapered but methotrexate was maintained for 6 months. In November 2000, the patient experienced an episode of nasal polychondritis; prednisone (60mg/day) and methotrexate (12.5 mg/week) was initiated. In February 2001, the patient experienced a flare involving the bridge of nose, face, and likely internal auditory structures and prednisone (40mg/day) and methotrexate (15 mg/week) were started. At this time, the patient became intolerant to a methotrexate dose of greater than 15mg/week. The patient subsequently experienced recurrent flares of nasal and ear chondritis as well as left ankle arthritis. Since the patient did not respond to a tapering of prednisone and was intolerant to methotrexate, infliximab was initiated at a dose of 5mg/kg (March 2001). Infliximab infusions were administered at weeks 0, 2, and 6 and continued every 8 weeks until October 01 (a total of 6 infusions). The patient then suspended infusions due to a remission of symptoms. In March 02, the patient again initiated infusions of infliximab (5mg/kg). The patient tolerated infliximab without side effect. The patient has had a remission of symptoms of chondritis of the ears, nose, and ankle for one year and has discontinued all other therapies except infliximab. Throughout the 10 year course of his disease, the patient had taken immuran, prednisone (up to 120mg/day), and methotrexate. Since the disease was evaluated to be organ threatening, the use of cyclophosphamide and cytotoxic agents was avoided.Conclusion: Infliximab resulted in remission of symptoms of relapsing polychondritis in this single patient. Additionally, the patient was able to discontinue the use of methotrexate and prednisone after initiation of infliximab therapy. Infliximab appears safe and well tolerated by this patient.