Ask the Experts - Therapy for Relapsing Polychondritis
What are the latest treatments for relapsing polychondritis?

Carolyn Pang, MD

Relapsing polychondritis is a rare condition characterized by autoreactive T cells; humoral reactivity to collagen may also play a role. Regarding therapy, the low prevalence of the disease precludes the types of larger controlled trials that have helped delineate effective therapeutic approaches to other autoimmune conditions. However, many clinicians extrapolate from the experience gained in other diseases with similar types of end-organ involvement (for example Wegener's granulomatosis and other vasculitides) and use these treatments in patients with relapsing polychondritis. Corticosteroids and cytotoxic agents such as cyclophosphamide are often the foundation of therapy for patients with severe disease. Other options include other immunomodulatory agents such as leflunomide, cyclosporine, azathioprine, and mycophenolate. Because patients with relapsing polychondritis often have intense inflammation at affected sites, the idea of using inhibitors of tumor necrosis factor (eg, etanercept, infliximab) holds theoretical appeal, but I am unaware of patients for whom this has been tried. Perhaps one of Medscape's readers has had the chance to gain experience with novel therapies.