Treatment of respiratory complications in recalcitrant relapsing polychondritis with infliximab

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Abstract
Sir, the outcome of relapsing polychondritis (RP) depends on remission of the underlying inflammatory process. Most patients experience a fluctuant inflammatory course, but the disease is generally progressive. Ten per cent of deaths in RP are due to respiratory complications. The optimal therapeutic approach to patients with RP is poorly understood. Corticosteroids are able to suppress disease activity but do not stop disease progression and are associated with side‐effects. Various disease‐modifying anti‐rheumatic drugs have been used in an attempt to achieve a lower dose of steroid or for refractory cases. Infliximab is a monoclonal antibody that binds and inactivates tumour necrosis factor α (TNF‐α) and has been successfully used in the management of TNF‐α‐mediated diseases, such as Crohn's disease and RA. Infliximab is not licensed for the treatment of RP, but because TNF‐α has a potential pathological role in this condition, it may be of therapeutic benefit, especially after failure of conventional therapeutic approaches. We report here a patient with RP who developed recalcitrant and life‐threatening respiratory tract complications, in whom treatment with infliximab led to resolution of disease activity.

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