TY - JOUR T1 - Refractory Relapsing Polychondritis Treated with Serial Success with Interleukin 6 Receptor Blockade JF - The Journal of Rheumatology JO - J Rheumatol SP - 100 LP - 101 DO - 10.3899/jrheum.120381 VL - 40 IS - 1 AU - ZACHARY S. WALLACE AU - JOHN H. STONE Y1 - 2013/01/01 UR - http://www.jrheum.org/content/40/1/100.abstract N2 - To the Editor:Relapsing polychondritis (RPC) can affect the ears, eyes, larynx, trachea, bronchi, joints, audiovestibular system, and heart valves1,2,3. Therapy is difficult in the subset of patients refractory to glucocorticoids and conventional immunosuppressive agents. We describe a 65-year-old woman with RPC refractory to glucocorticoids, cyclophosphamide, and infliximab. Interleukin 6 (IL-6) inhibition led to prompt control of RPC affecting her ears, nose, and trachea, as well as swift normalization of her acute-phase reactants. Re-treatment with tocilizumab on 2 occasions following disease flares again led to prompt disease control without the use of other medications.The patient presented with 4 months of intermittent but progressive swelling, erythema, and pain of her right ear (Figure 1A). The nasal bridge was swollen and faintly erythematous (Figure 1B), and the trachea was tender. Her left ear appeared normal (Figure 1C). She had thrombocytosis (platelets 767,000/mm3, normal 150,000−400,000/mm3) and elevations of the erythrocyte sedimentation rate (ESR; 103 mm/h, normal < 17 mm/h) and C-reactive protein (CRP; 170 mg/dl, normal < 8 mg/dl). Given her clinical presentation, a diagnosis of RPC was rendered … Address correspondence to Dr. J.H. Stone, Rheumatology Unit, Massachusetts General Hospital, 55 Fruit St., Yawkey 2, Boston, MA 02114, USA. E-mail: jhstone{at}partners.org ER -