Exploring Anti-TNF Therapy in Relapsing Polychondritis with Co-Existing Ulcerative Colitis: A Case Report and Literature Review.

BACKGROUND Relapsing polychondritis (RP) is a rare autoimmune disease characterized by recurrent inflammation involving the cartilaginous tissues such as ears, nose, joints, and cartilaginous small airways. The disease fluctuates in severity from mild auricular inflammation to life-threatening presentations such as cardiovascular or tracheobronchial involvement. Notably, a large number of case reports demonstrate an association between RP and inflammatory bowel disease. In these cases, ulcerative colitis (UC) is mostly seen in these patients, and very rarely Crohn's disease. CASE REPORT In our case, the patient experienced symptoms of UC in the form of abdominal pain and diarrhea after the initiation of adalimumab as treatment for RP. This raises the concern that UC might co-exist with RP as these conditions can occur concomitantly. Alternatively, the symptoms may have been related to the adalimumab treatment, as his RP symptoms improved but his UC symptoms persisted. Consequently, an alternative anti-TNF agent might be needed to induce remission of both diseases. CONCLUSIONS To conclude, both RP and inflammatory bowel disease can co-exist simultaneously in some patients. According to the literature, anti-TNF agents are emerging as a promising treatment in cases in which conventional immunosuppressive therapy has failed. In our case, treatment with adalimumab controlled the RP but it was not successful in treating the UC symptoms. This raises the question of whether infliximab should instead be the drug of choice as a TNF-alpha blocker in this situation, as the patient's UC symptoms subsided completely after the introduction of infliximab.