This paper presents a case with refractory
relapsing polychondritis (RPC), complicated with severe aortic involvement, which is successfully treated with
tocilizumab. Previous treatments consisted of
methotrexate,
corticosteroids,
cyclosporine,
cyclophosphamide,
infliximab, and
etanercept. With these treatments, the patient had recurrent episodes of
fever,
polyarthritis,
tenosynovitis, subcutaneous nodules, and progressive
cardiac disease. One year after the start of treatment with
tocilizumab, there is resolution of all symptoms, normalization of
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and the dose of
prednisolone is tapered down to 2 mg/day. We have reviewed the English literature for reports of patients with refractory RPC, successfully treated with
tocilizumab. We found five additional case reports. In one case report, a patient with refractory RPC complicated with
aortitis was successfully treated with
tocilizumab. In three case reports, patients with refractory RPC complicated with laryngotracheal involvement were successfully treated with
tocilizumab. All cases had, like our patient, failed conventional treatment. We also reviewed the literature for reports of the effect of
biologicals on cardiac involvement in RPC. Current literature is presented and discussed.