Why should immunosuppressants be used in conjunction with hormone therapy for relapsing polychondritis?

Author: Wang Guangfa, Chief Physician, Peking University First Hospital

Reviewer: Wang Lixiang, Chief Physician, Third Medical Center, PLA General Hospital

The 10th Chairman of the Science Popularization Branch of the Chinese Medical Association

Drugs are an important means of treating relapsing polychondritis.

First of all, we need to provide symptomatic treatment based on the severity of the patient's condition and the target organs damaged. For example, if there is a problem with the costal cartilage or joints, we may use non-steroidal anti-inflammatory drugs to solve the pain problem.

However, patients with eye, airway, heart or large blood vessels involvement must be taken seriously. At this time, some anti-inflammatory drugs may be used, and the most commonly used is glucocorticoids.

Prednisone is commonly used in the treatment of relapsing polychondritis glucocorticoids. It is usually started at 30-60 mg, depending on the patient's height and weight, and should be used for at least three months. Then the dosage should be gradually reduced, and special attention should be paid to the slow reduction rate. If the dosage is reduced too quickly, the patient will easily relapse, and each relapse is a blow to the patient. Some patients require long-term maintenance with low-dose glucocorticoids. Dapsone can also reduce the activity and recurrence of the disease. For some patients with poor results, these two drugs can be used in combination.

If the treatment effect of glucocorticoids is not good, immunosuppressants can be added. The most commonly used ones are cyclophosphamide, methotrexate and azathioprine. You can choose any one of them.

What is the purpose of using these immunosuppressants?

First, immunosuppressants can be used in patients who do not respond to glucocorticoid therapy.

Second, for patients who are currently using glucocorticoids, reduce the dosage of glucocorticoids. Because there may be many adverse reactions after using glucocorticoids. So try to reduce the dosage of glucocorticoids. In addition, because relapsing polychondritis is similar to many autoimmune diseases, it is always relapsing. After adding immunosuppressants, the relapse rate will be reduced, so for such patients, adding some immunosuppressants is helpful.

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We need to remind everyone that long-term use of glucocorticoids and immunosuppressants by patients with relapsing polychondritis may cause some adverse reactions, which should attract everyone's attention.

There are several problems with glucocorticoids. They can cause obesity, increase blood pressure, cause diabetes, and cause osteoporosis. As long as you take hormones, these adverse reactions are likely to occur.

However, the principle of our medical treatment is to weigh the pros and cons, the benefits and risks. If relapsing polychondritis is not controlled, airway stenosis will occur, which is fatal, so glucocorticoids must be used. There is no other way. We can only try to reduce the dosage of the drug and minimize its adverse reactions.

Immunosuppressants, such as cyclophosphamide, methotrexate, and azathioprine, have the most prominent problem of suppressing immunity. After use, white blood cells decrease, immune function deteriorates, and infection is more likely to occur. Therefore, monitoring is required during the treatment process. Once a problem occurs, the dosage should be reduced or the drug should be temporarily stopped, and then some drugs that increase white blood cells should be used.

In addition, these drugs may cause some damage to liver and kidney functions, so you should pay attention to monitoring them regularly. If these adverse reactions occur, you can reduce the dosage or stop the medication in time.

For patients with relapsing polychondritis, special attention should be paid to several issues while taking glucocorticoids:

First, you must take the medicine according to the doctor's instructions. You must not say that hormones can cause obesity, I want to be slim, I want to be beautiful, and I lose weight secretly today and tomorrow. In fact, this will harm yourself. When you find that the airway is narrowed, if you add hormones, the effect will be much worse. That is, you must try your best to avoid problems with the structure of important organs.

Second, pay attention to monitoring. As the disease is under control, the doctor may ask you to reduce the dosage. When reducing the dosage, you should observe these symptoms. For example, if you had ear pain before, and it stopped after taking medicine, but it started to hurt again after reducing the dosage, you must see a doctor at this time. If chondritis is active, the hormone dosage may need to be increased. In addition, generally speaking, this kind of reduction is relatively slow, that is, reduce it a little bit to see if there is any problem, then reduce it a little bit more and see again.

Third, regular check-ups are necessary. Some auxiliary examinations should be done regularly, such as regular check-ups of erythrocyte sedimentation rate and C-reactive protein, which is an indicator of inflammation. For some patients, if the condition is particularly severe or there is a special need to monitor the airway inflammation, we can consider doing PET/CT. Of course, this is also expensive and involves some radiation, so it cannot be done too frequently, but it can be used as a monitoring method.

In addition, patients themselves should also pay a little attention to prevent some adverse reactions of hormones.

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For example, for the problem of obesity, because taking hormones stimulates appetite, patients are often hungry, so they have to take the initiative to diet; for the problem of blood pressure, the dosage of antihypertensive drugs should be increased in time; for blood sugar, you should monitor your blood sugar in time and control the intake of carbohydrates, and your blood sugar may go down. Of course, some patients may have to use additional hypoglycemic drugs or even insulin. As long as blood sugar is controlled, the corresponding damage will not be serious; for the problem of osteoporosis, you can take more calcium supplements, drink milk, and eat some vitamin D, all of which can reduce the corresponding damage.