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Protocol critique: Relapsing polychondritis

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Protocol critique: Relapsing polychondritis

PATRICK FREE August 3, 2021 at 1:34 am

7 Replies

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  • #30936
    PATRICK FREE
    Member
    SSRP Certified

    Good evening everyone. I was looking for some advice on a patient regarding a protocol I am wanting to implement. The patient is a 61 y/o female who had been having years of generalized joint pain, HTN, Diabetes, and persistently elevated hs CRP levels in the mid to upper teens. She was eventually diagnosed with relapsing polychondritis, a rare autoimmune disease, which eventually caused her to have coronary artery and b/l renal stent placements. She is currently being treated by Mayo clinic and was placed on Humira, which controlled her pain and other symptoms for some time, but over the last few months she has been having break-through pain, and she began to look for alternative therapies, with an interest in peptides. We started her on TA1 initially with BPC157 and she was getting relief from her symptoms, in combination with an elimination diet., and optimized on hormone therapy. However, since TA1 is no longer available I was thinking of implementing the following protocol:

    For the first three months to clear senescent burden:

    -Rapamycin 2mg po once weekly

    -Quercetin/dasatinib: 400/30, one capsule 3 days monthly (would you recommend giving while on Humira?)

    -Epicatechin 500mg po qd for three weeks on then one week off.

    -TA1 when available

     

    After 3 months add in:

    -NMN 500-1g orally daily

    -NAD+ infusion

    -Sermorelin 300mcg sq M-F qhs

    -MOTS-C

    Thank you for your time, much appreciated,

    Patrick

    #30937
    Kristelle Reyes
    Member
    SSRP Staff

    Hello @byurthgmail-com and @drhusaininterlinkedmd-com, would love to have your insights here. Thank you! 🙂

    #30938
    Elizabeth Yurth
    Member
    SSRP Certified

    @free703msn-com

    Phew. Tough case!!

    I like your approach. Dont think need the rapamycin and quercetin. WOuld pick -likely use the rapamycin

    I think you still need to focus more on immune modulation and then improving collagen function. There is some interesting overlap between behcets and relapsing polychondritis in my recollection. Amlexanox 40mg po TID (have to get compounded) might be useful. AMlexanox is a TBK1 inhibitor, can modulate immune responses and has anti-inflammatory properties.

    I would also think about Thymosin beta 4 for a 8-12 week course with the bpc. I would add collagen peptides and IV Vitamin C weekly till better control. Would also consider pentosan polysulfate which would reduce the inflammation, block intrarticular TNF, IL6, IL1B and the dergradative ADAM and MMP enzymes that are upregulated and causing further damage WOuld do .45mls 2x weekly for 6 weeks then weekly until better control. Will add if think about other things but I think the amlexanox and pentosan may have sig value.

    EY

    #30939
    PATRICK FREE
    Member
    SSRP Certified

    @byurthgmail.com

    Thank you very much for the reply. I will definitely implement the amlexanox. She is on antiplatelet therapy for her CAD. What is your opinion on administering Pentosan in this scenario? Also, where are you getting TB4 these days? the fragment is the only form I am able to find, and there are so many mixed opinions on efficacy. I have been avoiding it for this reason, in combination with the cost. Thanks again.

     

    #30940
    Elizabeth Yurth
    Member
    SSRP Certified

    @free703msn-com

    Tough with the blood thinner.  With Pentosan Platelet counts decreased by 24-34% from baseline
    The aPTT was prolonged from 35 seconds to approximately 65 seconds and there was weak anti-Xa activity observed and the fibrinolytic activity. SO one option is could talk to her cardiologist about reducing or stopping the blood thinners for a 6 week course to see if make some headway in joint pain. I believe Pure or southlake have TB-4?

    #30941
    Elizabeth Yurth
    Member
    SSRP Certified

    @free703msn-com Just checked and SL or Cre8

    #30942
    PATRICK FREE
    Member
    SSRP Certified

    Thank you very much.

    #30943
    Kristelle Reyes
    Member
    SSRP Staff

    Claim your CME here: https://earnc.me/JLJSrV

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