Chronic Recurrent Multifocal Osteomyelitis Primarily Affecting the Spine Treated With Anti-TNF Therapy

Marangoni, Roberta Gonçalves; Halpern, Ari Stiel Radu

doi:10.1097/brs.0b013e3181c09601

Cited by 36 publications

(16 citation statements)

References 31 publications

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“…NSAIDs provides pain reduction, however, it is not always equal to the remission of CNO [11]. Therefore, if NSAIDs treatment failed to control CNO, corticosteroids [6, 30], MTX, or anti-TNFα therapy [31, 32] are reportedly used as the second-line therapy. Several pediatric reports have also suggested the efficacy of bisphosphonates for symptomatic improvement in CNO [17, 33–36].…”

Section: Discussionmentioning

confidence: 99%

Bone metabolism and inflammatory characteristics in 14 cases of chronic nonbacterial osteomyelitis

et al. 2017

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BackgroundChronic nonbacterial osteomyelitis (CNO) is a multifocal autoinflammatory disease that often impairs daily life in children. This study aimed to investigate the bone metabolic and inflammatory characteristics of patients with CNO, and to assess the differences between responders and nonresponders to conservative treatment.MethodsWe investigated the clinical symptoms; laboratory data including inflammatory and bone metabolic biomarkers; and imaging findings from plain radiography, magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), and dual-energy x-ray absorption (DEXA) in 14 patients with CNO. All patients underwent first-line treatment comprising systemic nonsteroidal anti-inflammatory drugs with or without bisphosphonate. According to the response to the first-line treatment, the patients were divided into the clinical remission/partial response group and the no response group. The differences in bone metabolic and inflammatory characteristics between the two groups were assessed.ResultsAll patients had low bone mineral density assessed with DEXA. The bone metabolic biomarkers (bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b) were increased in boys of all ages and in young girls. Multiple inflammatory regions were detected in all patients by using FDG-PET including asymptomatic regions. The no response group had higher immunoglobulin G (IgG) and a greater number of bone inflammatory lesions detected on MRI than the clinical remission/partial response group.ConclusionOur data indicate the involvement of abnormal bone turnover, necessity of whole-body scanning, and association of higher serum IgG levels and greater numbers of inflammatory lesions with prolonged disease activity in patients with CNO.

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Section: Discussionmentioning

confidence: 99%

Bone metabolism and inflammatory characteristics in 14 cases of chronic nonbacterial osteomyelitis

et al. 2017

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“…TNF-α blockers have also been proven to be effective [16,[82][83][84][85]. There is no consensus, however, on the drug regimen that should be used.…”

Section: Treatmentmentioning

confidence: 99%

Chronic Recurrent Multifocal Osteomyelitis

Costa-Reis

Sullivan

2013

J Clin Immunol

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Chronic recurrent multifocal osteomyelitis is a rare auto-inflammatory condition that primarily affects children and adolescents. It presents with recurrent episodes of pain related to the presence of foci of sterile bone inflammation. The long bones of the lower extremities are more frequently affected and the spine can also be involved. Imaging studies, including whole-body magnetic resonance, are important for diagnosis and detection of asymptomatic lesions. Bone biopsies may be necessary to exclude other diseases, including malignancy and infections. Non-steroidal anti-inflammatory drugs cause relief of symptoms in the majority of cases. Bisphosphonates and TNF-α blockers are alternatives for patients who do not respond or who have spinal involvement.

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“…Their efficacy was first reported in 2004 [137] and confirmed by several clinical studies published later [138]. TNF- α antagonists have also been employed with good results in the few CRMO patients refractory to bisphosphonates and nonsteroidal anti-inflammatory drugs [139]. …”

Section: Pyogenic Autoinflammatory Diseasesmentioning

confidence: 99%

Untangling the Web of Systemic Autoinflammatory Diseases

Rigante

Lopalco

Vitale

et al. 2014

Mediators of Inflammation

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The innate immune system is involved in the pathophysiology of systemic autoinflammatory diseases (SAIDs), an enlarging group of disorders caused by dysregulated production of proinflammatory cytokines, such as interleukin-1β and tumor necrosis factor-α, in which autoreactive T-lymphocytes and autoantibodies are indeed absent. A widely deranged innate immunity leads to overactivity of proinflammatory cytokines and subsequent multisite inflammatory symptoms depicting various conditions, such as hereditary periodic fevers, granulomatous disorders, and pyogenic diseases, collectively described in this review. Further research should enhance our understanding of the genetics behind SAIDs, unearth triggers of inflammatory attacks, and result in improvement for their diagnosis and treatment.

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Chronic Recurrent Multifocal Osteomyelitis Primarily Affecting the Spine Treated With Anti-TNF Therapy

Abstract: Our observation highlights the need of awareness for the differential diagnosis in suspected cases of osteomyelitis not responding to antibiotics. Anti-TNF-alpha agents should be considered in CRMO refractory cases.

Cited by 36 publications

References 31 publications

Bone metabolism and inflammatory characteristics in 14 cases of chronic nonbacterial osteomyelitis

Bone metabolism and inflammatory characteristics in 14 cases of chronic nonbacterial osteomyelitis

Chronic Recurrent Multifocal Osteomyelitis

Untangling the Web of Systemic Autoinflammatory Diseases

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