Artikel
Clinical features in CRMO patients with mandible manifestation – a cohort study
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Veröffentlicht: | 29. August 2016 |
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Gliederung
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Background: Chronic recurrent multifocal osteomyelitis (CRMO), an inflammatory disease with recurring episodes of sterile bone inflammation, is part of the SAPHO-spectrum and it is often used synonymously in adults. One to multiple sites can be affected, most often metaphyses of long bones, the clavicles, and the vertebral bodies. Patients are usually treated with NSAIDs, bisphosphonates and TNF-inhibitors. In a subgroup of patients only the mandibles are affected. According to our experience, these patients often require particularly intensive treatment. In this study, we assessed characteristics and treatment of patients with CRMO of the mandibles.
Methods: 66 Patients with CRMO were analyzed in a cross-sectional study using medical records and questionnaires with regard to the patient characteristics (age, gender, disease duration, smoking status and HLA-B27), pain perception (VAS), clinical manifestations (osteoarticular: osteitis, hyperostosis, spondylitis, and involvement of sternoclavicular and sacroiliac joints; dermatological: acne, palmoplantar pustulosis, psoriasis vulgaris), and treatment modalities (NSAIDs, opioids, steroids, TNF-inhibitors, bisphosphonates, antibiotics currently or in the past). T-test and chi-square test were used to compare differences between the cohorts (mandible vs. non-mandible CRMO), where applicable.
Results: From the 66 patients with CRMO seven presented with CRMO of the mandibles. The subpopulation of patients with mandible CRMO had fewer dermatological manifestations (p=0.001) and less sternoclavicular involvement (p=0.005) as compared to patients without mandible CRMO. Interestingly, this group reported significantly less pain (p=0.01) and these patients were also more likely non-smokers (p=0.03). With regard to previous treatments, significantly more patients with mandible involvement had experienced stronger immunosuppressive therapies such as steroids (p=0.03) and TNF-inhibitors (p=0.005) than patients without mandible involvement. The remaining patient characteristics, clinical manifestations and treatment modalities were similar between the two patient groups.
Conclusion: Patients with CRMO of the mandibles differ in several clinical characteristics from CRMO patients without mandible manifestation. Patients with CRMO of the mandibles were more frequently treated with steroids and TNF-inhibitors suggesting that these patients might represent a subgroup requiring more intensive therapy.