gms | German Medical Science

44. Kongress der Deutschen Gesellschaft für Rheumatologie, 30. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 26. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

31.08. - 03.09.2016, Frankfurt am Main

Clinical features in CRMO patients with mandible manifestation – a cohort study

Meeting Abstract

  • Dorothee Hauler - Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Rheumatologie, München
  • Johanna Meier - Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Rheumaeinheit, München
  • Matthias Witt - Rheumazentrum Bad Aibling-Erding, Erding
  • Mathias Grünke - Rheumapraxis Bad Aibling, Rheumatologische Schwerpunktpraxis, Bad Aibling
  • Claudia Dechant - Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Rheumatologie, München
  • Jan Leipe - Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Rheumatologie, München
  • Hendrik Schulze-Koops - Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Rheumatologie, München

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 44. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 30. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 26. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Frankfurt am Main, 31.08.-03.09.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocVS.04

doi: 10.3205/16dgrh130, urn:nbn:de:0183-16dgrh1301

Veröffentlicht: 29. August 2016

© 2016 Hauler et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

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.