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Clin Immunol ; 238: 109018, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35460903

RESUMO

Chronic nonbacterial osteomyelitis (CNO) can cause significant morbidity, including bone pain and damage. In the absence of clinical trials, treatments include non-steroidal anti-inflammatory drugs, corticosteroids, TNF-inhibitors (TNFi) and/or bisphosphonates. In a retrospective chart review in the United Kingdom and Germany, we investigated response to TNFi and/or pamidronate. Ninety-one patients were included, receiving pamidronate (n = 47), TNFi (n = 22) or both sequentially (n = 22). Patients with fatigue [p = 0.003] and/or arthritis [p = 0.002] were more frequently treated with TNFi than pamidronate. Both therapies were associated with clinical remission at 6 months, and reduction of bone lesions on MRI at 12 months. While not reaching statistical significance, pamidronate resulted in faster resolution of MRI lesions. Fewer flares were observed with TNFi. Failure to respond to pamidronate was associated with female sex [p = 0.027], more lesions on MRI [p = 0.01] and higher CRP levels [p = 0.03]. Randomized clinical trials are needed to confirm observations and generate evidence.


Assuntos
Difosfonatos , Osteomielite , Difosfonatos/uso terapêutico , Feminino , Humanos , Osteomielite/tratamento farmacológico , Osteomielite/patologia , Pamidronato/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Inibidores do Fator de Necrose Tumoral
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