Low Back and Buttock Pain in a NOMID/CINCA Syndrome Patient Under Canakinumab Therapy - Time for Another Biologic?

Elke Ungar, Paul Hasler and Ruediger B Mueller

Department of Medicine, University of Basel, University of Basel, Kantonsspital Aarau, Switzerland

^*Correspondance to: Ruediger B Mueller 

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Abstract:

Introduction: NOMID/CINCA Syndrome (Neonatal Onset Multisystem Inflammatory Disease/ Chronic Infantile Neurologic Cutaneous and Articular Syndrome) is a rare inflammatory periodic fever syndrome responding to treatment with IL-1 antagonists. Axial Spondyloarthritides (axSpA) are a group of diseases responding to TNF (Tumor Necrosis Factor alpha) or IL-17 antagonists. Overlap syndromes of these two entities have, so far, not been described. Of importance, NOMID/ CINCA syndrome does not respond to treatment with TNF antagonists and only a small subgroup of axial spondyloarthritides may respond to IL-1 antagonists. Combination therapy of anakinra, an IL-1 antagonist, and the TNF antagonist etanercept, was associated with an increased rate of infections in RA patients. Case Report: A 25-year-old woman with NOMID/CINCA-syndrome successfully treated with canakinumab developed inflammatory back pain and was, subsequently, diagnosed with axial spondylarthritis. After an ineffective therapeutic approach with both initial intra-articular spinal glucocorticoids injections and, subsequently, sulfasalazine, etanercept was initiated. Under this combined etanercept and canakinumab treatment both diseases, NOMID/CINCA-syndrome and axial spondylarthritis, were controlled and no severe infection developed. Conclusion: In summary, this case demonstrates a favorable response to treatment with canakinumab and etanercept in combination in a patient with an overlap syndrome of NOMID/ CINCA-syndrome and axial spondylarthritis with an acceptable safety profile. Such a combination therapy should be given with care and after other therapeutic alternatives failed.

Keywords:

Canakinumab; Etanercept; NOMID/CINCA syndrome; Axial spondylarthritis

Cite the Article:

Ungar E, Hasler P, Mueller RB. Low Back and Buttock Pain in a NOMID/ CINCA Syndrome Patient Under Canakinumab Therapy - Time for Another Biologic?. Ann Clin Case Rep. 2020; 5: 1885..