Oryniak Derek, Brown Meagan, Cholakis Lillie, Elgazzar Reda
Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada.
Front Oral Health. 2024 Jul 9;5:1427060. doi: 10.3389/froh.2024.1427060. eCollection 2024.
Medication-Related Osteonecrosis of the Jaw (MRONJ) is a challenging and evolving aspect of Oral and Maxillofacial Surgery. In recent years, several medications apart from those traditionally associated with MRONJ such as bisphosphates (BPs) and Denosumab (DMB) have been implicated in bony necrosis of the jaw. This aim of this report is to demonstrate a significant case of bone necrosis following dental extractions on a patient being treated with infliximab therapy for Crohn's disease. Several cases in literature have reported MRONJ associated with infliximab but very few patients have developed as significant a form of the disease as seen in this report. Previous investigators have proposed pathophysiological pathways via which TNF-α inhibitors such as infliximab have a causative mechanism for MRONJ. When osteoclastic activity is restricted via these pathways, bone healing is impaired and MRONJ can occur. However, it remains a diagnostic challenge to differentiate between antiresorptive MRONJ and chronic osteomyelitis with bone necrosis in patients with acquired immunodeficiency. This case aims to illustrate why the antiresorptive effects of TNF-α inhibitors need to be considered as a possible primary driver of bone necrosis in such patients.
药物相关性颌骨坏死（MRONJ）是口腔颌面外科中一个具有挑战性且不断发展的领域。近年来，除了那些传统上与MRONJ相关的药物，如双膦酸盐（BPs）和地诺单抗（DMB）之外，其他几种药物也被认为与颌骨骨坏死有关。本报告的目的是展示一例在用英夫利昔单抗治疗克罗恩病的患者拔牙后发生严重骨坏死的病例。文献中有几例报告了与英夫利昔单抗相关的MRONJ，但很少有患者出现像本报告中这样严重的疾病形式。先前的研究人员提出了病理生理途径，通过这些途径，诸如英夫利昔单抗之类的肿瘤坏死因子-α（TNF-α）抑制剂具有导致MRONJ的机制。当通过这些途径限制破骨细胞活性时，骨愈合会受到损害，进而可能发生MRONJ。然而，在获得性免疫缺陷患者中，区分抗吸收性MRONJ和伴有骨坏死的慢性骨髓炎仍然是一项诊断挑战。本病例旨在说明为何需要将TNF-α抑制剂的抗吸收作用视为这类患者骨坏死的一个可能主要驱动因素。
