Rituximab as a trigger factor of medication-related osteonecrosis of the jaw. A case report

Rituximab, an anti-CD20 monoclonal antibody, is an effective treatment for rheumatoid arthritis. Here we report the case of a patient with rheumatoid arthritis, having taken risedronate for 14 months to prevent corticosteroid-induced osteoporosis, more than 2 years ago, who presented osteonecrosis o...

Full description

Saved in:
Bibliographic Details
Published in:Journal of stomatology, oral and maxillofacial surgery oral and maxillofacial surgery, 2020-06, Vol.121 (3), p.300-304
Main Authors: Javelot, M.-J., Sergheraert, J., Agbo-Godeau, S., Levy-Weil, F., Laurence, S., Goudot, P., Khonsari, R.-H., Mauprivez, C.
Format: Article
Language:English
Subjects:
Herpetic gingivostomatitis
Human health and pathology
Life Sciences
Low-level laser therapy
Medication-related osteonecrosis of the jaw
Pharmaceutical sciences
Rituximab
Teriparatide
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Rituximab, an anti-CD20 monoclonal antibody, is an effective treatment for rheumatoid arthritis. Here we report the case of a patient with rheumatoid arthritis, having taken risedronate for 14 months to prevent corticosteroid-induced osteoporosis, more than 2 years ago, who presented osteonecrosis of jaw following herpetic gingivostomatitis two weeks after the beginning of a rituximab treatment associated with her usual anti-rheumatic drugs. Eight weeks later, no bone and/or gum healing was observed and a stage 2 medication-related osteonecrosis of the jaw (MRONJ) was diagnosed. A conservative approach was decided with antiseptic mouth washes, low-level laser treatment (LLLT) and systemic therapy with teriparatide. Complete mucosal coverage was obtained after more two years of follow-up. We suggest that rituximab as immunosuppressant might be a cause or a decompensating factor of MRONJ. Non-surgical periodontal treatment with LLLT and teriparatide are candidates for the treatment of MRONJ.
ISSN:2468-7855
2468-7855
DOI:10.1016/j.jormas.2019.06.009