Chronic Recurrent Multifocal Osteomyelitis Associated with Crohn Disease: A Potential Role of Exclusion Diet? Comment on Starz et al. The Modification of the Gut Microbiota via Selected Specific Diets in Patients with Crohn’s Disease. Nutrients 2021, 13, 2125

The efficacy of diet and its influence on gut microbiome composition has been largely demonstrated in inflammatory bowel disease (IBD). Little is known about its potential in the management of extraintestinal manifestations. We report a successful application of Crohn disease exclusion diet (CDED) in association with infliximab and methotrexate, as salvage therapy in a child affected by chronic recurrent multifocal osteomyelitis (CRMO) and Crohn disease (CD) resistant to optimized therapy. Both intestinal and bone symptoms remitted after the application of CDED. Diet may have acted on common microbic inciting agents that trigger both intestinal and bone inflammation, supporting the role of microbiota in the pathogenesis of IBD-associated extraintestinal manifestations. Our experience suggests the potential benefit of CDED in association with combined therapy in resistant patients affected by CD and extraintestinal manifestations.

Chronic recurrent multifocal osteomyelitis of the left femur associated with ulcerative colitis: a case report

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition characterized by chronic relapsing noninfectious bone inflammation of unknown etiology. Although CRMO is considered an extraintestinal manifestation in patients with inflammatory bowel disease, most cases of CRMO are associated with Crohn’s disease; very few are associated with ulcerative colitis (UC). We herein describe a 21-year-old patient with UC who developed recurrent left thigh pain. The patient was diagnosed with CRMO associated with UC, which was well controlled with azathioprine treatment.

Chronic recurrent multifocal osteomyelitis and primary sclerosing cholangitis with type 1 autoimmune hepatitis in a child with ulcerative colitis: a case report

Background Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a condition characterized by sterile bone inflammation, usually occurring in childhood. Although the etiology remains unclear, this condition has been associated with inflammatory bowel disease (IBD). Primary sclerosing cholangitis (PSC) and Autoimmune Hepatitis (AIH) are also uncommon pediatric conditions with a known association with IBD. Case presentation We present a unique case of a pediatric patient with an initial diagnosis of CRMO, with subsequent diagnosis of autoimmune hepatitis and PSC overlap, and eventually IBD. Conclusions Patients with CRMO may also develop PSC in addition to IBD, further highlighting the importance of IBD pathophysiology in both conditions. Clinical screening of associated gastrointestinal findings may be of value in patients with CRMO.

The Link Between Plant-based Diet Indices With Biochemical Markers of Bone Turn Over, Inflammation and Insulin in Iranian Older Adults

Background: The association of plant base diets and biomarkers of bone, insulin, and inflammation is still unclear. Objectives: We investigated the associations between biomarkers of bone, insulin, and inflammation and three plant-based diet indices: an overall plant-based diet index (PDI); a healty plant-based diet index (hPDI); and an unhealthy plant-based diet index (uPDI).Methods: We included 178 elderly subjects who referred to health centers in Tehran. Blood and urine samples were collected to measure osteocalcin, The Human C-telopeptide of type Ⅰ collagen (u-CTX-I), highly sensitive C-reactive protein (hs-CRP) Parathyroid hormone (PTH), 25(OH) D and insulin resistance and sensitivity. We created an overall PDI, hPDI and uPDI from semi quantitative food-frequency questionnaire (FFQ) data. Results: Dietary groups of Vegetables (r=0.15, P=0.03), nuts (r=0.16, P=0.03), dairy (r=0.25, P=0.001), eggs (r=0.27, P<0.001), red meat and animal products (r=0.25, P=0.001) were directly correlated with osteocalcin. Refined grains were also had positive association with serum insulin concentration (r=0.14, P=0.04). PTH levels are inversely associated with PDI score (β=-0.18, P=0.01). Also serum insulin concentration was negatively associated with PDI score (β=-0.10, P=0.04). Urine CTX-1 levels was significantly associated with hPDI score (β=-0.06, P=0.04). u-CTX-1 levels are inversely associated with uPDI score. This significance did not change with the adjustment of the confounders (β=-0.28, P<0.001). Conclusions: more adherence to PDI and hPDI and less in uPDI may have beneficial effect on biomarkers of bone, inflammation, and insulin thus preserving chronic diseases.

Parry Romberg disease with En Coup de Sabre Scleroderma: Effect of tocilizumab on periodontal bone inflammation

Parry Romberg disease and En Coupe de Sabre Scleroderma are frequently associated disorders that affect the face and can cause severe aesthetic and functional impairment. Systemic immunosuppression is the gold standard of first-line treatment in the pediatric rheumatology standpoint although it is often delayed in the pediatric dermatology clinics and more often used in cases of refractory neurological impairment. We report on a case with dental root resorption and severe periodontal bone inflammation detected on magnetic resonance imaging, which was successfully treated with the anti-IL-6 agent tocilizumab.

The Role of Nanoparticles in the Diagnosis and Treatment of Diseases

Nanotechnology is involved in the diagnosis and treatment of infectious and inflammatory diseases. It has shown a good role in regenerating, restoring and repairing damaged body parts, such as the heart, lungs and blood vessels. Nanoparticles (NPs) are helpful in osteoblasts formation and also used in the treatment of bone inflammation, skin infections, tuberculosis (TB), human immunodeficiency virus (HIV), Parkinson’s disease, atherosclerosis, cardiovascular and pulmonary diseases. They also assist the anti-inflammatory drugs in penetrating the skin. Platinum nanoparticles (NP) are used in bone allograft and dentistry while silver NPs possess an excellent potential against viruses, fungi and bacteria. For diagnostic purposes, nanoparticles are mostly used in the form of nanorobots, microchips and biosensors. Quantum dots give information about the tumor; the gold nano-particles are ideal to detect the antibodies of hepatitis and also for RNA and DNA delivery. Nanomaterials play an important role in the management of plant diseases and the activation of their defense mechanisms. The NPs of copper and silver are directly toxic to microorganisms while those of zinc, silicon, manganese, copper and boron have a function in host defense as a fertilizer and alter the nutritional status of the crop. Enzyme-based biosensors coated with Ti, Cu, Ag or Au-NPs greatly enhance the sensitivity of diagnostic probes for the detection of plant infections. The nano-Zn products have been effectively used to control viral, fungal, phytoplasma or bacterial diseases in crop plants. Nanoparticles are also used in packing edible food films.

Rapamycin rejuvenates oral health in aging mice

Periodontal disease is an age-associated disorder clinically defined by periodontal bone loss, inflammation of the specialized tissues that surround and support the tooth, and microbiome dysbiosis. Currently, there is no therapy for reversing periodontal disease, and treatment is generally restricted to preventive measures or tooth extraction. The FDA-approved drug rapamycin slows aging and extends lifespan in multiple organisms, including mice. Here, we demonstrate that short-term treatment with rapamycin rejuvenates the aged oral cavity of elderly mice, including regeneration of periodontal bone, attenuation of gingival and periodontal bone inflammation, and revertive shift of the oral microbiome toward a more youthful composition. This provides a geroscience strategy to potentially rejuvenate oral health and reverse periodontal disease in the elderly.

New variant in the IL1RN-gene (DIRA) associated with late-onset, CRMO-like presentation

Objective To report a chronic recurrent multifocal osteomyelitis (CRMO)-like clinical phenotype with multisystem inflammation associated with a novel gene variant in the spectrum of IL-1-mediated diseases. Methods A 3-year-old boy presented with recurrent episodes of fever, serositis, pancreatitis and high inflammatory markers with onset at age 13 months. At age 3 years, he started limping. Imaging revealed multifocal pelvic bone inflammation suggestive of CRMO. Autoinflammation panel testing was non-contributory. Whole exome sequencing (WES) and advanced IL-1 pathway analysis was conducted. Results WES identified a novel homozygous interleukin receptor 1 (IL1RN) variant (c.62C&gt;G; p. Ser21*) (NM_173842.2). Functional analysis of IL1RN mRNA and IL-1 receptor antagonist (IL-1RA) protein confirmed the diagnosis of a deficiency of the IL-1 receptor antagonist (DIRA). Treatment with the nonselective IL-1 inhibitor anakinra resulting in rapid remission; switch to the selective IL-1β antagonist canakinumab led to a flare within 6 weeks. Re-start of anakinra recaptured remission, last documented at the recent 19-month follow-up. Conclusion This is the first report of a novel late-onset DIRA confirmed by advanced diagnostic testing. In patients with systemic inflammation and CRMO-like bone lesions, IL1RN testing should be considered; even in the absence of skin manifestations. Non-selective IL-1 inhibition is an effective therapy.