Journal Basic Info

  • Impact Factor: 1.809**
  • H-Index: 6
  • ISSN: 2474-1655
  • DOI: 10.25107/2474-1655
**Impact Factor calculated based on Google Scholar Citations. Please contact us for any more details.

Major Scope

  •  Neurology
  •  Geriatric Medicine
  •  Breast Neoplasms
  •  Allergy & Immunology
  •  Forensic and Legal Medicine
  •  Cardio-Thoracic Surgery
  •  Urology Cases
  •  Endoscopy


Citation: Ann Clin Case Rep. 2020;5(1):1885.DOI: 10.25107/2474-1655.1885

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 

 PDF  Full Text Case Report | Open Access


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.


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..

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