P3.212: New Tricks for Old Drugs: Upadacitinib in Managing Chronic Recurrent Multifocal Osteomyelitis and Atopic Dermatitis

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is an autoimmune inflammatory disease of the bone that commonly affects children and adolescents. Atopic dermatitis (AD) is a chronic inflammatory cutaneous disorder marked by recurrent eczematous plaques commonly distributed on flexor surfaces.

Case Description: We discuss a case involving an 18-year-old male with a past medical history of AD diagnosed as an infant and cataract in the left eye who presented with acutely worsening back pain in the setting of a three-month history of chronic low back pain. Imaging and bone biopsy results were obtained and suggestive of CRMO. The patient was also experiencing worsening AD with multiple excoriations on his skin throughout the body. He was previously on dupilumab for AD, but failed treatment as he experienced minimal to no relief from his symptoms. He was therefore started on upadacitinib, a Janus-Kinase inhibitor, for his refractory AD. With upadacitinib, the patient not only experienced a significant improvement in his atopic dermatitis, but he also experienced a significant improvement in his back pain attributed to CRMO.

Discussion: Our case is notable because this is the first reported case of overlap of CRMO and severe atopic dermatitis, based on literature search. In addition, while the patient experienced improvement in his atopic dermatitis with the use of upadacitinib, he also experienced improvement in back pain, suggesting upadacitinib is efficacious in the treatment of CRMO as well.

Conclusion: Given the lack of clear guidelines regarding treatment of CRMO beyond NSAIDs, we believe this case demonstrates the need for further studies evaluating the efficacy of upadacitinib and other Janus-Kinase inhibitors in the treatment of CRMO, particularly that refractory to NSAIDs, bisphosphonates, and TNF inhibitors. These studies can elucidate further treatment options for CRMO and can eventually provide relief to many individuals who experience back pain and other debilitating symptoms characteristic of CRMO.