Adult-onset chronic nonbacterial osteitis mimicking refractory axial psoriatic arthritis: successful treatment with combined IL-1/IL-17 inhibition: a case report and brief literature review
- 1Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- 2Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
Abstract
We report a 46-year-old man with palmoplantar pustular psoriasis and severe axial inflammation who was initially diagnosed with refractory axial psoriatic arthritis. Despite sequential treatment with multiple biologic and targeted therapies, disease activity persisted. Reassessment based on anterior chest wall involvement, characteristic positron emission tomography/computed tomography findings, human leukocyte antigen B27 negativity, and exclusion of infectious, malignant, and monogenic autoinflammatory disorders supported a diagnosis of adult-onset chronic nonbacterial osteitis (CNO). The patient showed a marked clinical, laboratory, and imaging response to interleukin (IL)-1 blockade, and sustained disease control was achieved with combined IL-1/IL-17 inhibition. This case highlights the diagnostic challenges of adult CNO and suggests a potential role for dual cytokine inhibition in refractory disease. A brief literature review on current treatment options is provided.
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BibTeX
@article{karakoc2026adultonset,
title = {{Adult-onset chronic nonbacterial osteitis mimicking refractory axial psoriatic arthritis: successful treatment with combined IL-1/IL-17 inhibition: a case report and brief literature review}},
author = {Alican Karakoc and Andreas Wirsching and Laura Bucci and Giulia Corte and Armin Atzinger and Georg Schett and Filippo Fagni},
journal = {EULAR Rheumatology Open},
year = {2026},
month = oct,
doi = {10.1016/j.ero.2026.100262},
url = {https://doi.org/10.1016/j.ero.2026.100262},
note = {CC BY},
}
RIS
TY - JOUR
TI - Adult-onset chronic nonbacterial osteitis mimicking refractory axial psoriatic arthritis: successful treatment with combined IL-1/IL-17 inhibition: a case report and brief literature review
AU - Alican Karakoc
AU - Andreas Wirsching
AU - Laura Bucci
AU - Giulia Corte
AU - Armin Atzinger
AU - Georg Schett
AU - Filippo Fagni
PY - 2026
DA - 2026/10/23
JO - EULAR Rheumatology Open
DO - 10.1016/j.ero.2026.100262
UR - https://doi.org/10.1016/j.ero.2026.100262
AB - We report a 46-year-old man with palmoplantar pustular psoriasis and severe axial inflammation who was initially diagnosed with refractory axial psoriatic arthritis. Despite sequential treatment with multiple biologic and targeted therapies, disease activity persisted. Reassessment based on anterior chest wall involvement, characteristic positron emission tomography/computed tomography findings, human leukocyte antigen B27 negativity, and exclusion of infectious, malignant, and monogenic autoinflammatory disorders supported a diagnosis of adult-onset chronic nonbacterial osteitis (CNO). The patient showed a marked clinical, laboratory, and imaging response to interleukin (IL)-1 blockade, and sustained disease control was achieved with combined IL-1/IL-17 inhibition. This case highlights the diagnostic challenges of adult CNO and suggests a potential role for dual cytokine inhibition in refractory disease. A brief literature review on current treatment options is provided.
SN - 3050-7081
ER -