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

Résumé : 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.
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Submitted on : Thursday, February 17, 2022 - 6:09:55 PM
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M-J Javelot, Johan Sergheraert, S Agbo-Godeau, F Levy-Weil, S Laurence, et al.. Rituximab as a trigger factor of medication-related osteonecrosis of the jaw. A case report. Journal of Stomatology, Oral and Maxillofacial Surgery, Elsevier Masson, 2020, 121, pp.300 - 304. ⟨10.1016/j.jormas.2019.06.009⟩. ⟨hal-03579089⟩



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