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Last updated: April 23, 2019
Years published: 2007, 2011, 2019
NORD gratefully acknowledges Onyinye Kammelu, NORD Editorial Intern from the Massachusetts College of Pharmacy and Health Sciences, and Dr. Hal Hoffman, Professor of Pediatrics and Medicine, Division of Rheumatology, Allergy, and Immunology at the University of California at San Diego School of Medicine, for assistance in the preparation of this report.
Summary
Neonatal-onset multisystem inflammatory disease (NOMID), also known as chronic infantile neurologic cutaneous articular (CINCA) syndrome, is a rare, systemic, inflammatory condition characterized by fever, rash, joint symptoms, and central nervous system (CNS) symptoms. The hallmark of NOMID is onset during early infancy, usually before six months of age. The severity of NOMID varies from child to child. Early diagnosis and prompt treatment with specific medications is important for preventing severe complications of the disease and improving life expectancy.
Introduction
NOMID is the least common and most severe form of the cryopyrin associated periodic syndromes (CAPS) caused by mutations in the CIAS1/NLRP3 gene. All of these syndromes are characterized by fever, rash, and musculoskeletal pain.
In addition to fever, symptoms of NOMID involve the skin, CNS and joints. Skin rashes occur in all patients within the first six weeks of life and persist throughout their lives. CNS symptoms include inflammation around the brain (chronic aseptic meningitis), cognitive/mental deficits/learning disabilities, and seizures and sensory organ dysfunction, which can result in vision and hearing loss. Joint inflammation and joint and bone deformities range in severity. Enlargement of the bones around the knee is also characteristic of NOMID.
Other clinical features include stunted growth, enlargement of the liver and spleen, an abnormal increase in the number of white blood cells, an elevation in blood levels of the protein amyloid A, C-reactive protein, and erythrocyte sedimentation rate (blood tests used to measure elevations of these markers can detect or grade inflammation). In addition, abnormal facial features, narrowed smaller teeth and other dental abnormalities can sometimes be seen.
NOMID shares symptoms, and should not be confused, with juvenile idiopathic arthritis (JIA). High recurrent fevers, joint pain, deforming joint disease and rash are symptoms of both NOMID and JIA. However, NOMID is differentiated by the onset of skin disease at birth and a persistent rash. In addition, many patients with NOMID have nonspecific joint pain and enlargement of the knees, while patients with JIA present with inflamed synovial joints, such as the shoulder or knee, increased production of fluid in the synovial joints and warm, swollen, stiff joints.
NOMID patients suffer from frequent, almost daily flare-up episodes which cause great discomfort, can be very debilitating, and may require medical assistance during the episodes. Some patients are unable to walk or bear weight on their legs due to joint damage and/or pain. Many children with NOMID have cognitive and mental deficits and/or learning disabilities as well as vision and hearing loss.
About 50-60 percent of those who are diagnosed with NOMID have an alteration (mutation) in the CIAS1/NLRP3 gene that codes for the protein cryopyrin (NALP3). Most of the NOMID patients originally described without identifiable mutations were later found to be have somatic mutations a small percentage of their white blood cells (somatic mosaics). Mutations in this gene result in increased activity of a protein complex containing cryopyrin known as the inflammasome, which regulates inflammation in the body. Increased inflammasome activity leads to an increased release of a protein known as interleukin (IL-1ร), which leads to symptoms of inflammation such as fever and joint pain.
NOMID follows an autosomal dominant inheritance pattern. Dominant genetic disorders occur when only a single copy of an altered gene is necessary to cause a particular disease. The altered gene can be inherited from either parent or can be the result of a new mutation in the affected individual. The risk of passing the altered gene from affected parent to offspring is 50% for each pregnancy. The risk is the same for males and females.
NOMID is a very rare disorder; approximately 100 affected individuals with different ethnic backgrounds have been widely reported. Males and females are equally affected.
Diagnosis of NOMID is determined through an evaluation of a patientโs symptoms and medical history. Diagnosis includes: skin biopsy, eye exam, hearing test, brain MRI, joint x-rays and cerebrospinal fluid test (detects aseptic meningitis or high white blood counts in the spinal fluid). The diagnosis can be confirmed through genetic testing, but almost half of all NOMID patients do not have an easily identifiable mutation in the CIAS1/NLRP3 gene.
Treatment
Therapies that suppress inflammation, including high-dose corticosteroids and disease-modifying antirheumatic drugs have been used to treat NOMID.
Anakinra (Kineret) marketed by Sobi, Inc. was approved by the U.S. Food and Drug Administration (FDA) in 2013 to treat patients with NOMID, and is the only medication that is FDA approved to treat these patients.
Canakinumab (Ilaris) by Novartis Pharmaceuticals, a monoclonal antibody to interleukin-1 beta, was approved by the FDA in 2009 as a treatment for adults and children 4 years and older with familial cold autoinflammatory syndrome (FCAS) and Muckle-Wells syndrome (MWS). Ilaris has been used to successfully treat NOMID patients and is approved in Europe, although higher than standard doses are often required and it is not FDA approved for NOMID at this time.
Rilonacept (Arcalyst) by Regeneron Pharmaceuticals, an interleukin-1 blocker, was approved by the FDA in 2008 for the treatment of CAPS, including FCAS and MWS, in adults and children 12 years and older, but it is not approved for NOMID and there is limited clinical experience in NOMID patients.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Toll-free: (800) 411-1222
TTY: (866) 411-1010
Email: [email protected]
Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/living-with-a-rare-disease/find-clinical-trials/
For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com
For more information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/
Contact for additional information about NOMID:
Dr. Hal M. Hoffman
Associate Professor of Pediatrics and Medicine
Division of Rheumatology, Allergy, and Immunology
University of California at San Diego School of Medicine
(858) 534-2108
[email protected]
RareConnect offers a safe patient-hosted online community for patients and caregivers affected by this rare disease. For more information, visit www.rareconnect.org.
JOURNAL ARTICLES
Finetti M, Omenetti A, Federici S, Caorsi R, Gattorno M. Chronic Infantile Neurological Cutaneous and Articular (CINCA) syndrome: a review. Orphanet Journal of Rare Diseases. 2016;11:167. https://ojrd.biomedcentral.com/track/pdf/10.1186/s13023-016-0542-8
Caroli F, Pontillo A, DโOsualdo A, et al. Clinical and genetic characterization of Italian patients affected by CINCA syndrome. Rheumatology. 2007;46(3):473-8.
Goldbach-Mansky R, et al. Neonatal-onset multisystem inflammatory disease responsive to interleukin-1ร inhibition. New England Journal of Medicine. 2006;355(6):581-592.
Kilcline C, Shinkai K, Bree A, et al. Neonatal-onset multisystem inflammatory disorder. Archives of Dermatology. 2005;141:248-253.
Lovell D J, et al. Interleuken-1 blockade by Anakinra improves clinical symptoms in patients with neonatal-onset multisystem inflammatory disease. Arthritis & Rheumatism. 2005;52(4):1283-1286.
INTERNET
Chronic Infantile Neurological Cutaneous Articular syndrome. Genetic and Rare Diseases Information Center. Last updated: 10/25/2016. https://rarediseases.info.nih.gov/diseases/1356/chronic-infantile-neurological-cutaneous-articular-syndrome Accessed March 11, 2019.
Neonatal onset multisystem inflammatory disease. Genetics Home Reference. Reviewed: September 2008. https://ghr.nlm.nih.gov/condition/neonatal-onset-multisystem-inflammatory-disease Accessed March 11, 2019.
NORD and MedicAlert Foundation have teamed up on a new program to provide protection to rare disease patients in emergency situations.
Learn more https://rarediseases.org/patient-assistance-programs/medicalert-assistance-program/Ensuring that patients and caregivers are armed with the tools they need to live their best lives while managing their rare condition is a vital part of NORDโs mission.
Learn more https://rarediseases.org/patient-assistance-programs/rare-disease-educational-support/This first-of-its-kind assistance program is designed for caregivers of a child or adult diagnosed with a rare disorder.
Learn more https://rarediseases.org/patient-assistance-programs/caregiver-respite/The information provided on this page is for informational purposes only. The National Organization for Rare Disorders (NORD) does not endorse the information presented. The content has been gathered in partnership with the MONDO Disease Ontology. Please consult with a healthcare professional for medical advice and treatment.
The Genetic and Rare Diseases Information Center (GARD) has information and resources for patients, caregivers, and families that may be helpful before and after diagnosis of this condition. GARD is a program of the National Center for Advancing Translational Sciences (NCATS), part of the National Institutes of Health (NIH).
View reportOrphanet has a summary about this condition that may include information on the diagnosis, care, and treatment as well as other resources. Some of the information and resources are available in languages other than English. The summary may include medical terms, so we encourage you to share and discuss this information with your doctor. Orphanet is the French National Institute for Health and Medical Research and the Health Programme of the European Union.
View reportOnline Mendelian Inheritance In Man (OMIM) has a summary of published research about this condition and includes references from the medical literature. The summary contains medical and scientific terms, so we encourage you to share and discuss this information with your doctor. OMIM is authored and edited at the McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine.
View report
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