title: Azathioprine is effective for oral involvement in Crohn's disease but not for orofacial granulomatosis alone.
abstract: BACKGROUND
  There have been no previous reports assessing the effectiveness of azathioprine (AZA) in the treatment of orofacial granulomatosis (OFG). This report is a review of patients receiving AZA for active OFG with or without concomitant gut Crohn's disease (CD) in a specialist tertiary referral centre.
  
  
  METHODS
  Clinical response was defined by Global Physician Assessment at 4-, 12- and 24-month follow-up and a standardised oral disease activity score (ODAS).
  
  
  RESULTS
  Sixty of 215 patients seen with OFG in our clinic over a 12-year period were treated with AZA. Of these, 22 had concomitant CD. The proportion of patients responding to AZA with a diagnosis of CD/OFG vs. OFG only at 4, 12 and 24 months were 54% vs. 21% (P = 0.03), 59% vs. 21% (P = 0.003) and 41% vs. 24% (P = 0.16), respectively. A statistically significant difference was seen between starting and follow-up ODAS scores at 4 months in the CD/OFG group which was not observed in the OFG only group. Factors predicting a need for AZA included a diagnosis of intestinal CD, sulcal swelling, sulcal ulcers and upper lip involvement. The factor predicting response to treatment was a diagnosis of CD at 12 months of follow-up. No difference in the number of adverse effects was observed between the two groups of patients.
  
  
  CONCLUSIONS
  AZA is significantly more effective in the treatment of oral disease with a concurrent diagnosis of CD rather than in the treatment of OFG alone.
authors.affiliation: Department of Gastroenterology, Guy's and St. Thomas' NHS Foundation Trust and King's College, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mentzer
authors.affiliation: Department of Gastroenterology, Guy's and St. Thomas' NHS Foundation Trust and King's College, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Goel
authors.affiliation: Department of Gastroenterology, Guy's and St. Thomas' NHS Foundation Trust and King's College, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Elliott
authors.affiliation: Department of Nutrition, Guy's and St. Thomas' NHS Foundation Trust and King's College, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Campbell
authors.affiliation: Department of Oral Medicine and Pathology, Guy's and St. Thomas' NHS Foundation Trust and King's College, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Hullah
authors.affiliation: Department of Gastroenterology, Guy's and St. Thomas' NHS Foundation Trust and King's College, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Oral Medicine and Pathology, Guy's and St. Thomas' NHS Foundation Trust and King's College, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Challacombe
authors.affiliation: Department of Oral Medicine and Pathology, Guy's and St. Thomas' NHS Foundation Trust and King's College, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Escudier
authors.affiliation: Department of Gastroenterology, Guy's and St. Thomas' NHS Foundation Trust and King's College, London, UK.
authors.forename: J D
authors.initials: JD
authors.lastname: Sanderson
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D003424:Crohn Disease / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D051261:Granulomatosis, Orofacial / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007410:Intestinal Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D008046:Lip / Q000473:pathology; D008297:Male; D012189:Retrospective Studies
chemical_list: D001379:Azathioprine
keywords: Crohn's disease; azathioprine; orofacial granulomatosis