Chronic Recurrent Multifocal Osteomyelitis

Abstract

Chronic recurrent multifocal osteomyelitis is a rare auto-inflammatory condition that primarily affects children and adolescents. It presents with recurrent episodes of pain related to the presence of foci of sterile bone inflammation. The long bones of the lower extremities are more frequently affected and the spine can also be involved. Imaging studies, including whole-body magnetic resonance, are important for diagnosis and detection of asymptomatic lesions. Bone biopsies may be necessary to exclude other diseases, including malignancy and infections. Non-steroidal anti-inflammatory drugs cause relief of symptoms in the majority of cases. Bisphosphonates and TNF-α blockers are alternatives for patients who do not respond or who have spinal involvement.

Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

“…Therefore, the role of histopathology is to exclude infection or neoplasms that can be more definitively classified. During acute attacks, about two-thirds of patients develop moderate increases in the systemic inflammatory markers, although this was not clearly demonstrated in this patient [6]. The non-infectious nature of CRMO is supported by the fact that antibiotics do not alter the course of the disease [3].…”

“…Because CRMO has no specific clinical, laboratory, imaging, or pathological findings, the diagnosis is difficult to make and as a diagnosis of exclusion the true prevalence is likely underestimated [6]. Knowledge of this unusual case of CRMO in an adult man and its illustrative imaging findings may help skeletal radiologists maintain a high index of suspicion and be the first to suggest this diagnosis.…”

Influence of Chronic Recurrent Multifocal Osteomyelitis (CRMO) On Densitometry Measurements Obtained by Dual X-Ray Absorptiometry

“…Chronic recurrent multifocal osteomyelitis (CRMO) is a noninfectious auto-inflammatory bone disease of unknown etiology [1]. CRMO typically affects the metaphysis of long bones and spine in children and young adolescents [1].…”

“…CRMO typically affects the metaphysis of long bones and spine in children and young adolescents [1]. Radiographically, early CRMO lesions show osteolysis, whereas later stages of the disease may present as hyperostosis and sclerosis [2].…”

“…Radiographically, early CRMO lesions show osteolysis, whereas later stages of the disease may present as hyperostosis and sclerosis [2]. Treatment options include non-steroidal anti-inflammatory agents (NSAIDs), corticosteroids, methotrexate, bisphosphonates as well as anti-TNF therapies [1]. The overall goals of treatment are to slow disease progression and achieve good symptom control while maintaining normal bone growth and range of motion.…”