Chronic Recurrent Multifocal Osteomyelitis and Its Management

Yousaf, Amman; Muhammad, Shoaib; Zoghoul, Sohaib; Alam, Syed Intakhab; Elsyaed, Ahmed Mounir

doi:10.7759/cureus.18872

Cited by 5 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The frequency of bisphosphonate infusions was in accordance with previously described therapeutic attempts, though the quantity of cycles exceeded the previously reported mean [ 32 , 35 , 36 ]. Nevertheless other studies presented cases in which pamidronate was inefficient in controlling CRMO [ 17 , 37 , 38 ]. The aetiology of differences in response to bisphosphonates treatment is not yet clear.…”

Section: Discussionmentioning

confidence: 99%

A Successful Bisphosphonates Monotherapy in Spinal Form of Paediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO)—Case Report

et al. 2023

View full text Add to dashboard Cite

Chronic recurrent multifocal osteomyelitis (CRMO) is a non-infectious inflammatory disorder resulting from the multifocal bone and bone marrow lesions with periodic relapses and remissions and with an uncertain prognosis. Treatment options in CRMO are based on expert opinion and relatively small groups of patients. A nine-year-old female patient with no significant past medical history presented with compression fractures and multifocal bone lesions in the thoracic and lumbar spine, as shown in imaging (CT, MRI). Densitometry revealed a diffuse decrease in bone density. Based on the patient’s clinical image and above examinations, the other possible aetiologies—infectious (including tuberculosis), neoplasms, Langerhans cell histiocytosis—were ruled out, which led to eventual final diagnosis—CRMO. The patient was successfully treated with pamidronate infusion initiated in cycles over three consecutive days every 3 months. In addition to clinical improvement, there was a significant remission of inflammation and bone structure healing assessed by MRI after four treatment cycles. Intravenous bisphosphonates usage seems to be a good therapeutic option in CRMO paediatric patients with spinal localization of the lesions complicated by compressive fractures. However, more data, based on larger patient populations, are needed to provide a detailed paediatric CRMO treatment algorithm.

show abstract

Section: Discussionmentioning

confidence: 99%

A Successful Bisphosphonates Monotherapy in Spinal Form of Paediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO)—Case Report

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Chronic non-bacterial osteomyelitis manifests as osteoarticular pain, often at night, joint swelling and tenderness. In addition, generalized inflammatory symptoms such as fever, weakness and weight loss may be present [ 56 ]. Whole body MRI should be performed in any patient presenting with the above symptoms.…”

Section: Chronic Non-bacterial Osteomyelitismentioning

confidence: 99%

Magnetic resonance imaging of the musculoskeletal system in the diagnosis of rheumatic diseases in the pediatric population

Ożga,

Mężyk,

Kmiecik

et al. 2024

Reumatologia

View full text Add to dashboard Cite

Magnetic resonance imaging (MRI) of the musculoskeletal system is an examination increasingly performed for suspected juvenile idiopathic arthritis, chronic nonbacterial osteomyelitis and juvenile idiopathic inflammatory myopathies, as well as other rheumatic diseases of developmental age. T1-, T2- and PD-weighted with or without fat suppression or short tau inversion recovery/turbo inversion recovery magnitude (STIR/TIRM) sequences and post-contrast sequences are evaluated to diagnose pathological changes in the synovial membrane, subchondral bone marrow and surrounding soft tissues. Magnetic resonance imaging allows detection of synovitis, tenosynovitis, bursitis, and enthesitis as well as bone marrow edema and soft tissue edema. Several pediatric-specific MRI scoring systems have been developed and validated to standardize and facilitate the assessment of the extent of the inflammatory process and disease activity in MRI. Early detection of inflammatory changes allows the inclusion of comprehensive pharmacotherapy giving the possibility of permanent remission and objective measurement of the effectiveness of treatment.

show abstract

“…Anti-TNF agents, such as etanercept or anakinra, are another type of treatment for CRMO [ 24 ]. TNFα is expressed in increased levels from monocytes in CRMO patients and has shown some benefit for patients [ 25 , 26 ]. However, given the off-label use and the high cost of TNF inhibitors along with safety concerns, it is recommended to reserve use for complicated cases [ 5 , 25 ].…”

Section: Reviewmentioning

confidence: 99%

“…On the other hand, corticosteroids are not ideal for long treatment courses given their side effects profile [ 5 , 6 ]. The commencement of biologics, such as etanercept or anakinra, has benefits in the clinical response in patients with CRMO, but these medications are very expensive [ 5 , 25 , 26 ]. Additionally, starting biologics requires testing for tuberculosis prior to starting treatment, and routine follow-up to monitor clinical response and the development of adverse effects, as well.…”

Section: Reviewmentioning

confidence: 99%

Chronic Recurrent Multifocal Osteomyelitis: A Comprehensive Literature Review

Hassan¹,

Assi²,

Hassan³

et al. 2023

Cureus

View full text Add to dashboard Cite

Chronic recurrent multifocal osteomyelitis (CRMO) is a non-infectious, inflammatory disorder of the bones. CRMO typically affects children, with a predisposition to females. Bone-related pain is often felt in the metaphysis of long bones, particularly of the lower extremities, but it can also target other sites at varied time intervals. Patients are likely to complain of tenderness and swelling that may cause considerable disability and adversely impact quality of life. There are three main pathophysiological mechanisms that have been hypothesized to drive CRMO including imbalanced cytokine expression, increased inflammasome activation, and enhanced osteoclast differentiation. Therapies have been based on targeting and suppressing these key players in CRMO patients. The first step in management involves pain control. Non-steroidal anti-inflammatory drugs should provide initial relief, albeit temporarily. It is imperative to initiate immunosuppressive medication that will help limit bone involvement and thereby prevent the development of fractures or leg-length discrepancies, for example. The purpose of this literature review is to study the pathophysiology of CRMO and carefully dissect the agents that have been previously employed in the management of CRMO patients. This could allow for the purposeful formulation of individualized care plans and improving the overall well-being of patients. The authors included a multitude of PubMed-indexed articles published from 2000 onwards in this review.

show abstract

Chronic Recurrent Multifocal Osteomyelitis and Its Management

Cited by 5 publications

References 10 publications

A Successful Bisphosphonates Monotherapy in Spinal Form of Paediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO)—Case Report

A Successful Bisphosphonates Monotherapy in Spinal Form of Paediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO)—Case Report

Magnetic resonance imaging of the musculoskeletal system in the diagnosis of rheumatic diseases in the pediatric population

Chronic Recurrent Multifocal Osteomyelitis: A Comprehensive Literature Review

Contact Info

Product

Resources

About