Crohn's-associated chronic recurrent multifocal osteomyelitis responsive to infliximab

Carpenter, Ellen; Jackson, Mary Anne; Friesen, Craig A.; Scarbrough, Marc; Roberts, Charles S.

doi:10.1016/j.jpeds.2003.12.038

Cited by 84 publications

(38 citation statements)

References 32 publications

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“…Other dermatologic manifestations include psoriasis vulgaris [5, 8-12, 19, 21], acne [22], Sweet syndrome [23,24], pyoderma gangrenosum [11,25,26], dermatomyositis [4] and tumor calcinosis [27]. Gastrointestinal associations include Crohn disease [5,11,[28][29][30], ulcerative colitis [5] and celiac disease [5]. The spectrum of diseases associated with CRMO is large, also including sclerosing cholangitis [11,29], granulomatosis with polyangiitis [11], Takayasu's arteritis [9,10,26], Ollier disease (multiple enchondromatosis) [11] and parenchymal lung disease [31,32].…”

Section: Disease Associations With Crmomentioning

confidence: 99%

Chronic Recurrent Multifocal Osteomyelitis

Costa-Reis

Sullivan

2013

J Clin Immunol

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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.

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Section: Disease Associations With Crmomentioning

confidence: 99%

Chronic Recurrent Multifocal Osteomyelitis

Costa-Reis

Sullivan

2013

J Clin Immunol

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“…Another child with CRMO followed by Crohn's disease also had a good response to infliximab with resolution of pain and decrease in size of the bony lesion [22]. A further case report using a lower dose of 3 mg/kg at the same intervals led to resolution of pain at the third dose, and continuing for the 2 years of follow-up.…”

Section: Biologicsmentioning

confidence: 90%

“…Involvement of the skin includes palmoplantar pustulosis, occurring in approximately 20 %, acneiform lesions or psoriasis [2,15,[18][19][20]. Inflammatory bowel disease, particularly Crohn's-like lesions have been associated with CRMO and may represent "enteropathic CRMO" [21][22][23][24][25]. There is a female preponderance with twice as many girls affected and a median age of onset of around 10 years [3,5,26,27].…”

Section: Clinical Featuresmentioning

confidence: 99%

Chronic Recurrent Multifocal Osteomyelitis

Roderick

Ramanan

2012

Advances in Experimental Medicine and Biology

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Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease occurring primarily in children and adolescents. Episodes of systemic inflammation occur due to immune dysregulation without autoantibodies, pathogens or antigen-specific T cells. CRMO is characterised by the insidious onset of pain with swelling and tenderness over the affected bones. Clavicular involvement was the classical description; however, the metaphyses and epiphyses of long bones are frequently affected. Lesions may occur in any bone, including vertebrae. Characteristic imaging includes bone oedema, lytic areas, periosteal reaction and soft tissue reaction. Biopsies from affected areas display polymorphonuclear leucocytes with osteoclasts and necrosis in the early stages. Subsequently, lymphocytes and plasma cells predominate followed by fibrosis and signs of reactive new bone forming around the inflammation. Diagnosis is facilitated by the use of STIR MRI scanning, potentially obviating the need for biopsy and unnecessary long-term antibiotics due to incorrect diagnosis. Treatment options include non-steroidal anti-inflammatory drugs and bisphosphonates. Biologics have been tried in resistant cases with promising initial results. Gene identification has not proved easy although research in this area continues. Early descriptions of the disease suggested a benign course; however, longer-term follow up shows that it can cause significant morbidity and longer-term disability. Although it has always been thought of as very rare, the prevalence is likely to be vastly underestimated due to poor recognition of the disease.

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“…Overall, TNF-alpha (TNF-) blocking agents seem to have the most beneficial effect. TNF is a proinflammatory cytokine that has a wide range of effects, including granulocyte recruitment and activation, induction of edema, activation of coagulation, induction of granuloma formation, and activation of T and B cells (Carpenter, Jackson et al 2004). , and 25 th (bottom) percentile, respectively, of the reference range for healthy subjects (Miettunen, Wei et al 2009).…”

Section: Biologic Therapymentioning

confidence: 99%

“…Infliximab, a chimeric monoclonal IgG1k antibody directed against TNF-, has resulted in clinical and at times radiologic improvement in sternal hyperostosis, clavicular osteitis, and SAPHO syndrome (Eleftheriou, Gerschman et al 2010). Infliximab has also resulted in remission of Crohn's disease associated CRMO (Carpenter, Jackson et al 2004). The improvement in symptoms occurred within 2 weeks in most patients, although some patients had loss of efficacy with ongoing treatment, and others experienced relapse of symptoms within 6 months after infliximab withdrawal.…”

Section: Expected Clinical Responsementioning

confidence: 99%

Chronic Non-Bacterial Osteitis/Chronic Recurrent Multifocal Osteomyelitis

Miettunen¹

2012

Osteomyelitis

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Crohn's-associated chronic recurrent multifocal osteomyelitis responsive to infliximab

Cited by 84 publications

References 32 publications

Chronic Recurrent Multifocal Osteomyelitis

Chronic Recurrent Multifocal Osteomyelitis

Chronic Recurrent Multifocal Osteomyelitis

Chronic Non-Bacterial Osteitis/Chronic Recurrent Multifocal Osteomyelitis

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