Die chronisch rekurrierende multifokale Osteomyelitis (CRMO)

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual clinical entity. More than 200 cases are described in the literature and it is presented here with special reference to its radiological aspects. It is an acquired disease of the skeleton which occurs predominantly during childhood and adolescence. About ten per cent of cases begin in early or, rarely, in later adult life. This variant is described here for the first time and is discussed as "adult CRMO". The underlying pathology is a bland, predominantly lympho-plasma cellular osteomyelitis which is self-limiting and leads to bone sclerosis (Garrè). It probably involves an abnormal immune process which follows an infection but remains clinically latent and remains aseptic and sterile. In a quarter of cases there is an association with pustulosis palmo-plantaris and its relationship with psoriatic arthropathy is discussed. The clinical, histopathological and imaging features (radiological and particularly MRT) and the bone changes are described. This provides a spectrum of symptoms; the radiological differential diagnosis and the relationship with hyperostotic spondyloarthroses during adult life are discussed. The relationship between CRMO, the SAPHO syndrome and acquired hyperostosis syndrome are analysed.

Chronic nonbacterial osteomyelitis in childhood: prospective follow-up during the first year of anti-inflammatory treatment

“…Other organs including the skin, eyes, gastrointestinal tract and lungs can also be affected by inflammation [4-7]. Chronic recurrent multifocal osteomyelitis (CRMO) is considered the pediatric form of the SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) and is the most severe form of CNO [8,9]. Histological bone lesions in unifocal and multifocal CNO, as well as in SAPHO syndrome, show similar inflammatory features [10,11].…”

Sacroiliitis, hyperostosis sternoclavicularis, and psoriasis palmoplantaris in monozygotic twins

“…We describe herein a pair of HLA-B27 negative monozygotic twins with hyperostotic spondylarthropathy pustulopsoriatica in the context of a SAPHO syndrome with characteristic radiologic and dermatologic findings (1,2).…”

“…This syndrome is characterized by the simultaneous occurrence of synovitis, hyperostosis of articulations of the anterior chest wall, and osteitis with acne fulminans or psoriasis palmoplantaris. Based on clinical presentation, more specific subsets of the SAPHO syndrome, e.g., chronic recurrent multifocal osteomyelitis (sterile multifocal osteomyelitis, with a predilection for the metaphyses of the long bones of the leg, associated with psoriasis palmoplantaris) or sternoclavicular hyperostosis (bony hypertrophy and ligamentous ossification involving the anterior chest wall together with acne or psoriasis) have been defined (2,3).…”

Schnitzler's Disease as an Important Differential Diagnosis of Chronic Recurrent Multifocal Osteomyelitis: A Case Report

“…Only 10% of the reported cases start in the early or late adulthood. In the cases of late manifestation, the sternum and diaphysis of the long bones especially the distal femora and the proximal and the distal tibiae are the most affected bones [4, 5]. The main symptoms are pain and swelling of the affected bones, low-grade fever as well as skin disorders normally in form of pustulosis palmoplantaris [6, 7].…”