Management of chronic recurrent multifocal osteomyelitis: review and update on the treatment protocol

Ferjani, H.; Yasmine, M.; Maatallah, Kaouther; Triki, Wafa; Nessib, Dorra Ben; Kaffel, Dhia; Hamdi, Wafa

doi:10.1080/14712598.2022.2078161

Cited by 10 publications

(3 citation statements)

References 38 publications

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“…Osteomyelitis often occurs in more serious open fractures, where the bone fracture ends are exposed, which is easy to be invaded by bacteria, leading to bone tissue infection or local residual bacterial lesions [24] . Due to the destruction of skin soft tissue and blood vessels around the bone fracture end, it is very easy to lead to bacterial growth and bacterial biofilm adhesion, resulting in the repeated development of clinical Osteomyelitis, which is difficult to cure [25,26] . At present, the clinical treatment for chronic Osteomyelitis is mainly debridement and drainage, and systemic sensitive antibiotics [23,27,28] .…”

Section: Discussionmentioning

confidence: 99%

Myh7 regulates SDRC protein and biofilm formation to alleviate osteomyelitis induced by Staphylococcus aureus

Qi,

Yang,

Guo

et al. 2024

Preprint

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SDRC is implicated in the pathogenesis of Staphylococcus aureus osteomyelitis. However, the precise mechanism by which SDRC contributes to the progression of this infection remains unclear. To explore SDRC’s role in osteomyelitis, experiments were conducted on mouse models infected with Staphylococcus aureus strains containing either the wild type SDRC sequence or a knockout (KO-SDRC) sequence. Levels of inflammatory factors like IL-6 and TNF-α were measured using Elisa. Furthermore, changes in osteogenic indicators such as ALP, OST, and Runx2 were detected using qPCR and Western blot analysis. Additionally, transcriptome sequencing was employed to gain deeper insights into the potential molecular mechanisms underlying SDRC’s promotion of Staphylococcus aureus-induced osteomyelitis. The study revealed that the ability of Staphylococcus aureus to form biofilms was significantly weakened in strains where the SDRC protein was knocked out. Moreover, mice infected with the KO-SDRC strain exhibited enhanced ossification processes. Transcriptome sequencing demonstrated significant overexpression of the Myh7 gene in the SDRC knockout osteomyelitis mouse. Subsequent knockout of the Myh7 gene led to notable reductions in mRNA and protein expressions of osteogenic indicators including Runx2, ALP, OSX, and Osteocalcin. Overall, these findings suggest that SDRC plays a crucial role in promoting the malignant progression of osteomyelitis caused by Staphylococcus aureus. Its main mechanism involves enhancing the formation of Staphylococcus aureus biofilms. Conversely, Myh7 may exert an inhibitory effect on the SDRC protein, reducing biofilm formation and mitigating the severity of osteomyelitis. These findings offer novel insights into potential therapeutic targets for the treatment of osteomyelitis.

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Section: Discussionmentioning

confidence: 99%

Myh7 regulates SDRC protein and biofilm formation to alleviate osteomyelitis induced by Staphylococcus aureus

Qi,

Yang,

Guo

et al. 2024

Preprint

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“…NSAIDs are the first-line treatment option, but may lead to relapses in many cases. [ 3 , 27 ] Second-line treatments include corticosteroids, TNF-α inhibitors, DMARDs, and bisphosphonates, etc. [ 11 , 28 ] Bisphosphonates are powerful inhibitors of osteoclastic bone resorption and have been proven to be effective in CRMO treatment.…”

Section: Discussionmentioning

confidence: 99%

Chronic recurrent multifocal osteomyelitis: Case report and review of the literature

Liu,

Zhang,

Nie

et al. 2024

Medicine

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Backgrounds: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory disease. Objective: This report aims to analyze the clinical characteristics of CRMO and enhance clinicians’ comprehension. We present 3 atypical cases, highlighting their unique clinical features, diagnostic challenges, and effective treatment strategies. Methods: We retrieved 3 CRMO cases in our hospital from September 2019 to August 2022. The clinical features were analyzed retrospectively, and relevant literatures were reviewed. Results: All 3 cases initially presented with bone pain, normal leucocyte counts, negative rheumatoid factors and no signs of sclerotic or hyperostotic lesions. Case 1, a 12-year-old girl, exhibited concurrent acne on the forehead and historic necrotizing lymphadenitis, a previously unreported association with CRMO. Case 2, a 14-year-old boy, tested positive for human leukocyte antigen-B27 and displayed scoliosis along with multifocal osteomyelitis. Case 3, a 9-year-old girl, presented with scoliosis, and chest computed tomography revealed changes in the T8 vertebral body, initially suggesting Langerhans cell histiocytosis. Bone biopsy was conducted in case 1 and case 3, revealing chronic inflammation. All 3 cases affected long bones, pelvis, and vertebra, involving 8, 6 and 5 bones, respectively, identified by magnetic resonance imaging. Genetic analysis was undertaken in cases 1 and 2 but no pathogenic mutations were identified. Upon the confirmation of a CRMO diagnosis, all patients were initiated on a treatment regimen comprising nonsteroidal anti-inflammatory drugs and tumor necrosis factor-α inhibitors. In cases 1 and 2, due to the severity of their bone pain, they were also administered to disease-modifying anti-rheumatic drugs, specifically methotrexate. All 3 patients achieved remission of bone pain. To gain a more comprehensive understanding of CRMO, we conducted a thorough review of relevant literature. Conclusion: CRMO is a rare autoinflammatory bone disorder with diverse clinical presentations and a lack of specific laboratory tests, which leads to potency to misdiagnosis or delayed diagnosis. By raising awareness and improving diagnostic criteria, physicians are now better equipped to identify CRMO. We contribute to share our understanding of CRMO by presenting 3 cases with untypical clinical features, highlighting the importance of recognizing this rare condition for timely and effective management.

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“…It is the latter localisation which is associated with compressive fractures and malformations, leading to the developmental problems [ 11 ]. As the main pathophysiological factor causing the CRMO is the autoinflammatory process, non-steroid anti-inflammatory drugs (NSAIDs) are a natural first-line treatment strategy [ 12 ], which enables an efficient disease management in most cases [ 13 ]. Nevertheless, there are cases, in which NSAIDs do not reverse the disorder progression—in these patients the second-line treatment may provide the optimal control of the pathology.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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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.

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Management of chronic recurrent multifocal osteomyelitis: review and update on the treatment protocol

Cited by 10 publications

References 38 publications

Myh7 regulates SDRC protein and biofilm formation to alleviate osteomyelitis induced by Staphylococcus aureus

Myh7 regulates SDRC protein and biofilm formation to alleviate osteomyelitis induced by Staphylococcus aureus

Chronic recurrent multifocal osteomyelitis: Case report and review of the literature

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

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