scholarly journals Contiguous Three-Level Vertebral Collapse in Thoracic Spine: A Novel Presentation of Chronic Recurrent Multifocal Osteomyelitis in 12 years old and Review of Literature

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
Dheeraj Batheja ◽  
Sudarshan Munigangaiah ◽  
Harsha H Jayanna ◽  
Aashish Ghodke
Keyword(s):  
Thoracic Spine ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Autoimmune Disorder ◽  
Childhood And Adolescence ◽  
Management Options ◽  
Spinal Involvement ◽  
Multifocal Osteomyelitis ◽  
Body Magnetic Resonance Imaging ◽  
Inflammatory Drugs ◽  
Full Body

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoimmune disorder of childhood and adolescence which often manifests as recurring episodes of inflammatory bone pains. Spinal involvement is rare; however, recent studies advocate full body magnetic resonance imaging in all suspected cases to pick up asymptomatic lesions early to prevent complications. Spinal involvement may manifest as fractures, scoliosis, or kyphotic deformity. Case Report: We present a case of a 12-year-old boy who had three-level involvement of thoracic spine, T6-T8, and was worked up and managed for pathological fracture of spine. He underwent biopsy for the same and was later diagnosed as CRMO. Here, we discuss the diagnostic challenges involved in CRMO, need for biopsy, and the management options available. Conclusions: Identifying CRMO is challenging and remains a diagnosis of exclusion. Nonsteroidal anti-inflammatory drugs often constitute the first line of treatment and other drugs such as bisphosphonates and biologics such as TNF-alpha antagonists are reserved for more severe cases. Although CRMO is considered a benign disease, recent data suggest up to 50% rate of residual impairments despite optimal management. Keywords: Chronic recurrent multifocal osteomyelitis, spine, contiguous, child.

scholarly journals Response of Different Treatment Protocols to Treat Chronic Non-Bacterial Osteomyelitis (CNO) of the Mandible in Adult Patients: A Systematic Review

2020 ◽  
Vol 17 (5) ◽  
pp. 1737
Author(s):  
Maximilian Timme ◽  
Lauren Bohner ◽  
Sebastian Huss ◽  
Johannes Kleinheinz ◽  
Marcel Hanisch
Keyword(s):  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Unknown Etiology ◽  
Special Focus ◽  
Treatment Protocols ◽  
First Choice ◽  
Therapy Recommendation ◽  
Multifocal Osteomyelitis ◽  
Inflammatory Drugs ◽  
Meta Analyses ◽  
Evidence Based Therapy

(1) Background: Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone disease of finally unknown etiology, which can occur alone or related with syndromes (chronic recurrent multifocal osteomyelitis—CRMO; synovitis, acne, pustulosis, hyperostosis and osteitis syndrome—SAPHO). The involvement of the mandible is rather rare. (2) Methods: We carried out a systematic literature search on CNO with mandibular involvement, according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines, considering the different synonyms for CNO, with a special focus on therapy. (3) Results: Finally, only four studies could be included. A total of 36 patients were treated in these studies—therefore, at most, only tendencies could be identified. The therapy in the included works was inconsistent. Various therapies could alleviate the symptoms of the disease. A complete remission could only rarely be observed and is also to be viewed against the background of the fluctuating character of the disease. The success of one-off interventions is unlikely overall, and the need for long-term therapies seems to be indicated. Non-steroidal anti-inflammatory drugs (NSAIDs) were not part of any effective therapy. Surgical therapy should not be the first choice. (4) Conclusions: In summary, no evidence-based therapy recommendation can be given today. For the future, systematic clinical trials on therapy for CNO are desirable.

scholarly journals Chronic Recurrent Multifocal Osteomyelitis of the First Metatarsal Bone: A Case Report

2009 ◽  
Vol 17 (1) ◽  
pp. 119-122 ◽  
Author(s):  
CK Chiu ◽  
VA Singh
Keyword(s):  
Case Report ◽  
Symptomatic Relief ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Metatarsal Bone ◽  
First Metatarsal ◽  
History Of ◽  
Multifocal Osteomyelitis ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

We report a case of chronic recurrent multifocal osteomyelitis in a 9-year-old girl. She presented with a 9-month history of gradually worsening pain and swelling in her left foot. Non-steroidal anti-inflammatory drugs were prescribed but the symptoms persisted. She underwent curettage through a small oval corticotomy window on the first metatarsal bone. The pain and swelling improved promptly and she was able to walk without pain 2 weeks later. Curettage enabled rapid symptomatic relief and induced remission, with little risk of complications.

scholarly journals Whole-Body MRI in Rheumatology: Major Advances and Future Perspectives

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1770
Author(s):  
Luca Deplano ◽  
Matteo Piga ◽  
Michele Porcu ◽  
Alessandro Stecco ◽  
Jasjit S. Suri ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Standard Technique ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Whole Body ◽  
Whole Body Mri ◽  
Treatment Response Evaluation ◽  
Multifocal Osteomyelitis ◽  
Body Magnetic Resonance Imaging ◽  
Juvenile Spondyloarthritis

Whole-body magnetic resonance imaging is constantly gaining more importance in rheumatology, particularly for what concerns the diagnosis, follow-up, and treatment response evaluation. Initially applied principally for the study of ankylosing spondylitis, in the last years, its use has been extended to several other rheumatic diseases. Particularly in the pediatric population, WB-MRI is rapidly becoming the gold-standard technique for the diagnosis and follow-up of both chronic recurrent multifocal osteomyelitis and juvenile spondyloarthritis. In this review, we analyze the benefits and limits of this technique as well as possible future applications.

scholarly journals POS1306 TREATMENT STRATEGIES IN CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS (CMRO) OR CHRONIC NON-BACTERIAL OSTEOMYELITIS (CNO): SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 935.1-935
Author(s):  
R. Dos-Santos ◽  
C. Gomez-Vieites ◽  
D. Fernández Fernández ◽  
I. González Fernández ◽  
A. Souto Vilas ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Meta Analysis ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Response Rates ◽  
Complete Response ◽  
Treatment Recommendation ◽  
Remission Rates ◽  
Multifocal Osteomyelitis ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background:Glucocorticoids (GC), bisphosphonates (BP), non-steroidal anti-inflammatory drugs (NSAID) and classical synthetic or biological disease-modifying antirheumatic drugs (cs/bDMARD) have been employed in the treatment of chronic recurrent multifocal osteomyelitis (CRMO) or chronic non-bacterial osteomyelitis (CNO).1, 2 This one is a rare bone childhood illness and none treatment guidelines have been carried out till present.3Objectives:To asses which treatment schedule employed in CRMO had the best response rates and try to expose a treatment recommendation.Methods:A systematic literature review was made using Medline, Embase, Cochrane library and the Web of Science databases. The search strategy focused on synonyms of CRMO. A prevalence meta-analysis was performed to evaluate each treatment response. Stata 15.1 was used to perform statistical analysis.Results:The search identified 1883 articles, of which 43 were finally selected. Complete response rate reached with NSAIDs was acceptable [50% (CI95% 40-60)]. Lower response rates were reached by GC treatment [44% (CI95% 25-63)] or csDMARD [38% (CI95% 28-48)]. The best complete response rates were reached by bDMARD and BP treatments [69% (CI95% 56-82) and 73% (CI95% 62-84), respectively].Conclusion:This review and meta-analysis supports, taking into account its remission rates and its risk-benefit profile, NSAIDs as potential first-line agents in CRMO treatment. bDMARD and BP have reached the higher remission rates, turning into helpful treatment alternatives. There is not any treatment guidelines driving CRMO patients, but this analysis could help to select a suitable agent for each patient. Decision-making should be individualized.References:[1]Wipff J, Costantino F, Lemelle I, et al. A large national cohort of French patients with chronic recurrent multifocal osteitis. Arthritis & Rheumatol. 2014;67(4):1128-1137.[2]Zhao Y, Wu E Y, Oliver M S, et al. Consensus treatment plans for chronic nonbacterial osteomielitis refractory to nonsteroideal anti-inflammatory drugs and/or with active spinal lesions. Arthritis Care Res. 2018;70(8):1228-1237.[3]Menashe SJ, Aboughalia H, Zhao Y, et al. The many faces of pediatric chronic recurrent multifocal osteomyelitis (CRMO): a practical location- and case-based approach to differenciate CRMO from its mimics. J Magn Reson Imaging. 2020;e27299.Disclosure of Interests:None declared

Chronic mandible inflammation as the first symptom of chronic recurrent multifocal osteomyelitis (CRMO) – a case report

2018 ◽  
Vol 23 (2) ◽  
Author(s):  
Ewa Krasuska-Sławińska ◽  
Paulina Piekarska ◽  
Piotr Gietka ◽  
Anna Wieteska-Klimczak ◽  
Mirela Wadecka ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Unknown Aetiology ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Soft Tissue Swelling ◽  
Multifocal Osteomyelitis ◽  
Inflammatory Drugs ◽  
Mild Fever

Chronic recurrent multifocal osteitis (CRMO) is a rare disease of an unknown aetiology, occurring mainly in children aged 4-14 years. It is characterised by recurring episodes of osteitis, with no detectable cause, lasting from several months up to a few years. It usually affects the metaphysis of long bones. Primary lesions in the form of isolated focuses rarely occur in the mandible. The clinical symptoms of CRMO include ostealgia, soft tissue swelling (oedema), skin reddening, and mild fever. The diagnosis is difficult. It involves numerous laboratory and radiological investigations. In order to exclude infectious and neoplastic aetiology, it is advisable to perform a tissue biopsy. The disease is long-lasting with exacerbations and remissions. The prognosis is uncertain. Non-steroidal anti-inflammatory drugs and empirical antibiotic therapy are a recommended first-line therapy; if no improvement is observed, corticosteroids should be used. The analysed case concerns a 10-year-old boy with mandible inflammation as the first symptom of chronic recurrent multifocal osteitis (CRMO). Mandibular lesions may be the first symptom of chronic recurrent multifocal osteitis. The non-specific onset and variable clinical picture delay the diagnosis. Early diagnosis enables early treatment, which prevents complications.

Imaging of chronic recurrent multifocal osteomyelitis of childhood first presenting with isolated primary spinal involvement

2003 ◽  
Vol 32 (6) ◽  
pp. 328-336 ◽  
Author(s):  
S. E. Anderson ◽  
P. Heini ◽  
M. J. Sauvain ◽  
E. Stauffer ◽  
L. Geiger ◽  
...  
Keyword(s):  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Spinal Involvement ◽  
Multifocal Osteomyelitis
Sign in / Sign up

Export Citation Format

Share Document