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Chronic Recurrent Multifocal Osteomyelitis

CRMO


Presentation

  • Nuclear scintigraphy identifies additional foci of involvement that present concurrently or sequentially.[ncbi.nlm.nih.gov]
  • A second patient presented with a soft tissue mass, which on MRI mimicked a sarcoma. The final patient presented with lesions in the wrist and phalanges of the toes at the unusual age of 38.[ncbi.nlm.nih.gov]
  • CONCLUSION: The present case underlines the fact that rare diseases might occasionally present with even more rare symptoms. These occasions can obviously be considered to present a considerable diagnostic challenge.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Parotid mass or swelling is a common presentation of CRMO involving the mandible. The possibility of this diagnosis should be raised when typical clinical and imaging features are present.[ncbi.nlm.nih.gov]
  • The lesions are reported to present most frequently in the long bones.[ncbi.nlm.nih.gov]

Workup

  • […] description While histological analysis of bone lesions may help to exclude malignant processes, the histologic appearance of CRMO may mimic acute and secondary chronic osteomyelitis caused by microbiological infection Therefore, an extensive microbiological workup[pathologyoutlines.com]
Microcytosis
  • Peripheral blood films showed hypochromia and microcytosis. The sites involved by CRMO were periarticular, mainly around the elbow, knee, wrist and small joints of the hand.[ncbi.nlm.nih.gov]

Treatment

  • Treatment with corticosteroids in children has the risk of causing growth retardation as a potential adverse effect, and alternative treatments are of great interest.[ncbi.nlm.nih.gov]
  • According to our small experience, we suggest considering therapy with etanercept for the treatment of severe cases with persistently active disease despite multiple treatments.[ncbi.nlm.nih.gov]
  • […] for a total treatment duration of 12 to 42 months).[ncbi.nlm.nih.gov]
  • OBJECTIVE: To describe an unusual manifestation and treatment of a rare disease. SUMMARY OF BACKGROUND DATA: CRMO is a rare inflammatory bone disease that should be differentiated from bacterial osteomyelitis.[ncbi.nlm.nih.gov]
  • Laboratory studies and clinical trials are warranted to: establish biomarkers that predict flares and clinical outcomes, identify patients that require additional treatment on top of NSAIDs, establish evidence-based treatment regimens, allow a risk-benefit[ncbi.nlm.nih.gov]

Prognosis

  • Favorable, self-limited long-term prognosis of CRMO has been assumed. Antibiotics provide no improvement. Course, severity and recurrency can be influenced positively by antiphlogistic substances, although this has not yet been proved.[ncbi.nlm.nih.gov]
  • Prognosis is generally good although the disease can relapse and remit over many years. At 9 months follow up, the lesions were resolving and the deformity had resolved.[ncbi.nlm.nih.gov]
  • The prognosis can vary among individuals: some children may go into complete remission when they become adults and some may continue with this disease.[checkorphan.org]
  • Prognosis will depend on your child's individual disease and response to treatment. It is best to discuss the prognosis with your child's pediatric rheumatologist.[en.wikipedia.org]
  • Treatment and prognosis CRMO should be treated by a rheumatologist. While non-steroidal anti-inflammatory drugs may cause some symptomatic relief, there is often the need for a greater degree of immunosupression and possibly biological agents.[radiopaedia.org]

Etiology

  • Several observations suggest the contribution of genetic factors to the etiology of chronic recurrent multifocal osteomyelitis.[ncbi.nlm.nih.gov]
  • Abstract Chronic recurrent multifocal osteomyelitis is a rare inflammatory form of osteomyelitis of unknown etiology.[ncbi.nlm.nih.gov]
  • Abstract Chronic recurrent multifocal osteomyelitis (CRMO) is a very rare condition of unknown etiology and most commonly occurs during childhood or adolescence.[ncbi.nlm.nih.gov]
  • Abstract Chronic recurrent multifocal osteomyelitis (CRMO) is an extremely rare and most severe form of chronic nonbacterial osteomyelitis of unknown etiology.[ncbi.nlm.nih.gov]

Epidemiology

  • No epidemiological data on incidence and prevalence have been published so far. However, the incidence might be estimated at 1:1,000,000.The cause of this condition is unknown, despite the intensive investigation over a period of more than 30 years.[medigoo.com]
  • […] based on presumed etiology and pathogenesis of disease These criteria are therefore considered a tertiary classification criteria These tertiary criteria help determine the necessary therapeutic strategies which may differ somewhat among the subgroups Epidemiology[pathologyoutlines.com]
  • Osteosarcoma incidence and survival rates from 1973 to 2004: data from the surveillance, epidemiology, and end results program. Cancer. 2009;115(7):1531–43. PubMed CrossRef Google Scholar 63. Arndt CA, Crist WM.[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • We summarize the clinical presentation, diagnostic approaches, most recent advances in understanding the pathophysiology, and available treatment options and outcomes in CNO/CRMO.[ncbi.nlm.nih.gov]
  • This review briefly summarizes the main clinical and radiologic aspects of the disease and then focuses on genetics and pathophysiology and provides an update on treatment.[ncbi.nlm.nih.gov]
  • A timely diagnosis and treatment initiation is complicated by the absence of widely accepted diagnostic criteria and an incomplete pathophysiological understanding.[ncbi.nlm.nih.gov]
  • Remember, trauma is part of the pathophysiology of this disease. First they bang into something, then they have a transient bacteremia and the bacteria sets up shop in that bone. So, the legs are particularly prone.[lecturio.com]
  • Hedrich, Chronic Nonbacterial Osteomyelitis: Pathophysiological Concepts and Current Treatment Strategies, The Journal of Rheumatology, 10.3899/jrheum.160256, 43, 11, (1956-1964), (2016).[doi.org]

Prevention

  • It is important to publish cases like this, because the recognition of CRMO can prevent aggressive surgical and medical treatment.[ncbi.nlm.nih.gov]
  • CONCLUSION: The case demonstrates to general practitioners and other clinicians that a prolonged administration of antibiotics can be prevented by means of a comprehensive diagnostic procedure for possible bacterial osteomyelitis.[ncbi.nlm.nih.gov]
  • Patients are refractory to antibiotic therapy, but dramatically respond to systemic steroids and may need to be maintained on low-dose steroids to prevent relapse.[ncbi.nlm.nih.gov]
  • Radiologists should be familiar with the typical imaging findings of CRMO to prevent unnecessary multiple biopsies and long-term antibiotic treatment in children with CRMO. Copyright RSNA, 2009[ncbi.nlm.nih.gov]
  • Prevention - Chronic recurrent multifocal osteomyelitis Not supplied. Diagnosis - Chronic recurrent multifocal osteomyelitis Prognosis - Chronic recurrent multifocal osteomyelitis Since CRMO is an autoinflammatory condition it can wax and wane.[checkorphan.org]

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