Chronic Recurrent Multifocal Osteomyelitis (CRMO)

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  • Chronic Recurrent Multifocal Osteomyelitis (CRMO) affects predominantly children and adolescents, with a peak age of onset of 10 years and a female preponderance.
  • CRMO is characterized by recurrent inflammation at multiple skeletal sites, most commonly involving the tibia, femur, clavicle, foot, or vertebral body and rarely the pelvis or rib cage.
  • Associated inflammatory disorders, includes
  • → Palmoplantar pustulosis
  • → Chronic arthritis
  • → Psoriasis
  • → Inflammatory bowel disease
  • → Pyoderma gangrenosum 
  • → Sweet's syndrome, and 
  • → Severe acne.

Clinical Features

→ Multiple episodes of localized redness, pain, & swelling of insidious onset & spontaneous regression.
→ Minimal functional impairment during the episodes.

Pathophysiology

  • The pathogenesis of this condition remains unexplained.
  • Theories include an autoimmune process or an infection from an as yet unrecognized causative agent (such as Mycoplasma, Chlamydia, atypical mycobacterium, or virus).
  • Histopathologic examination of lesions may show changes suggestive or diagnostic of osteomyelitis, with numerous neutrophils, bone necrosis, granuloma, and fibrosis with round cell infiltration.

Evaluation


• The diagnosis of CRMO is essentially one of exclusion.


Diagnostic Criteria includes-



(1) Protracted clinical course of > 3 months' duration

(2) Open biopsy results consistent with chronic inflammation, and 
(3) Failure to identify any infectious organism by culture.


  • The initial evaluation of CRMO should include the same laboratory and radiographic studies performed for any suspected infection.

  • Microbiologic tests of blood and tissue cultures should not be omitted.
  • Plain radiographs of each symptomatic area should be obtained and supplemented by bone scintigraphy, because asymptomatic lesions are occasionally identified in this manner.

Treatment

  • There is No well-defined treatment for CRMO, although most children are treated with NSAIDs and occasionally corticosteroids.
  • Effective treatment with interferon gamma has been reported in one case, and it is hoped that this method may help circumvent the prolonged, relapsing nature of CRMO.

Complications

  • CRMO is often described as a self-limiting condition of childhood that follows a benign, protracted course without sequelae.
  • An early diagnosis can avoid complications associated with unnecessary surgical or antibiotic treatment. 

Comments

  1. Unknown17 August 2017 at 16:04

    Its a very nice for orthopaedic resident n consultants

    ReplyDelete

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