Chronic recurrent multifocal osteomyelitis and pustulosis palmoplantaris

Evolution of chronic recurrent multifocal osteitis toward spondylarthropathy over the long term

“…In these forms, the recourse to bone biopsy is essential in order to eliminate an infectious or tumoral process. In the other forms, several observations, similar to some of ours and those reported in the literature (4,22,23,25,26), plead in favor of CRMO, i.e., the multiplicity of bone sites involved initially (mean of 2.4/patient in our series), the inefficacy of antibiotic therapy often prescribed empirically in the absence of bacteriologic documentation, and, above all, the chronic evolution with exacerbations and remissions and progressive involvement of other bone sites.…”

“…Other than some hypotheses that have been presented in the literature, especially related to autoimmune processes (1,21), the pathogenesis of CRMO remains unknown. The number of involved bone sites at the onset of the disease varies between 1 and 8 (4,22,23). CRMO is particularly difficult to diagnose when only 1 bone site is affected, because the clinical symptoms are suggestive of subacute bacterial osteomyelitis, especially in children, or a bone tumor, in that some cases of CRMO present as a pseudosarcoma (24).…”

“…Many authors think that CRMO usually has a favorable evolution with no major sequelae (4,5,10,22,27). However, the long-term (i.e., Ͼ5 years) outcome of CRMO has not been extensively investigated.…”

“…First described by Giedion et al in 1972 (1) and then by Gustavson and Wilbrand in 1974 (2) under the name of subacute and chronic symmetrical osteomyelitis, this entity has been accorded diverse denominations in the literature: chronic multifocal symmetric osteomyelitis or chronic multifocal cleido-metaphyseal osteomyelitis (3). However, because the lesions are not always symmetric, Bjorksten et al finally proposed the name of CRMO (4). Its radiologic and histopathologic features were described by Probst et al (5) and Bjorksten and Boquist (6), respectively.…”

“…Indeed, several studies have demonstrated that CRMO in adults and children can be associated with palmoplantar pustulosis (PPP) (4,(7)(8)(9), psoriasis (10), acne (11), or, more rarely, Sweet's syndrome (12). Sonozaki et al (7) proposed the name of pustulotic arthro-osteitis for the osteoarticular manifestations associated with PPP.…”