Chronic Recurrent Multifocal Osteomyelitis with Concomitant Features of Juvenile Idiopathic Arthritis

Abstract

We report a case of a 13-year-old girl with chronic recurrent multifocal osteomyelitis (CRMO) who developed severe arthritis in four different joints within the first year from the onset of the disease. Her multiple vertebrae lesions showed significant amelioration after a 2-month treatment with prednisolone. In parallel, the initial severe symmetrical arthritis of both knees showing overt synovitis and joint effusion, in the absence of lesions in the metaphyses of the femur or the tibia, responded remarkably well in intra-articular triamcinolone hexacetonide injections. However, upon discontinuation of prednisolone, the patient developed severe arthritis of her right ankle and the proximal interphalangeal joint of her right middle finger. Thus, prednisolone was reinitiated combined with methotrexate, and the patient went into remission, which persists one year after prednisolone tapering. The appearance of arthritis in both knees in the absence of bone lesions and the emergence of severe arthritis of the ankle after remission of spinal bone lesions suggest that CRMO and juvenile idiopathic arthritis may coexist and be causally related.

Juvenile spondyloarthritis and chronic recurrent multifocal osteomyelitis overlap syndrome in a 16-year-old adolescent. A case report and literature review

“…(27) , among others, but also the coexistence of JSpA and CRMO. The case of the 16-year-old girl with an overlap syndrome presented in this study, which was diagnosed after a few years of delay, is not an isolated one: there are cases reported in medical literature in which both conditions were not diagnosed at the same time (28–31) . However, in the cases described in the literature CRMO was diagnosed first and then JIA was identified (28–32) , while our case is the first one in which JIA was diagnosed before CRMO.…”

Systemic juvenile idiopathic arthritis with chronic recurrent multifocal osteomyelitis in an adolescent: A case report

“…Their further assessments revealed no manifestation of IBD. 9 However, Tsitsami et al 10 represented another case with CRMO, which had concurrent manifestations of JIA but not sJIA. However, JIA cannot be exclusively excluded from the differential diagnoses of CRMO, as arthritis, morning stiffness, and asymmetrical joint involvement have been reported in a study by Beck et al, 11 who investigated 37 patients with CRMO.…”

Chronic Non-Bacterial («Sterile») Osteomyelitis in the Practice of Pediatric Rheumatologist, the Contemporary Diagnostic and Treatment Approaches: Literature Review and Own Data Analysis

“…сhronic non-bacterial osteomyelitis, CNO) -хро-ническое воспалительное заболевание скелета неин-фекционного происхождения неизвестной этиологии с моно-и мультиочаговым поражением, склонное к реци-дивированию [1]. Ввиду относительной редкости ХНО [2], большинство врачей недостаточно осведомлены о дан-ной патологии. Существенное улучшение знаний о пато-генезе ХНО в последние годы при явно недостаточном числе отечественных публикаций, принципиальное сме-щение от хирургических подходов к дифференцирован-ным терапевтическим требует четкого представления о современной тактике его диагностики и лечения.…”