How Have the Diagnosis and Treatment of Chronic Recurrent Multifocal Osteomyelitis Changed Over Time?

Beck, Nicole; Roudnitsky, Emily; Nuzzi, Laura C.; Padwa, Bonnie L.; Dedeoğlu, Fatma

doi:10.1016/j.joms.2022.10.005

Cited by 3 publications

(8 citation statements)

References 39 publications

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“…Anti-TNF agents, such as etanercept or anakinra, are another type of treatment for CRMO [ 24 ]. TNFα is expressed in increased levels from monocytes in CRMO patients and has shown some benefit for patients [ 25 , 26 ]. However, given the off-label use and the high cost of TNF inhibitors along with safety concerns, it is recommended to reserve use for complicated cases [ 5 , 25 ].…”

Section: Reviewmentioning

confidence: 99%

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Chronic Recurrent Multifocal Osteomyelitis: A Comprehensive Literature Review

Hassan¹,

Assi²,

Hassan³

et al. 2023

Cureus

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Chronic recurrent multifocal osteomyelitis (CRMO) is a non-infectious, inflammatory disorder of the bones. CRMO typically affects children, with a predisposition to females. Bone-related pain is often felt in the metaphysis of long bones, particularly of the lower extremities, but it can also target other sites at varied time intervals. Patients are likely to complain of tenderness and swelling that may cause considerable disability and adversely impact quality of life. There are three main pathophysiological mechanisms that have been hypothesized to drive CRMO including imbalanced cytokine expression, increased inflammasome activation, and enhanced osteoclast differentiation. Therapies have been based on targeting and suppressing these key players in CRMO patients. The first step in management involves pain control. Non-steroidal anti-inflammatory drugs should provide initial relief, albeit temporarily. It is imperative to initiate immunosuppressive medication that will help limit bone involvement and thereby prevent the development of fractures or leg-length discrepancies, for example. The purpose of this literature review is to study the pathophysiology of CRMO and carefully dissect the agents that have been previously employed in the management of CRMO patients. This could allow for the purposeful formulation of individualized care plans and improving the overall well-being of patients. The authors included a multitude of PubMed-indexed articles published from 2000 onwards in this review.

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Section: Reviewmentioning

confidence: 99%

“…DMARDs, such as methotrexate, sulfasalazine, and leflunomide, have also become increasingly used as a treatment in the past few years but information regarding their benefit is sparse [ 25 ]. IL-1 blocking strategies seem to be a promising therapy due to increased NLRP3 inflammasome assembly, but studies have shown conflicting results [ 6 ].…”

Section: Reviewmentioning

confidence: 99%

Chronic Recurrent Multifocal Osteomyelitis: A Comprehensive Literature Review

Hassan¹,

Assi²,

Hassan³

et al. 2023

Cureus

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“…Previous studies have reported that about 50% of first- or second-degree relatives of those with CRMO have an autoimmune condition, with Crohn’s disease and psoriasis being the most common [ 6 ]. Furthermore, about 25% of CRMO patients have an associated inflammatory disorder [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Treatment modalities have evolved substantially within the last two decades as more historical data regarding this rare disease has become available. Nonsteroidal anti-inflammatory agents (NSAIDS) remain the most common first-line treatment, but a combination of tumor necrosis factor inhibitors and disease-modifying anti-rheumatic drug therapies has become increasingly popular [ 7 ]. There has been a corresponding decrease in the use of surgical interventions, antibiotics, and hyperbaric oxygen to treat CRMO [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nonsteroidal anti-inflammatory agents (NSAIDS) remain the most common first-line treatment, but a combination of tumor necrosis factor inhibitors and disease-modifying anti-rheumatic drug therapies has become increasingly popular [ 7 ]. There has been a corresponding decrease in the use of surgical interventions, antibiotics, and hyperbaric oxygen to treat CRMO [ 7 ]. Available literature suggests that by 18-21 months post-therapy, a patient’s symptoms can be expected to return to baseline [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Case Presentation of a Nine-Year-Old Female With Chronic Recurrent Multifocal Osteomyelitis

Huang¹,

Wolfe²,

Yaeger³

et al. 2023

Cureus

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Multifocal bone pain in a pediatric patient prompts a broad differential diagnosis, which should include chronic recurrent multifocal osteomyelitis (CRMO), particularly when the patient has a personal or family history of autoimmune diseases or chronic inflammatory disorders. CRMO is a difficult diagnosis, as several similar disorders must be ruled out first, and it requires extensive verification based on clinical, radiological, and pathological criteria. It often mimics other medical diagnoses, including Langerhans cell histiocytosis and infectious osteomyelitis. Maintaining a high index of suspicion for CRMO is important to minimize unnecessary medical testing, optimize pain control, and preserve physical function. We present the case of a nine-year-old female who presented with multifocal bone pain and was diagnosed with CRMO.

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