Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated?

被引:101
作者
Girschick, Hermann J.
Zimmer, Christiane
Klaus, Guenter
Darge, Kassa
Dick, Anke
Morbach, Henner
机构
[1] Univ Wurzburg, Childrens Hosp, Div Paediat Rheumatol, Wurzburg, Germany
[2] Univ Wurzburg, Childrens Hosp, Div Immunol, Wurzburg, Germany
[3] Univ Wurzburg, Childrens Hosp, Div Infect Dis, Wurzburg, Germany
[4] Univ Wurzburg, Childrens Hosp, Div Paediat Gastroenterol, Wurzburg, Germany
[5] Univ Marburg, Childrens Hosp, Div Paediat Rheumatol & Nephrol, Marburg, Germany
[6] Univ Wurzburg, Inst Radiodiagnost, Dept Pediat Radiol, Wurzburg, Germany
[7] Univ Wurzburg, Childrens Hosp, Div Paediat Gastroenterol, Wurzburg, Germany
来源
NATURE CLINICAL PRACTICE RHEUMATOLOGY | 2007年 / 3卷 / 12期
关键词
chronic inflammatory bowel disease; chronic nonbacterial osteomyelitis; chronic recurrent multifocal osteomyelitis; Crohn's disease; SAPHO syndrome;
D O I
10.1038/ncprheum0653
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Chronic recurrent multifocal osteomyelitis (CRMO) is the most severe form of chronic nonbacterial osteomyelitis. In children and adolescents, chronic nonbacterial osteomyelitis predominantly affects the metaphyses of the long bones, but lesions can occur at any site in the skeleton. Other organs (the skin, eyes, gastrointestinal tract and lungs) can also be affected. Clinical diagnosis is often difficult because the symptoms and course of disease vary significantly. We present a 10-year-old girl diagnosed with CRMO involving several vertebrae, the femur and the metatarsus. Investigations Physical examination, abdominal ultra sonography, conventional X-ray, MRI, technetium bone scan, esophagogastroduodenoscopy, colonoscopy, tests for HLA-B27 and thiopurine methyltransferase, polymerase chain reaction and thoracic vertebral bone biopsies. Diagnosis CRMO and Crohn's disease. Management The patient's condition improved whilst being treated with NSAIDs for 3 months; however, the patient had an allergic skin reaction to this therapy. Treatment was switched to sulfasalazine, accompanied by 3 weeks of therapy using oral prednisone, but sulfasalazine was discontinued 2 months later because the patient exhibited a minor elevation in the levels of liver enzymes. The patient was free of musculoskeletal symptoms for 6 months, at which time she started to complain again about pain in her back and bowel. Multimodal therapy, consisting of mesasalazine, corticosteroids (budesonide) and azathioprine, induced clinical remission of Crohn's disease.
引用
收藏
页码:733 / 738
页数:6
相关论文
共 22 条
[1]   Chronic recurrent multifocal osteomyelitis associated with chronic inflammatory bowel disease in children [J].
Bousvaros, A ;
Marcon, M ;
Treem, W ;
Waters, P ;
Issenman, R ;
Couper, R ;
Burnell, R ;
Rosenberg, A ;
Rabinovich, E ;
Kirschner, BS .
DIGESTIVE DISEASES AND SCIENCES, 1999, 44 (12) :2500-2507
[2]   Chronic recurrent multifocal osteomyelitis of the spine and mandible: Case report and review of the literature [J].
Chun, CSY .
PEDIATRICS, 2004, 113 (04) :E380-E384
[3]   A missense mutation in pstpip2 is associated with the murine autoinflammatory disorder chronic multifocal osteomyelitis [J].
Ferguson, PJ ;
Bing, XY ;
Vasef, MA ;
Ochoa, LA ;
Mahgoub, A ;
Waldschmidt, TJ ;
Tygrett, LT ;
Schlueter, AJ ;
El-Shanti, H .
BONE, 2006, 38 (01) :41-47
[4]  
Giedion A, 1972, Ann Radiol (Paris), V15, P329
[5]   Chronic multifocal non-bacterial osteomyelitis in hypophosphatasia mimicking malignancy [J].
Girschick H.J. ;
Mornet E. ;
Beer M. ;
Warmuth-Metz M. ;
Schneider P. .
BMC Pediatrics, 7 (1)
[6]   Chronic recurrent multifocal osteomyelitis in children:: Diagnostic value of histopathology and microbial testing [J].
Girschick, HJ ;
Huppertz, HI ;
Harmsen, D ;
Krauspe, R ;
Müller-Hermelink, K ;
Papadopoulos, T .
HUMAN PATHOLOGY, 1999, 30 (01) :59-65
[7]   Chronic recurrent osteomyelitis with clavicular involvement in children: diagnostic value of different imaging techniques and therapy with non-steroidal anti-inflammatory drugs [J].
Girschick, HJ ;
Krauspe, R ;
Tschammler, A ;
Huppertz, HI .
EUROPEAN JOURNAL OF PEDIATRICS, 1998, 157 (01) :28-33
[8]   Chronic non-bacterial osteomyelitis in children [J].
Girschick, HJ ;
Raab, P ;
Surbaum, S ;
Trusen, A ;
Kirschner, S ;
Schneider, P ;
Papadopoulos, T ;
Müller-Hermelink, HK ;
Lipsky, PE .
ANNALS OF THE RHEUMATIC DISEASES, 2005, 64 (02) :279-285
[9]   Chronic recurrent multifocal osteomyelitis (CRMO): evidence for a susceptibility gene located on chromosome 18q21.3-18q22 [J].
Golla, A ;
Jansson, A ;
Ramser, J ;
Hellebrand, H ;
Zahn, R ;
Meitinger, T ;
Belohradsky, BH ;
Meindl, A .
EUROPEAN JOURNAL OF HUMAN GENETICS, 2002, 10 (03) :217-221
[10]   SAPHO syndrome: A long-term follow-up study of 120 cases [J].
Hayem, G ;
Bouchaud-Chabot, A ;
Benali, K ;
Roux, S ;
Palazzo, E ;
Silbermann-Hoffman, O ;
Kahn, MF ;
Meyer, O .
SEMINARS IN ARTHRITIS AND RHEUMATISM, 1999, 29 (03) :159-171