The Limping Adolescent

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The Limping Adolescent - Page #4

Working Diagnosis: Chronic Recurrent Multifocal Osteomyelitis (CRMO) Treatment: NSAIDS as first line (2 year course here), then Disease Modifying Anti Rheumatologic Drugs (DMARDs), then Bisphosphonates Outcome: Favorable. Return to baseline level of activity. Author's Comments: CRMO is a non-infectious autoimmune inflammatory disorder, osteomyelitis indicating inflammation of bone, not infectious. Epidemiology 1/1,000,000 with orphan disease designation. The median age at diagnosis is 10 years old,female:Male is 2:1, average time to diagnosis 18 months. 1/3 will have additional autoimmune disease. The pathophysiology not well understood but believed to immune based. Tumor Necrosis Factor (TNF)levels are elevated. Most common location for a lesion is the clavicle. Typically metaphysis and epiphysis of long bones of lower extremity. Editor's Comments: Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory bone condition. Signs and symptoms include recurrent episodes of pain and joint swelling, with or without fever. Symptoms typically begin in childhood. CRMO may occur alone, with psoriasis or inflammatory bowel disease. For most children, CRMO resolves after many years without lasting effects. However, CRMO can cause slow growth and permanent bone deformity. References: Ferguson PJ, Sandu M. Current understanding of the pathogenesis and management of chronic recurrent multifocal osteomyelitis. Curr Rheumatol Rep. 2012 Apr;14(2):130-41; http://www.ncbi.nlm.nih.gov/pubmed/?term=22359228 Return To The Case Studies List.		Back
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