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Sgaglione J, Muran A, Rhode M, Goodman HJ, Edelman MC, Shah SA, Greenberg AS, Kenan S. Geriatric chronic recurrent multifocal osteomyelitis (CRMO) mimicking multifocal multiple myeloma: a first in an octogenarian. Skeletal Radiol 2024:10.1007/s00256-024-04653-z. [PMID: 38499893 DOI: 10.1007/s00256-024-04653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO), an autoinflammatory bone disorder characterized by non-bacterial osteomyelitis causing recurrent multifocal bone lesions, is a well-known, yet uncommon pediatric condition that rarely affects adults; to date, it has never been diagnosed over the age of 75. The following report will discuss the first octogenarian diagnosed with CRMO and therefore represents an exceptionally rare presentation of a rare disease. An 83-year-old woman presented with progressive right shoulder, forearm, and hip pain, with associated weight loss and global weakness, requiring a wheelchair for mobility. Imaging revealed a pathologic right ulna fracture in addition to lytic lesions of the right proximal humerus and proximal femur. The clinical picture was thus that of a patient with probable multiple myeloma versus metastatic disease. After an extensive workup, however, the lesions were not malignant; histologic findings were instead suggestive of chronic osteomyelitis with negative cultures. Given the multifocal nature of this condition, combined with a lack of clinical symptoms of infection, a diagnosis of CRMO was rendered. The patient underwent intramedullary nailing of the right femur and splinting of the ulna, with a subsequent remarkable recovery to painless ambulation, complete union of the right ulna fracture, and resolution of the lytic lesions without receiving any targeted medical treatment. This case highlights the importance of maintaining CRMO on the differential for multifocal skeletal lesions, regardless of age. Performing a thorough workup with necessary imaging, biopsy, and culture are critical to establishing this diagnosis, which can only made as a diagnosis of exclusion.
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Affiliation(s)
- Jonathan Sgaglione
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell 500 Hofstra Blvd, Hempstead, NY, 11549, USA
| | - Andrew Muran
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell 500 Hofstra Blvd, Hempstead, NY, 11549, USA
| | - Matthew Rhode
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell 500 Hofstra Blvd, Hempstead, NY, 11549, USA
| | - Howard J Goodman
- Northwell Health, Long Island Jewish Medical Center Department of Orthopaedic Surgery, 270-05 76th Avenue, New York, NY, 11040, USA
| | - Morris C Edelman
- Pediatric Pathology Division, Northwell Health, Long Island Jewish Medical Center Department of Pathology, 270-05 76th Avenue, New York, NY, 11040, USA
| | - Suhail Ahmed Shah
- Department of Internal Medicine, Northwell Health, Long Island Jewish Medical Center Department of Orthopaedic Surgery, 270-05 76th Avenue, New York, NY, 11040, USA
| | - Andrew S Greenberg
- Orthopaedic Associates of Manhasset, 600 Northern Blvd, Lake Success, NY, 11021, USA
| | - Shachar Kenan
- Northwell Health, Long Island Jewish Medical Center Department of Orthopaedic Surgery, 270-05 76th Avenue, New York, NY, 11040, USA.
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Saffarzadeh M, Haydar S, Chan D, Andrews G, Ouellette H, Mallinson P, Munk PL, Sheikh A. A clinico-radiological review of chronic non-bacterial osteomyelitis in paediatrics, adolescents, and adults: demystifying a forgotten differential. Clin Radiol 2024; 79:170-178. [PMID: 38160105 DOI: 10.1016/j.crad.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
Chronic non-bacterial osteomyelitis (CNO), also known as non-bacterial osteitis, is a chronic autoinflammatory disease of unknown aetiology that primarily occurs in the paediatric population, although rare cases of adult-onset disease also exist. CNO has non-specific clinical and radiological presentations, and the affected population often present with bone pain of insidious onset secondary to sterile bony inflammation that can be associated with swelling, focal tenderness, and warmth at the affected sites. The pattern of bony involvement appears to be dependent on the age of onset, with adults frequently having axial skeletal lesions and children and adolescents often being affected in the appendicular skeletal sites. CNO is a diagnosis of exclusion, and imaging is heavily relied on to identify and characterise the bony lesions in addition to exclude diseases that can mimic CNO. Magnetic resonance imaging is often the reference standard with biochemical and histopathological findings being complementary. Although combining imaging methods can be used to facilitate the diagnosis, a single technique could be adequate depending on the clinical picture. Given the relatively rare incidence of CNO, limited awareness of the disease among care providers, and its similarity in clinical and radiological presentation to various bony diseases, there are often long delays in diagnosis, with adults being unfavourably affected compared to paediatrics and adolescents. This review of CNO will describe the condition, overview its clinical presentation, highlight the radiological features, and emphasise clinical pearls that can aid in diagnosis and ruling out the mimics.
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Affiliation(s)
- M Saffarzadeh
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
| | - S Haydar
- Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - D Chan
- Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - G Andrews
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - H Ouellette
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - P Mallinson
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - P L Munk
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - A Sheikh
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
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Duan H, Gao S, Zhang L, Song L, Zhai J, Deng X. The clinical characteristics and prognosis of patients with SAPHO syndrome--a real-world cohort study. Clin Rheumatol 2024; 43:561-568. [PMID: 37755548 DOI: 10.1007/s10067-023-06782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/22/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES We aimed to analyze the clinical characteristics and outcomes of patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. METHODS The clinical records of 64 patients with SAPHO syndrome were collected, and the treatment and outcomes of 27 patients were followed up. The patients were divided into three groups according to the site of bone lesions: only anterior chest wall (ACW) involvement, only spinal involvement, and bone lesion involvement at both sites. The clinical characteristics and outcomes were compared. The clinical characteristics of the patients with and without peripheral joint involvement were compared. RESULTS Among all patients, 31.25% (20/64) had only ACW involvement, 15.63% (10/64) had only spinal involvement, and 53.12% (34/64) had both ACW and spinal involvement. Peripheral joint involvement was observed in 25.00% (16/64) of the patients. Patients with only spinal involvement were older than those with only ACW involvement (p = 0.006). Patients with both ACW and spinal involvement were older than those with only ACW involvement (p = 0.002) and had a longer diagnosis delay (p = 0.015). Patients with peripheral joint involvement were younger than those without peripheral joint involvement (p = 0.028). During follow-up, 88.89% (24/27) of patients had good outcomes. Twenty-two patients were treated with non-steroidal anti-inflammatory drugs + Iguratimod (IGU), and the outcomes of 90.91% (20/22) improved. CONCLUSIONS A relationship may exist between the sites of bone lesions and clinical characteristics of patients with SAPHO syndrome. The clinical outcomes of these patients may be good, and IGU may be effective in treating SAPHO syndrome. Key Points • This study is the first long-term follow-up on the effectiveness of iguratimod in treating patients with SAPHO. • This study revealed that patients with SAPHO and different bone lesion sites may present with different clinical characteristics.
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Affiliation(s)
- Hongji Duan
- Department of Orthopedic Medicine, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East St, Xicheng District, Beijing, 100035, China
| | - Shuang Gao
- Department of Hematology, Lymphoma Center, Peking University Third Hospital, Beijing, China
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
| | - Jiayu Zhai
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Xiaoli Deng
- Department of Orthopedic Medicine, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East St, Xicheng District, Beijing, 100035, China.
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Romagnuolo M, Moltrasio C, Iannone C, Gattinara M, Cambiaghi S, Marzano AV. Pyoderma gangrenosum following anti-TNF therapy in chronic recurrent multifocal osteomyelitis: drug reaction or cutaneous manifestation of the disease? A critical review on the topic with an emblematic case report. Front Med (Lausanne) 2023; 10:1197273. [PMID: 37324147 PMCID: PMC10264797 DOI: 10.3389/fmed.2023.1197273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory disease, clinically characterized by chronic and recurrent episodes of osteoarticular inflammation, that generally presents in children and adolescents. From a dermatological point-of-view, CMRO can be associated with skin rashes mainly including psoriasis, palmoplantar pustulosis and acne. Pyoderma gangrenosum (PG) is a rare immune-mediated inflammatory skin disease classified within the spectrum of neutrophilic dermatoses that, in some cases, has been reported as cutaneous manifestation in CMRO patients. This paper presents a 16-year female patient diagnosed with CMRO, who presented PG lesions located on the lower leg, that arose after the administration of the tumour necrosis factor (TNF)-α inhibitor adalimumab. Cases of PG have been reported in patients being treated with certain medications, including TNF-α antagonists, leading to classified them in a setting aptly termed "drug-induced PG." In this paper, we discuss the co-occurrence of PG and CRMO, in the light of recent evidence on the pathogenesis of both diseases and giving ample space to a literature review on drug induced PG. In our case, it is plausible that PG could be considered a cutaneous manifestation of CRMO, although the mechanisms underlying this intriguingly relationship remain to be fully unraveled.
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Affiliation(s)
- Maurizio Romagnuolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Iannone
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy
| | - Maurizio Gattinara
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Stefano Cambiaghi
- Pediatric Dermatology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Ma M, Wei S, Yin D, Li W, Li C. A Case of Neutrophilic Dermatoses-Sweet’s Syndrome Coexisting with SAPHO Syndrome. Clin Cosmet Investig Dermatol 2023; 16:739-742. [PMID: 37008190 PMCID: PMC10065417 DOI: 10.2147/ccid.s404390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a rare disease characterized by osteoarticular and cutaneous manifestations. SAPHO syndrome mostly involves the skin, mainly presented as palmoplantar pustulosis and severe acne. Sweet's syndrome (SS) is a neutrophilic dermatosis of unknown cause, which may be caused by autoinflammation. So far, SAPHO syndrome complicated with SS has been rarely reported worldwide. Here, we present a rare case diagnosed in our hospital with detailed clinical information. This patient presented pain and swelling in her right leg. Later, she developed red papules on her right lower eyelid and a skin biopsy showed diffuse lymphocytic and neutrophilic infiltration in the superficial dermis. She was diagnosed with SAPHO syndrome and SS according to medical history and examination. These two diseases share parts of autoinflammatory signaling pathways and might be different variations of the spectrum of autoinflammatory diseases. Through this case, we aim to provide a new horizon for the regulation of neutrophils in SAPHO syndrome and skin lesions like SS.
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Affiliation(s)
- Mingwei Ma
- School of Clinical Medicine, Peking Union Medical College Hospital (PUMC and CAMS), Beijing, 100730, People’s Republic of China
| | - Shufeng Wei
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
| | - Dan Yin
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
| | - Weizhong Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
- Correspondence: Chen Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No. 4, Chengguan Health Road, Fangshan District, Beijing, People’s Republic of China, Tel +86 13810988688, Email
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Chang E, Vickery J, Zaiat N, Sallam E, Hanan A, Baker S, Alhamar M, Poulik J, Demian E, Shehata BM. Chronic Recurrent Multifocal Osteomyelitis (CRMO): A Study of 12 Cases from One Institution and Literature Review. Fetal Pediatr Pathol 2022; 41:759-770. [PMID: 34542007 DOI: 10.1080/15513815.2021.1978602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND CRMO is a sterile auto inflammatory bone disease that affects the pediatric population. Recently, single gene mutations in LPIN2, DIRA, and IL1RN have been reported in murine models of CRMO. MATERIALS AND METHODS The medical records and histopathological slides of twelve patients were reviewed. RESULTS The diagnosis was determined by multiple lesions, imaging, negative cultures, bone biopsy, and lack of antibiotic response. Biopsy showed early neutrophilic infiltrates, and older lesions showed lymphoplasmacytic infiltrates and fibrosis. Patients were treated with anti-inflammatory medication with some lesions completely resolving. CONCLUSION Bone biopsy aids the diagnosis of CRMO in correlation with clinical presentation, imaging, and culture findings. Our findings indicate the kinetics of CRMO is not well defined and the fibrosis may be reached after months, in contrast to the previously reported several years. We hope that these genetic mutations can be further studied in human models to describe the genetics behind CRMO.
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Affiliation(s)
- Eric Chang
- Pathology, Children Hospital of Michigan, Detroit MI, USA
| | | | - Nadeen Zaiat
- Pathology, Children Hospital of Michigan, Detroit MI, USA
| | - Eman Sallam
- Pathology, Children Hospital of Michigan, Detroit MI, USA
| | - Abdul Hanan
- Pathology, Children Hospital of Michigan, Detroit MI, USA
| | - Scott Baker
- Pathology, Children Hospital of Michigan, Detroit MI, USA
| | | | - Janet Poulik
- Pathology, Children Hospital of Michigan, Detroit MI, USA
| | - Ereny Demian
- Pathology, Children Hospital of Michigan, Detroit MI, USA
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Ravi S, Dey A, McKay D, Sharma P, Pillay S. The value of multi-modality imaging in establishing the diagnosis of Adolescent SAPHO. Radiol Case Rep 2022; 17:1236-1245. [PMID: 35198085 PMCID: PMC8844709 DOI: 10.1016/j.radcr.2022.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022] Open
Abstract
SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is a rare chronic autoinflammatory disorder of unknown etiology. Radiological investigation, including the use of magnetic resonance imaging and nuclear medicine is pivotal to the diagnosis of SAPHO syndrome. We present a case of a 15-year-old male diagnosed with SAPHO syndrome displaying the classic diagnostic findings of this condition on bone scan and magnetic resonance imaging.
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8
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Zhao M, Wu D, Yu K, Shen M. Clinical and Genetic Features of Chinese Adult Patients With Chronic Non-Bacterial Osteomyelitis: A Single Center Report. Front Immunol 2022; 13:860646. [PMID: 35422809 PMCID: PMC9002012 DOI: 10.3389/fimmu.2022.860646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/07/2022] [Indexed: 12/21/2022] Open
Abstract
Objectives Chronic non-bacterial osteomyelitis (CNO) is a rare polygenic autoinflammatory bone disease. We aimed to characterize the clinical manifestations and gene variants of Chinese adult patients with CNO. Methods By reviewing data of all CNO patients being diagnosed and followed up at the Center for Adult Autoinflammation Diseases, Department of Rheumatology, Peking Union Medical College Hospital, clinical and genetic features of these patients were evaluated and concluded. Results The median age of disease onset was 19 (6-64) years old, and adult-onset was observed in 6 (60%) patients. The mean time of diagnosis delay was 92 ± 78 months. The common symptoms were bone pain (10, 100%), fever (9, 90%), and arthritis (6, 60%). In total, there were 54 skeletal lesions, and each patient had no less than 2 lesions. The most frequently affected sites included lower limbs (20.5%), mandible, vertebrae and pelvis (17.5%, separately). Variants of 4 genes were detected in our study including COL1A1, PSTPIP1, LRP5 and CLCN7. In seven patients who were treated with combination therapy containing tumor necrosis factor (TNF) α inhibitors, five (55.6%) had a complete response and 2 (44.4%) had a partial response. Conclusion This is the first and largest case series of CNO in the Chinese adult patients. Four novel genetic mutations potentially associated with CNO were identified. Notably, CNO should be considered in the differential diagnosis of adult patients with long disease course and recurrent multifocal osteomyelitis of unknown cause, and these patients might benefit from combination therapy containing TNFα inhibitors.
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Affiliation(s)
- Mengzhu Zhao
- Department of Rheumatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Di Wu
- Department of Rheumatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Keyi Yu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Min Shen
- Department of Rheumatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Chronic Osteomyelitis With Proliferative Periostitis of the Mandible in a Child: Report of a Case Managed by Immunosuppressive Treatment. Pediatr Infect Dis J 2022; 41:e10-e15. [PMID: 34711782 DOI: 10.1097/inf.0000000000003368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Osteomyelitis with proliferative periostitis is a relatively uncommon inflammatory condition of the jaws, mainly characterized by periosteal formation of reactive bone. It primarily affects children and adolescences, also referred to as Garre's osteomyelitis, more frequently involving the molar region of the mandible. Cases lacking an obvious source of infection may have an immunologically mediated etiopathogenesis, falling under the spectrum of primary chronic osteomyelitis or chronic recurrent multifocal osteomyelitis (CRMO). CASE REPORT Herein, we present a case of chronic osteomyelitis in a 6.5-year-old girl, who suffered from recurrent painful episodes of swelling of the mandible for the last 2 years, previously requiring hospitalization and administration of intravenous (IV) antibiotics and NSAIDs with limited responsiveness. The biopsy showed features consistent with osteomyelitis with proliferative periostitis. The patient was initially managed with an IV combination antibiotic regimen with only partial improvement. The possibility of an autoimmune mechanism in the context of primary chronic osteomyelitis or CRMO was considered, and immunosuppressive therapy (TNF inhibitor etanercept along with corticosteroids and methotrexate) was administered, resulting in clinical resolution. CONCLUSIONS Osteomyelitis and its childhood variants are relatively rare and their management presents several challenges. Although typically treated with administration of antibiotics, possibly along with surgical intervention, other treatment modalities may be necessary for resilient and persistent cases. In a subset of cases, especially in the absence of local infectious factors, immunologically mediated mechanisms may play an important role and appropriate immunosuppressive therapy may be effective.
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Shah A, Rosenkranz M, Thapa M. Review of spinal involvement in Chronic recurrent multifocal osteomyelitis (CRMO): What radiologists need to know about CRMO and its imitators. Clin Imaging 2021; 81:122-135. [PMID: 34710802 DOI: 10.1016/j.clinimag.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 11/03/2022]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a distinct disease entity of unknown etiology primarily affecting children and adolescents. It is an autoinflammatory process that typically affects multiple bones with a waxing and waning course. About one third of the patients diagnosed with CRMO have spinal involvement which can lead to long term morbidity. The clinical presentation and imaging features of CRMO involving the spine are nonspecific and can mimic other disease processes like infection or malignancy. Since imaging plays a very important role in the diagnosis and management of CRMO, we intend to highlight various imaging patterns of spinal CRMO alongside its clinical features and briefly discuss its imitators, management and outcomes.
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Affiliation(s)
- Amisha Shah
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Margalit Rosenkranz
- Department of Rheumatology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America
| | - Mahesh Thapa
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, United States of America
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Chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO). J Transl Autoimmun 2021; 4:100095. [PMID: 33870159 PMCID: PMC8040271 DOI: 10.1016/j.jtauto.2021.100095] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/22/2021] [Accepted: 03/10/2021] [Indexed: 01/01/2023] Open
Abstract
Chronic nonbacterial osteomyelitis (CNO) is an inflammatory bone disorder that most frequently affects children and adolescents. Chronic recurrent multifocal osteomyelitis (CRMO) is a severe form of CNO, usually characterized by symmetrical inflammatory bone lesions and its waxing and waning character. Sometimes severe and chronic pain can significantly affect the quality of life and psychosocial development of individuals affected. In the absence of prospectively tested and widely accepted diagnostic criteria or disease biomarkers, CNO remains a diagnosis of exclusion, and infections, malignancy and other differentials require consideration (1). The pathophysiology of CNO is not fully understood, but imbalanced cytokine expression and increased inflammasome activation in monocytes from CNO patients contribute to a pro-inflammatory phenotype that contributes to bone inflammation (2). Currently, no medications are licensed for the use in CNO. Most patients show at least some response to nonsteroidal anti-inflammatory drugs, others require more aggressive treatment that can include corticosteroids, cytokine-blocking agents and/or bisphosphonates (3). While under the care of an experienced team and sufficient treatment, the prognosis is good, but some patients will develop sequalae which can include vertebral compression fractures (1). CNO is an autoinflammatory bone disorder mostly affecting children and adolescents. Dysregulated cytokine expression and pathological activation of inflammasomes play a central role. Treatment is based on experience from case series and expert consensus treatment plans. Understanding the exact molecular pathophysiology will allow patient stratification and individualized treatment.
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12
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Nedley A, Ramos O, Zuppan C, Wongworawat YC, Danisa O. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome presenting with a cervical vertebral fracture: A case report. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 5:100050. [PMID: 35141616 PMCID: PMC8820063 DOI: 10.1016/j.xnsj.2021.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Allen Nedley
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, United States
| | - Omar Ramos
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, United States
- Corresponding author.
| | - Craig Zuppan
- Department of Pathology, Loma Linda University, Loma Linda, CA, United States
| | - Yan C. Wongworawat
- Department of Pathology, Loma Linda University, Loma Linda, CA, United States
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, United States
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Campbell V, Jackson P, Devereux C. A pediatric case of SAPHO-CNO syndrome with clinical correlation between cutaneous and osteoarticular features. Eur J Rheumatol 2020; 7:eurjrheum.2020.20026. [PMID: 32910763 PMCID: PMC7574761 DOI: 10.5152/eurjrheum.2020.20026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/08/2020] [Indexed: 11/22/2022] Open
Abstract
Synovitis acne pustulosis hyperostosis osteitis (SAPHO) and chronic nonbacterial osteomyelitis (CNO) represent overlapping osteoarticular autoinflammatory syndromes, with a minority displaying neutrophilic skin features at the time of diagnosis. The pathophysiological link and chronological timeframe between skin and osteoarticular findings remain ambiguous, which in turn can manifest in diagnostic delay. We present a rare pediatric case of SAPHO-CNO with a clear association between cutaneous and osteoarticular symptoms, treated with nonsteroidal anti-inflammatory medications, corticosteroids, and intravenous pamidronate. By raising physician awareness of these syndromes, we hope that appropriate management will be initiated in a more timely fashion avoiding unnecessary investigations and treatment.
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Affiliation(s)
- V. Campbell
- Department of Dermatology, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - P. Jackson
- Department of Paediatric Rheumatology, Musgrave Park Hospital, Belfast, Northern Ireland, UK
| | - C. Devereux
- Department of Dermatology, Antrim Area Hospital, Antrim, Northern Ireland, UK
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14
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From bone to skin. J Paediatr Child Health 2020; 56:1483-1484. [PMID: 32949199 DOI: 10.1111/jpc.2_14839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/28/2022]
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15
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Katsuo K, Honda T, Kaku Y, Nishitani-Isa M, Honda Y, Yasumi T, Kabashima K. Pyoderma gangrenosum associated with chronic recurrent multifocal osteomyelitis as a possible paradoxical reaction to anti-tumor necrosis factor-α therapy. J Dermatol 2020; 47:e283-e284. [PMID: 32515066 DOI: 10.1111/1346-8138.15417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kosuke Katsuo
- Departments of, Department of, Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tetsuya Honda
- Departments of, Department of, Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yo Kaku
- Departments of, Department of, Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Yoshitaka Honda
- Department of, Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiro Yasumi
- Department of, Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Kabashima
- Departments of, Department of, Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Assmann G, Köhm M, Schuster V, Behrens F, Mössner R, Magnolo N, Oji V, Burkhardt H, Hüffmeier U. Genetic variants in FBLIM1 gene do not contribute to SAPHO syndrome and chronic recurrent multifocal osteomyelitis in typical patient groups. BMC MEDICAL GENETICS 2020; 21:102. [PMID: 32397996 PMCID: PMC7216525 DOI: 10.1186/s12881-020-01037-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Abstract
Background Syndrome of synovitis acne pustulosis hyperostosis osteitis (SAPHO) and chronic recurrent multifocal osteomyelitis (CRMO) present two diseases of a dermatologic and rheumatologic spectrum that are variable in manifestation und therapeutic response. Genetic risk factors have long been assumed in both diseases, but no single reliable factor has been identified yet. Therefore, we aimed to clinically characterize a patient group with syndrome of synovitis acne pustulosis hyperostosis osteitis (SAPHO) (n = 47) and chronic recurrent multifocal osteomyelitis (CRMO)/ chronic non-bacterial osteomyelitis (CNO) (n = 9) and analyze a CRMO candidate gene. Methods Clinical data of all patients were collected and assessed for different combinations of clinical symptoms. SAPHO patients were grouped into categories according to the acronym; disease-contribution by pathogens was evaluated. We sequenced coding exons of FBLIM1. Results Palmoplantar pustular psoriasis (PPP) was the most common skin manifestation in CRMO/CNO and SAPHO patients; most SAPHO patients had sterno-costo-clavicular hyperostosis. The most common clinical category of the acronym was S_PHO (n = 26). Lack of pathogen detection from bone biopsies was more common than microbial isolation. We did not identify autosomal-recessive FBLIM1 variants. Conclusions S_PHO is the most common combination of symptoms of its acronym. Genetic analyses of FBLIM1 did not provide evidence that this gene is relevant in our patient group. Our study indicates the need to elucidate SAPHO’s and CRMO/CNO’s pathogenesis.
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Affiliation(s)
- Gunter Assmann
- Department of Internal Medicine I, José-Carreras Centrum for Immuno- and Gene Therapy, University of Saarland Medical School, /Saar, Homburg, Germany
| | - Michaela Köhm
- Division of Rheumatology and IME, Fraunhofer Institute, Branch for Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Volker Schuster
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Frank Behrens
- Division of Rheumatology and IME, Fraunhofer Institute, Branch for Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Rotraut Mössner
- Department of Dermatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Nina Magnolo
- Department of Dermatology, University of Münster, Münster, Germany
| | - Vinzenz Oji
- Department of Dermatology, University of Münster, Münster, Germany
| | - Harald Burkhardt
- Division of Rheumatology and IME, Fraunhofer Institute, Branch for Translational Medicine and Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Ulrike Hüffmeier
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 10, 91054, Erlangen, Germany.
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Meinzer U, See H, Bader-Meunier B, Juillard C, Duquesne A, Melki I, Faye A, Bourrat E. Clinical Characteristics of Acne Fulminans Associated With Chronic Nonbacterial Osteomyelitis in Pediatric Patients. J Rheumatol 2020; 47:1793-1799. [PMID: 32238518 DOI: 10.3899/jrheum.191232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Acne fulminans (AF) is a rare, explosive systemic form of acne. Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO) is a primarily pediatric autoinflammatory disorder characterized by sterile osteolytic bone lesions. Concomitant occurrence of CNO/CRMO and AF is very rare, and little is known about the epidemiological and clinical particularities of this association. The aim of this retrospective observational study was to describe the characteristics of pediatric patients with CNO/CRMO associated to AF. METHODS Electronic mailing lists of French medical societies were used to call for patients with CNO/CRMO and AF. A search for published patients with CNO/CRMO and AF was performed by screening PubMed. RESULTS We identified 5 original patients and 10 patients from the literature. All patients were adolescent boys. Mean age at disease onset was 14.8 years. Nine of 15 patients had received isotretinoin before the sudden onset of AF. Osteoarticular symptoms appeared within < 1-3 months after the onset of AF. The mean numbers of clinical and radiological bone lesions were 3.6 and 5.6, respectively. The percentages of patients with involvement of vertebrae, pelvis, chest, and cranial were 40%, 40%, 33.3%, and 6.6%, respectively. Arthritis was observed in 69.2% of patients and sacroiliac arthritis in 46.2%. CONCLUSION CNO/CRMO associated to AF occurs predominantly in male adolescents and is characterized by frequent involvement of the axial skeleton and arthritis. Epidemiological and clinical features of these patients differ from general CNO/CRMO cohorts. Clinical management requires careful handling of isotretinoin doses.
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Affiliation(s)
- Ulrich Meinzer
- U. Meinzer, MD, PhD, Department of General Pediatrics, Pediatric Infectious Diseases and Pediatric Rheumatology, Hôpital Robert Debré, AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), and Université Paris Diderot-Sorbonne Paris-Cité, INSERM, UMR1149, and Biology and Genetics of Bacterial Cell Wall Unit, Institut Pasteur, Paris;
| | - Helene See
- H. See, MD, I. Melki, MD, PhD, Department of General Pediatrics, Pediatric Infectious Diseases and Pediatric Rheumatology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Paris
| | - Brigitte Bader-Meunier
- B. Bader-Meunier, MD, Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Paris
| | - Caroline Juillard
- C. Juillard, MD, Department of Dermatology, Hôpital Saint-Louis, Paris
| | - Agnes Duquesne
- A. Duquesne, MD, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon
| | - Isabelle Melki
- H. See, MD, I. Melki, MD, PhD, Department of General Pediatrics, Pediatric Infectious Diseases and Pediatric Rheumatology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Paris
| | - Albert Faye
- A. Faye, MD, PhD, Department of General Pediatrics, Pediatric Infectious Diseases and Pediatric Rheumatology, Hôpital Robert Debré, AP-HP, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), and Biology and Genetics of Bacterial Cell Wall Unit, Institut Pasteur, Paris
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18
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Huhn CK, Schauer F, Schempp CM, Venhoff N, Finzel S. Hautentzündungen mit Arthritis, Synovitis und Enthesitis. Teil 1: Psoriasisarthritis, SAPHO-Syndrom, Morbus Still, Morbus Behçet. J Dtsch Dermatol Ges 2019; 17:43-66. [PMID: 30615292 DOI: 10.1111/ddg.13742_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Christian K Huhn
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg
| | - Franziska Schauer
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg
| | - Christoph M Schempp
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg
| | - Nils Venhoff
- Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Stephanie Finzel
- Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
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Znajdek M, Gazda A, Gietka P, Wysmołek M, Sudoł-Szopińska I. Juvenile spondyloarthritis and chronic recurrent multifocal osteomyelitis overlap syndrome in a 16-year-old adolescent. A case report and literature review. J Ultrason 2019; 19:152-157. [PMID: 31355588 PMCID: PMC6750310 DOI: 10.15557/jou.2019.0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/12/2019] [Indexed: 01/22/2023] Open
Abstract
The authors present a very rare case of juvenile spondyloarthritis and chronic recurrent multifocal osteomyelitis overlap syndrome in a 16-year-old girl and discuss diagnostic difficulties associated with this case. Juvenile spondyloarthropathies are a type of rheumatic diseases characterized by non-symmetrical peripheral arthritis and enthesitis as well as by spondylitis. Chronic recurrent multifocal osteomyelitis is a rare, possibly autoimmune disease found primarily in children and adolescents. The disease is characterized by bone marrow inflammation and the presence of lytic and sclerotic lesions. Diagnostic imaging plays a key role in the identification of both diseases. The primary modality is X-ray; however, currently, magnetic resonance imaging and ultrasound are increasingly important. A correct early diagnosis allows one to start appropriate treatment to reduce the consequences of these diseases.
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Affiliation(s)
- Michał Znajdek
- Department of Radiology , National Institute of Geriatrics , Rheumatology and Rehabilitation , Warsaw , Poland
| | - Agnieszka Gazda
- Department of Pediatrics , National Institute of Geriatrics , Rheumatology and Rehabilitation , Warsaw , Poland
| | - Piotr Gietka
- Department of Pediatrics , National Institute of Geriatrics , Rheumatology and Rehabilitation , Warsaw , Poland
| | - Marta Wysmołek
- Department and Outpatient Clinic of Rheumatology , National Institute of Geriatrics , Rheumatology and Rehabilitation , Warsaw , Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology , National Institute of Geriatrics , Rheumatology and Rehabilitation , Warsaw , Poland ; Department of Medical Imaging , Second Faculty of Medicine , Medical University of Warsaw , Warsaw , Poland
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Diagnostic and therapeutic difficulties in a patient with chronic recurrent multifocal osteomyelitis coexisting with ulcerative colitis. Reumatologia 2019; 57:109-116. [PMID: 31130750 PMCID: PMC6532115 DOI: 10.5114/reum.2019.84817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/25/2019] [Indexed: 11/25/2022] Open
Abstract
Chronic non-bacterial osteomyelitis (CNO) is a rare autoinflammatory bone disease, affecting mainly children. CNO includes a broad clinical spectrum of symptoms and signs, from mild, limited in time, unifocal osteitis to severe, chronic, active or recurrent, multifocal osteomyelitis. In 2014 diagnostic criteria for CNO were proposed, the Bristol Criteria for the Diagnosis of Chronic Non-bacterial Osteitis, taking into account the clinical picture – location and number of inflammatory foci, characteristic changes on radiological examination (X-ray) and magnetic resonance imaging (MRI), C-reactive protein (CRP) concentration, and changes in bone biopsy. The paper presents the case of a four-year-old boy in whom the diagnosis of multifocal osteomyelitis coexisting with ulcerative colitis was established. Attention was paid to the long diagnostic process of the disease, requiring in the first place differentiation with proliferative diseases. The choice of drugs was also a significant problem in the patient described in view of both intolerance of individual preparations and their ineffectiveness.
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21
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Buch K, Thuesen ACB, Brøns C, Schwarz P. Chronic Non-bacterial Osteomyelitis: A Review. Calcif Tissue Int 2019; 104:544-553. [PMID: 30456556 DOI: 10.1007/s00223-018-0495-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
Chronic non-bacterial osteomyelitis (CNO) is a rare auto-inflammatory bone disorder, with a prevalence of around one in a million patients. In the more severe form, it is referred to as chronic recurrent multifocal osteomyelitis (CRMO). We present the current knowledge on epidemiology, pathophysiology as well as diagnostic options and treatment regimens. CNO/CRMO most commonly affects children and lesions are often seen in the metaphyseal plates of the long bones, but cases have been described affecting all age groups as well as lesions in almost every bone. It is, therefore, a disease that clinicians can encounter in many different settings. Diagnosis is mainly a matter of exclusion from differential diagnoses such as bacterial osteomyelitis and cancer. Magnetic resonance imaging is the best radiological method for diagnosis coupled with a low-grade inflammation and a history of recurring episodes. Treatment is based on case reports and consists of alleviating symptoms with non-steroidal anti-inflammatory drugs since the disease is often self-limiting. Recently, more active treatments using either bisphosphonates or biological treatment are becoming more common, to prevent long term bone damage. In general, due to its rarity, much remains unclear regarding CNO/CRMO. We review the known literature on CNO/CRMO and propose areas of interest as well as possible ways to make current diagnostic criteria more detailed. We also find unifocal cases of the jaw to be a possible sub-type that may need its own set of criteria.
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Affiliation(s)
- Kristian Buch
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Anne Cathrine Baun Thuesen
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Charlotte Brøns
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Peter Schwarz
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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Huhn CK, Schauer F, Schempp CM, Venhoff N, Finzel S. Skin inflammation associated with arthritis, synovitis and enthesitis. Part 1: psoriatic arthritis, SAPHO syndrome, Still's disease, Behçet's disease. J Dtsch Dermatol Ges 2019; 17:43-64. [DOI: 10.1111/ddg.13742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Christian K. Huhn
- Department of Dermatology and Venereology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
| | - Franziska Schauer
- Department of Dermatology and Venereology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
| | - Christoph M. Schempp
- Department of Dermatology and Venereology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
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Osteoarticular Infections Following Open or Penetrating Trauma in Children in the Post-Community-Acquired Methicillin-resistant Staphylococcus aureus Era: The Impact of Enterobacter cloacae. Pediatr Infect Dis J 2018; 37:1204-1210. [PMID: 29570590 PMCID: PMC6150854 DOI: 10.1097/inf.0000000000001991] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most cases of pediatric osteoarticular infections (OAIs) are hematogenous in nature and caused by Staphylococcus aureus. OAI in children can also occur through direct inoculation of microorganisms secondary to penetrating or open trauma. No studies in the United States have evaluated the microbiology or outcomes of trauma-related OAI (TROAI) in children in the era of community-acquired methicillin-resistant S. aureus (CA-MRSA). METHODS Cases were identified from the inpatient infectious diseases consultation database at Texas Children's Hospital from January 2011 to December 2016. TROAI cases were those in which OAI developed following a clear history of penetrating trauma, open fracture, crush injury or traumatic amputation. Only cases with radiographic evidence of bone abscess, gross appearance of infection at the time of surgery and/or positive cultures from bone or joint were included. Complications included recurrence of infection, pathologic fracture or chronic osteomyelitis. RESULTS During the study period, 692 consultations for OAI were performed, with 34 meeting inclusion criteria. In 68%, at least 1 organism was isolated, and the most commonly isolated organisms were S. aureus (32% overall, 21% MRSA) and Enterobacter cloacae (24%). Polymicrobial infections occurred in 38% of patients. Eighty-five percentage of patients had at least 1 surgical procedure, and 38% underwent ≥ 2 procedures. Eighty-two percentage of patients were discharged on oral therapy. Complications developed in 15% of patients and were more commonly associated with E. cloacae (80% vs. 14%, P = 0.007) and fungi (P = 0.03). CONCLUSION TROAI are relatively uncommon in children but cause significant morbidity. While MRSA contributes substantially to TROAI, the highly diverse microbiology emphasizes the importance of obtaining cultures for microbiologic diagnosis and management. Clinicians should be aware of the frequency of E. cloacae in TROAI and its high risk for sequelae.
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Snipaitiene A, Sileikiene R, Klimaite J, Jasinskiene E, Uktveris R, Jankauskaite L. Unusual case of chronic recurrent multifocal osteomyelitis. Pediatr Rheumatol Online J 2018; 16:49. [PMID: 30053822 PMCID: PMC6062932 DOI: 10.1186/s12969-018-0267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/19/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic recurrent multifocal osteomyelitis (CRMO) is a rare auto-inflammatory bone disorder that primarily affects young girls, with a mean age of 10 years at onset. Generally, it is a self-limited disease. However, recent data indicate that more than 50% of patients have a chronic persistent disease and about 20% a recurring course of this condition. Also, there are more cases reported with associated auto-inflammatory and autoimmune diseases. In this case report, we present a rare case of sporadic CRMO in which the patient eventually developed C-ANCA (cytoplasmic anti-neutrophil cytoplasmic antibodies)-associated renal vasculitis and hyperparathyroidism. CASE PRESENTATION A 14 year old female patient was brought to the emergency department with a sudden onset of left leg pain and oedema. After physical evaluation and initial investigation, she was diagnosed with femoral and pelvic deep vein thrombosis. While searching for possible thrombosis causes, osteomyelitis of the left leg was identified. Additional CT and MRI scans hinted at the CRMO diagnosis. Due to the multifocal lesions of CRMO, endocrinological evaluation of calcium metabolism was done. The results showed signs of hyperparathyroidism with severe hypocalcaemia. Moreover, when kidney damage occurred and progressed, a kidney biopsy was performed, revealing a C-ANCA associated renal vasculitis. Treatment was started with cyclophosphamide and prednisolone according to the renal vasculitis management protocol. Severe metabolic disturbances and hyperparathyroidism were treated with alfacalcidol, calcium and magnesium supplements. Secondary glomerulonephritis (GN) associated hypertension was treated with ACE (angiotenzine converting enzyme) inhibitors. Anticoagulants were prescribed for deep vein thrombosis. After 1.5 years of treatment, the patient is free of complaints. All microelement and parathormone levels are within normal range. Kidney function is now normal. To date, there are no clinical or diagnostic signs of deep vein thrombosis. CONCLUSIONS This case report presents a complex immunodysregulatory disorder with both auto-inflammatory and autoimmune processes. We hypothesize that the long lasting active inflammation of CRMO may induce an autoimmune response and result in concomitant diseases like C-ANCA-associated vasculitis in our patient. Any potential specific pathogenic relationships between these two rare pathologies may need to be further studied. Furthermore, there is a lack of specific biomarkers for CRMO and more studies are necessary to identify CRMO's characteristic patterns and how to best monitor disease progression.
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Affiliation(s)
- Ausra Snipaitiene
- The Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania. .,The Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu g. 2, Kaunas, Lithuania.
| | - Rima Sileikiene
- 0000 0004 0432 6841grid.45083.3aThe Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania ,0000 0004 0575 8750grid.48349.32The Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu g. 2, Kaunas, Lithuania
| | - Justina Klimaite
- 0000 0004 0575 8750grid.48349.32The Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu g. 2, Kaunas, Lithuania
| | - Edita Jasinskiene
- 0000 0004 0432 6841grid.45083.3aThe Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania ,0000 0004 0575 8750grid.48349.32The Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu g. 2, Kaunas, Lithuania
| | - Rimantas Uktveris
- 0000 0004 0432 6841grid.45083.3aThe Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania ,0000 0004 0575 8750grid.48349.32The Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu g. 2, Kaunas, Lithuania
| | - Lina Jankauskaite
- 0000 0004 0432 6841grid.45083.3aThe Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania ,0000 0004 0575 8750grid.48349.32The Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu g. 2, Kaunas, Lithuania
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25
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Girschick H, Finetti M, Orlando F, Schalm S, Insalaco A, Ganser G, Nielsen S, Herlin T, Koné-Paut I, Martino S, Cattalini M, Anton J, Mohammed Al-Mayouf S, Hofer M, Quartier P, Boros C, Kuemmerle-Deschner J, Pires Marafon D, Alessio M, Schwarz T, Ruperto N, Martini A, Jansson A, Gattorno M. The multifaceted presentation of chronic recurrent multifocal osteomyelitis: a series of 486 cases from the Eurofever international registry. Rheumatology (Oxford) 2018; 57:1203-1211. [PMID: 29596638 DOI: 10.1093/rheumatology/key058] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 02/08/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Chronic non-bacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder characterized by sterile bone osteolytic lesions. The aim of this study was to evaluate the demographic data and clinical, instrumental and therapeutic features at baseline in a large series of CNO/CRMO patients enrolled in the Eurofever registry. METHODS A web-based registry collected retrospective data on patients affected by CRMO/CNO. Both paediatric and adult centres were involved. RESULTS Complete baseline information on 486 patients was available (176 male, 310 female). The mean age of onset was 9.9 years. Adult onset (>18 years of age) was observed in 31 (6.3%) patients. The mean time from disease onset to final diagnosis was 1 year (range 0-15). MRI was performed at baseline in 426 patients (88%), revealing a mean number of 4.1 lesions. More frequent manifestations not directly related to bone involvement were myalgia (12%), mucocutaneous manifestations (5% acne, 5% palmoplantar pustulosis, 4% psoriasis, 3% papulopustular lesions, 2% urticarial rash) and gastrointestinal symptoms (8%). A total of 361 patients have been treated with NSAIDs, 112 with glucocorticoids, 61 with bisphosphonates, 58 with MTX, 47 with SSZ, 26 with anti-TNF and 4 with anakinra, with a variable response. CONCLUSION This is the largest reported case series of CNO patients, showing that the range of associated clinical manifestations is rather heterogeneous. The study confirms that the disease usually presents with an early teenage onset, but it may also occur in adults, even in the absence of mucocutaneous manifestations.
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Affiliation(s)
- Hermann Girschick
- Paediatric and Adolescent Medicine, Perinatal Centre, Clinic for Paediatric and Adolescent Medicine, Vivantes Klinikum Berlin, Germany
- Section of Paediatric Rheumatology, Children's Hospital, Osteology, Immunology and Infectious Diseases, University of Wuerzburg, Germany
| | - Martina Finetti
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Genoa
| | - Francesca Orlando
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Genoa
- Dipartimento di Pediatria, Università di Napoli Federico II, Naples
| | - Susanne Schalm
- Klinikum der Universität, von Haunersches Kinderspital, Munich, Germany
| | | | - Gerd Ganser
- Clinic of Paediatric Rheumatology, St. Josef-Stift Hospital, Sendenhorst, Germany
| | - Susan Nielsen
- Paediatric Rheumatology, Rigshospitalet, Copenhagen, Denmark
| | - Troels Herlin
- Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark
| | - Isabelle Koné-Paut
- Service de rhumatologie pédiatrique, Le Kremlin-Bicêtre University Hospital, Paris-Sud University, Paris, France
| | - Silvana Martino
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, University of Torino, Torino, Italy
| | - Marco Cattalini
- Unita di Immunologia e Reumatologia Pediatrica, Clinica Pediatrica dell'Universita di Brescia, Spedali Civili, Brescia, Italy
| | - Jordi Anton
- Paediatric Rheumatology, Hospital Sant Joan de Déu. Universitat de Barcelona, Spain
| | | | - Michael Hofer
- Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Pierre Quartier
- IMAGINE Institute, Paris-Descartes University, Necker Children's Hospital, Paris, France
| | - Christina Boros
- Paediatrics and Reproductive Health, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | | | | | - Maria Alessio
- Dipartimento di Pediatria, Università di Napoli Federico II, Naples
| | - Tobias Schwarz
- Section of Paediatric Rheumatology, Children's Hospital, Osteology, Immunology and Infectious Diseases, University of Wuerzburg, Germany
- Clinic of Paediatric Rheumatology, St. Josef-Stift Hospital, Sendenhorst, Germany
| | | | - Alberto Martini
- Direzione Scientifica, Istituto Giannina Gaslini, Genoa, Italy
| | - Annette Jansson
- Klinikum der Universität, von Haunersches Kinderspital, Munich, Germany
| | - Marco Gattorno
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Genoa
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Abstract
BACKGROUND Chronic recurrent multifocal osteomyelitis (CRMO) is a rare auto-inflammatory disease of the bone. It tends to be multifocal and usually the symptoms tend to run for months and years before diagnosis is usually made. The objective of our study was to understand the clinical presentation and short-term response to treatment of CRMO patients. MATERIALS AND METHODS A retrospective analysis of patients diagnosed with CRMO between 2011 and 2016 was done. Case records of these were retrospectively reviewed for clinical features, investigations and treatment received. RESULTS Six patients were diagnosed with CRMO. The median age of onset and time to diagnosis from onset of symptoms was 8 and 3.5 years respectively. Lower limb bones were the most commonly involved. CONCLUSIONS There is significant delay in diagnosis of CRMO and this could be because of a lack of awareness of this condition amongst clinicians. Our case series with only male affection is rather unique as compared to other case series reported in medical literature which tend to have more female predilection. Pain with or without swelling was the most common symptom. Most of patients responded to combination therapy.
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Affiliation(s)
- Anand Prahalad Rao
- Pediatric Rheumatology Clinic, Manipal Hospital and Vijaya Children's Clinic, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Pooja Prakash Mallya
- Department of Pediatric Hemato-Oncology, Mazumdar Shaw Cancer Center, Bengaluru, Karnataka, India,Address for correspondence: Dr. Pooja Prakash Mallya, 46, 2nd Cross, Panduranga Nagar, Bannerghatta Road, Bengaluru - 560 076, Karnataka, India. E-mail:
| | - Shashi Ranjani
- Department of Pediatric Hemato-Oncology, Healthcare Global Enterprises, Bengaluru, Karnataka, India
| | - Jyothi Raghuram
- Pediatric Rheumatology Clinic, Indira Gandhi Institute of Child Health and Columbia Asia Hospital, Bengaluru, Karnataka, India
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Hofmann SR, Kapplusch F, Mäbert K, Hedrich CM. The molecular pathophysiology of chronic non-bacterial osteomyelitis (CNO)-a systematic review. Mol Cell Pediatr 2017; 4:7. [PMID: 28685269 PMCID: PMC5500598 DOI: 10.1186/s40348-017-0073-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/27/2017] [Indexed: 02/07/2023] Open
Abstract
Chronic non-bacterial osteomyelitis (CNO) belongs to the growing spectrum of autoinflammatory diseases and primarily affects the skeletal system. Peak onset ranges between 7 and 12 years of age. The clinical spectrum of CNO covers sometimes asymptomatic inflammation of single bones at the one end and chronically active or recurrent multifocal osteitis at the other.Despite the intense scientific efforts, the exact molecular mechanisms of CNO remain unknown. Recent data suggest CNO as a genetically complex disorder with dysregulated TLR4/MAPK/inflammasome signaling cascades resulting in an imbalance between pro- and anti-inflammatory cytokine expression, leading to osteoclast activation and osteolytic lesions.In this manuscript, the current understanding of molecular patho-mechanisms in CNO will be discussed.
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Affiliation(s)
- Sigrun Ruth Hofmann
- Pediatric Rheumatology and Immunology, Children's Hospital Dresden, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Franz Kapplusch
- Pediatric Rheumatology and Immunology, Children's Hospital Dresden, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Katrin Mäbert
- Pediatric Rheumatology and Immunology, Children's Hospital Dresden, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Christian Michael Hedrich
- Pediatric Rheumatology and Immunology, Children's Hospital Dresden, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
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28
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Schaub S, Sirkis HM, Kay J. Imaging for Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome. Rheum Dis Clin North Am 2017; 42:695-710. [PMID: 27742022 DOI: 10.1016/j.rdc.2016.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multifocal osteomyelitis and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome constitute a spectrum of disease that includes inflammatory bone lesions and dermatologic findings. Radiographic features resemble those of the spondyloarthropathies with anterior chest wall involvement. Early radiographic findings are osteodestructive with lytic lesions. Bone scintigraphy of the sternoclavicular region classically yields a 'bull's head' pattern of radionuclide uptake. Magnetic resonance imaging (MRI) can demonstrate corner lesions of vertebral bodies. Ultrasound often reveals peripheral enthesitis. Late radiographic features are usually osteoproliferative. PET/CT can identify chronic lesions. Differential diagnostic considerations include osteomyelitis and malignancy, which often prompt bone biopsy.
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Affiliation(s)
- Steven Schaub
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605, USA
| | - Hartley M Sirkis
- Division of Musculoskeletal Imaging, Department of Radiology, UMass Memorial Medical Center and University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605, USA.
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Moreira A, Torres B, Peruzzo J, Mota A, Eyerich K, Ring J. Skin symptoms as diagnostic clue for autoinflammatory diseases. An Bras Dermatol 2017; 92:72-80. [PMID: 28225960 PMCID: PMC5312182 DOI: 10.1590/abd1806-4841.20175208] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/12/2015] [Indexed: 12/18/2022] Open
Abstract
Autoinflammatory disorders are immune-mediated diseases with increased production of inflammatory cytokines and absence of detectable autoantibodies. They course with recurrent episodes of systemic inflammation and fever is the most common symptom. Cutaneous manifestations are prevalent and important to diagnosis and early treatment of the syndromes. The purpose of this review is to emphasize to dermatologists the skin symptoms present in these syndromes in order to provide their early diagnosis.
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Affiliation(s)
- Alvaro Moreira
- Department of Dermatology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Barbara Torres
- Department of Dermatology and Venereology, Faculty of Medicine of the University of Porto, Porto, Portugal.,Unidade de Saúde Familiar Vale de Sorraia, Coruche, Portugal
| | - Juliano Peruzzo
- Faculdade de Medicina - Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil
| | - Alberto Mota
- Department of Dermatology and Venereology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Kilian Eyerich
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Johannes Ring
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.,Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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Hameed F, Steer H. A case of bronchiolitis obliterans organising pneumonia associated with SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome. BMJ Case Rep 2017; 2017:bcr-2017-219822. [PMID: 28765183 DOI: 10.1136/bcr-2017-219822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 57-year-old woman with SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome presented with recurrent episodes of pneumonia. She was treated with multiple courses of antibiotics with no success. The transbronchial biopsy undertaken via bronchoscopy revealed organising pneumonia (OP). She was treated with steroids and responded well with full clinical recovery and normalisation of her chest X-ray.To our knowledge, this is the first reported case of OP in association with SAPHO syndrome. This case report highlights the importance of considering OP in patients with SAPHO syndrome who present with chest infection.
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Affiliation(s)
- Fawad Hameed
- Department of Respiratory Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Henry Steer
- Department of Respiratory Medicine, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
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31
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Cianci F, Zoli A, Gremese E, Ferraccioli G. Clinical heterogeneity of SAPHO syndrome: challenging diagnose and treatment. Clin Rheumatol 2017; 36:2151-2158. [PMID: 28725947 DOI: 10.1007/s10067-017-3751-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 12/11/2022]
Abstract
Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a rare disease which is often misdiagnosed and under-recognized, because of its peculiar and heterogeneous clinical presentation. Its main features consist of cutaneous and osteoarticular manifestations, the latter affecting more often the anterior chest wall and having typical radiologic findings. There are no validated diagnostic criteria for SAPHO and no guidelines for treatment, due mainly to its rarity; as a consequence, therapy is empirical and aimed to control pain and modifying inflammatory process. To date, the use of anti-TNF agents has been proved to be a valid alternative for patients unresponsive to conventional treatments, such as NSAIDs, corticosteroids, DMARDs and biphosphonates. The clinical heterogeneity of the disease, possibly due to differences in pathogenic mechanism of different manifestations, is challenging for both diagnosis and treatment, which should aim to control both skin and bone involvement in different clinical subsets. Here, we summarize the current status of knowledge about the SAPHO syndrome and present two cases of patients with very different disease manifestations, suggesting the need for personalized treatment.
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Affiliation(s)
- Francesco Cianci
- Istituto di Reumatologia e Scienze Affini, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Zoli
- Istituto di Reumatologia e Scienze Affini, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Gremese
- Istituto di Reumatologia e Scienze Affini, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Ferraccioli
- Istituto di Reumatologia e Scienze Affini, Università Cattolica del Sacro Cuore, Rome, Italy. .,Institute of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico Gemelli, CIC-Via Moscati 31, 00168, Rome, Italy.
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32
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Bocchialini G, Ferrari L, Rossini M, Bozzola A, Burlini D. Chronic nonbacterial osteomyelitis involving the mandible: A case report. Int J Surg Case Rep 2017; 37:149-153. [PMID: 28675846 PMCID: PMC5496487 DOI: 10.1016/j.ijscr.2017.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/11/2017] [Accepted: 06/11/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO), is a very rare condition of unknown aetiology. It is characterised by focal sterile inflammatory disease with prolonged, self-limiting and recurrent episodes. CASE PRESENTATION We report the discovery of this very rare disease following a mandibular abscess in a 10-year-old female. We initially focus on the difference between the preoperative orthopantomography and the maxillofacial computed tomography and magnetic resonance images obtained, and then on the improvement of strategies for correct diagnosis and treatment of this disease. DISCUSSION Bone pain and localised swelling can occur in a single bone or can spread to soft tissue and adjacent bone; areas commonly affected by CMRO include the metaphyseal plates of the long bones, as well as the spine, clavicle and, rarely, the maxillofacial area. The clinical presentation of CMRO includes pain, functional impairment, and swelling, similar to our case. CONCLUSIONS We report a very rare case of this unifocal mandibular disease in a child who presented for an abscess and was then diagnosed and treated for CNO.
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Affiliation(s)
| | - Luca Ferrari
- Maxillofacial Pediatric Surgery Unit, Ospedale dei Bambini-Asst., Spedali Civili, Brescia, Italy
| | - Manuela Rossini
- Maxillofacial Pediatric Surgery Unit, Ospedale dei Bambini-Asst., Spedali Civili, Brescia, Italy
| | - Anna Bozzola
- Department of Molecular and Translational Medicine, Section of Pathology, University Spedali Civili Di Brescia, Spedali Civili di Brescia, Unità Operativa di anatomia patologica- Brescia, Italy
| | - Dante Burlini
- Maxillofacial Pediatric Surgery Unit, Ospedale dei Bambini-Asst., Spedali Civili, Brescia, Italy
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33
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Queiroz RM, Rocha PHP, Lauar LZ, Costa MJBD, Laguna CB, Oliveira RGGD. Chronic recurrent multifocal osteomyelitis exhibiting predominance of periosteal reaction. Rev Assoc Med Bras (1992) 2017; 63:303-306. [PMID: 28614530 DOI: 10.1590/1806-9282.63.04.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 10/04/2016] [Indexed: 11/22/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis is an idiopathic nonpyogenic autoinflammatory bone disorder involving multiple sites, with clinical progression persisting for more than 6 months and which may have episodes of remission and exacerbation in the long term. It represents up to 2-5% of the cases of osteomyelitis, with an approximate incidence of up to 4/1,000,000 individuals, and average age of disease onset estimated between 8-11 years, predominantly in females. The legs are the most affected, with a predilection for metaphyseal regions along the growth plate. We describe the case of a female patient, aged 2 years and 5 months, with involvement of the left ulna, right jaw and left tibia, showing a predominance of periosteal reaction as main finding.
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Affiliation(s)
- Rodolfo Mendes Queiroz
- Department of Radiology and Imaging Diagnosis, Documenta, Hospital São Francisco, Ribeirão Preto, SP, Brazil
| | | | - Lara Zupelli Lauar
- Division of Radiology and Imaging Diagnosis, Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mauro José Brandão da Costa
- Department of Radiology and Imaging Diagnosis, Documenta, Hospital São Francisco, Ribeirão Preto, SP, Brazil
| | - Claudio Benedini Laguna
- Department of Radiology and Imaging Diagnosis, Documenta, Hospital São Francisco, Ribeirão Preto, SP, Brazil
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34
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Li H, Chen Z, Yong Z, Li X, Huang Y, Wu D. Emergency 1-stage anterior approach for cervical spine infection complicated by epidural abscess. Medicine (Baltimore) 2017; 96:e7301. [PMID: 28658132 PMCID: PMC5500054 DOI: 10.1097/md.0000000000007301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
It was a retrospective analysis.The aim of the study was to explore the safety and reliability of emergency 1-stage radical debridement and reconstruction using titanium mesh filled with autologous bone for patients with cervical spine infection complicated by epidural abscess.At present, cervical spine infection complicated by epidural abscess is known as a severe spine disease. Recently, case report of this disease is showing quite an increasing tendency, particularly in economically undeveloped areas and countries. Regarding the treatment of this disease, 1-stage radical debridement and reconstruction has been widely adopted; however, emergency 1-stage anterior approach surgery without medication is considered as a relatively taboo, since it is generally acknowledged that such operation would possibly cause unexpected infection. Nevertheless, regular elective surgery may require longer time for preparation. In addition, long hour compression and stimulation of the abscess may leave the patients with irreversible spinal neural impairment. However, our department has finished 14 cases of cervical spine infection complicated with epidural abscess without 1 single case of postoperative infection.A retrospective study was conducted on 14 patients (9 males and 5 females; average age 57.4 years) who were diagnosed with cervical spine infection complicated by epidural abscess from January 2005 to December 2014. All the patients were admitted to hospital with varying degrees of neurological function losses, and then underwent 1-stage anterior focal debridement and reconstruction using titanium mesh within 24 hours after admission. They received postoperative standard antibiotic chemotherapy for 10 to 12 weeks. They were followed up for 18 to 36 months, an average of 27.4 months. X-ray, computed tomography (CT), and MRI (magnetic resonance imaging (MRI) were used to determine the fusion state and vertebral stability. American Spinal Injury Association (ASIA) international standards for neurological classification were adopted, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were evaluated to infection activity, and Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) criteria were used to judge clinical efficacy.All the 14 patients had no postoperative spread of infection. No recurrence of infection was found during the last follow-up. ASIA grade, VAS score, and JOA score were significantly improved (P < .05) after the operation. WBC, ESR, and CRP became normal after the operation (P < .05). Postoperative follow-up imaging results showed no significant loss of cervical curvature, collapse of the grafted bone or implant displacement but good spinal canal volume.Emergency 1-stage radical debridement and reconstruction using titanium mesh filled with autologous bone, combined with antibiotic chemotherapy, is a safe and effective surgical therapy for cervical infection complicated by epidural abscess.
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Dietzel CT, Schäfer C, Vordermark D. Successful treatment of chronic recurrent multifocal osteomyelitis using low-dose radiotherapy : A case report. Strahlenther Onkol 2016; 193:229-233. [PMID: 27822735 DOI: 10.1007/s00066-016-1065-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/06/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory disease, which lacks an infectious genesis and predominantly involves the metaphysis of long bones. Common treatments range from nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids at first onset of disease, to immunosuppressive drugs and bisphosphonates in cases of insufficient remission. The therapeutic use of low-dose radiotherapy for CRMO constitutes a novelty. CASE REPORT A 67-year-old female patient presented with radiologically proven CRMO affecting the right tibia/talus and no response to immunosuppressive therapy. Two treatment series of radiation therapy were applied with an interval of 6 weeks. Each series contained six fractions (three fractions per week) with single doses of 0.5 Gy, thus the total applied dose was 6 Gy. Ten months later, pain and symptoms of osteomyelitis had completely vanished. CONCLUSION Radiotherapy seems to be an efficient and feasible complementary treatment option for conventional treatment refractory CRMO in adulthood. The application of low doses per fraction is justified by the inflammatory pathomechanism of disease.
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Affiliation(s)
- Christian T Dietzel
- Universitätslinik und Poliklinik für Strahlentherapie, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany.
| | - Christoph Schäfer
- Universitätsklinik und Poliklinik für Innere Medizin II, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Dirk Vordermark
- Universitätslinik und Poliklinik für Strahlentherapie, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
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36
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Yang H, Hao Y, Liu Q, Mi Z, Wang Z, Zhu L, Feng Q, Hu N. Preparation and in vitro study of hydrochloric norvancomycin encapsulated poly (d,l-lactide-co-glycolide, PLGA) microspheres for potential use in osteomyelitis. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2016; 45:1326-1330. [PMID: 27776425 DOI: 10.1080/21691401.2016.1233110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Haibo Yang
- Department of Orthopedic Trauma, Affiliated General Hospital, Ning Xia Medical University, Yinchuan, China
| | - Yujie Hao
- Hebei Province People's Hospital, Qian'an, China
| | - Qiming Liu
- Department of Orthopedic Trauma, Affiliated General Hospital, Ning Xia Medical University, Yinchuan, China
| | - Zhanhu Mi
- Department of Orthopedic Trauma, Affiliated General Hospital, Ning Xia Medical University, Yinchuan, China
| | - Zhibin Wang
- Ning Xia Medical University, Yinchuan, China
| | - Lei Zhu
- Ning Xia Medical University, Yinchuan, China
| | - Qingling Feng
- State Key Laboratory of New Ceramics and Fine Processing, Department of Materials Science and Engineering, Tsinghua University, Beijing, China
| | - Ningmin Hu
- Department of Orthopedic Trauma, Affiliated General Hospital, Ning Xia Medical University, Yinchuan, China
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Wurm MC, Brecht I, Lell M, Brunner K, Mitsimponas KT, Chada M, Jahn J, Neukam FW, von Wilmowsky C. Chronic recurrent multifocal osteomyelitis in association with pyoderma gangraenosum. BMC Oral Health 2016; 16:85. [PMID: 27585859 PMCID: PMC5009688 DOI: 10.1186/s12903-016-0275-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/12/2016] [Indexed: 11/24/2022] Open
Abstract
Background Chronic recurrent multifocal osteomyelitis (CRMO) is a rare acquired inflammatory skeletal disorder of unknown origin. CRMO was first described by Gideon in 1972 and mainly affects children and young adults of female gender. The CRMO is part of the clinical picture of non-bacterial Osteomyelitis (NBO) and typically presents a relapsing recurring course with both remission and spontaneous exacerbation. CRMO is typically encountered in the limbs and the metaphysis of long bones in particular. Usually the clinical symptoms include painful swellings of the affected regions. This case report describes the rare case of a CRMO of the mandible in association with pyoderma gangraenosum. Case presentation A 14-year old female caucasian patient, residing in the south of Germany, presented in the oncological outpatient clinic of our Department of Paediatrics and Adolescent Medicine in June 2014 complaining of increasing neck pain and progressive swelling at her left cheek ongoing for about 6 weeks. These symptoms had been occurring quarterly for 4 years, but had never been as pronounced. Blood biochemistry showed a moderately elevated CRP (35 mg/l) and a significantly increased blood sedimentation rate (BSR 48/120 mm). The panoramic radiograph, however, revealed a bone alteration in the left mandibular region. Further investigations confirmed the diagnosis of CRMO. Conclusion The present case underlines the fact that rare diseases might occasionally present with even more rare symptoms. These occasions can obviously be considered to present a considerable diagnostic challenge.
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Affiliation(s)
- Matthias Christian Wurm
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany.
| | - Ines Brecht
- Department of Paediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Lell
- Department of Radiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Kathrin Brunner
- Department of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Martin Chada
- Department of Paediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Jahn
- Department of Dermatology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich-Wilhelm Neukam
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
| | - Cornelius von Wilmowsky
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
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Shimizu M, Saikawa Y, Yachie A. Role of 18-fluoro-2-deoxyglucose positron emission tomography in detecting acute inflammatory lesions of non-bacterial osteitis in patients with a fever of unknown origin: A comparative study of 18-fluoro-2-deoxyglucose positron emission tomography, bone scan, and magnetic resonance imaging. Mod Rheumatol 2016; 28:1058-1062. [DOI: 10.1080/14397595.2016.1193112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Masaki Shimizu
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan and
| | - Yutaka Saikawa
- Department of Pediatrics, School of Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Akihiro Yachie
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan and
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39
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OKAMOTO YUKA, ISHIDA HAJIME, KIMURA RYOSUKE, SATO TAKEHIRO, TSUCHIYA NANAE, MURAYAMA SADAYUKI, FUKASE HITOSHI, NAGAOKA TOMOHITO, ADACHI NOBORU, YONEDA MINORU, WEBER ANDRZEJ, KATO HIROFUMI. An Okhotsk adult female human skeleton (11th/12th century AD) with possible SAPHO syndrome from Hamanaka 2 site, Rebun Island, northern Japan. ANTHROPOL SCI 2016. [DOI: 10.1537/ase.160608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- YUKA OKAMOTO
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho
| | - HAJIME ISHIDA
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho
| | - RYOSUKE KIMURA
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho
| | - TAKEHIRO SATO
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho
| | - NANAE TSUCHIYA
- Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho
| | - SADAYUKI MURAYAMA
- Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho
| | - HITOSHI FUKASE
- Division of Human Evolution Studies, Graduate School of Medicine, Hokkaido University, Sapporo
| | - TOMOHITO NAGAOKA
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki
| | - NOBORU ADACHI
- Department of Legal Medicine, University of Yamanashi Interdisciplinary Graduate School of Medicine and Engineering, Chuo
| | | | - ANDRZEJ WEBER
- Department of Anthropology, University of Alberta, Edmonton
- Laboratoire Méditerranéen de Préhistoire Europe Afrique (LAMPEA)—UMR 7269, Aix-Marseille Université, Aix-en-Provence
| | - HIROFUMI KATO
- Hokkaido University Center for Ainu and Indigenous Studies, Sapporo
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40
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Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man. Skeletal Radiol 2015; 44:1359-64. [PMID: 25771734 DOI: 10.1007/s00256-015-2130-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/20/2015] [Accepted: 02/26/2015] [Indexed: 02/02/2023]
Abstract
We present the case of a 33-year-old man with no significant medical history who developed right scapular pain, left-sided sacroiliac joint pain, and lower back pain, and was eventually diagnosed with chronic recurrent multifocal osteomyelitis (CRMO). Imaging demonstrated multiple scattered T2-hyperintense lesions on MRI at the spine and the left SI joint, some of which progressed and one regressed in size on follow-up. Histopathology demonstrated only non-specific chronic inflammation compatible with CRMO. No evidence of infectious organisms or neoplastic processes was found. The pain was relapsing and remitting in nature. Laboratory investigations were notable for no evidence of hematologic malignancy or infection, but only a mild increase in alkaline phosphatase. This case highlights that CRMO, despite being thought of as a childhood-onset disease, can present in adults as well, and also provides illustrative examples of imaging and histological findings.
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41
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Webb K, Hlela C, Jordaan HF, Suliman S, Scriba T, Lipsker D, Scott C. A Review and Proposed Approach to the Neutrophilic Dermatoses of Childhood. Pediatr Dermatol 2015; 32:437-46. [PMID: 25727235 DOI: 10.1111/pde.12502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neutrophilic dermatoses (NDs) are inflammatory skin conditions that are not associated with infection. The classification and clinical approach to these conditions in children is poorly described. This review classifies these conditions into five nosological subtypes: Sweet's syndrome, pyoderma gangrenosum, aseptic pustules, neutrophilic urticarial dermatoses, and Marshall's syndrome. In addition, we review the various secondary diseases that need to be excluded in the clinical management of the NDs of childhood, with a focus on the autoinflammatory conditions that the reader may not be familiar with. We propose a practical clinical approach to these disorders.
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Affiliation(s)
- Kate Webb
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa.,Department of Dermatology, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa.,Department of Dermatology, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - H Francois Jordaan
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Sara Suliman
- South African TB Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Thomas Scriba
- South African TB Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Dan Lipsker
- Faculté de Médecine, Université de Strasbourg and Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Chris Scott
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa
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42
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Kaiser D, Bolt I, Hofer M, Relly C, Berthet G, Bolz D, Saurenmann T. Chronic nonbacterial osteomyelitis in children: a retrospective multicenter study. Pediatr Rheumatol Online J 2015; 13:25. [PMID: 26088861 PMCID: PMC4473828 DOI: 10.1186/s12969-015-0023-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 06/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the clinical presentation, current treatment and outcome of children with nonbacterial inflammatory bone disease. METHODS Retrospective multicenter study of patients entered into the Swiss Pediatric Rheumatology Working Group registry with a diagnosis of chronic nonbacterial osteomyelitis (CNO) and synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome. The charts were reviewed for informations about disease presentation, treatment, course and outcome. RESULTS Forty-one children (31 girls and 10 boys) from 6 pediatric hospitals in Switzerland diagnosed between 1995 and 2010 were included in the study. The diagnosis was multifocal CNO (n = 33), unifocal CNO (n = 4) and SAPHO syndrome (n = 4). Mean age at onset of CNO was 9.5 years (range 1.4-15.6) and mean follow-up time was 52 months (range 6-156 months). Most patients (n = 27) had a chronic persistent disease course (>6 months), 8 patients had a course with one or more relapses and 6 patients had only one episode of CNO. Forty nine percent had received at least one course of antibiotics. In 57% treatment with nonsteroidal anti-inflammatory drugs (NSAID) was sufficient to control the disease. Twelve out of 16 children with NSAID failure subsequently received corticosteroids, methotrexate, TNF α inhibitors, bisphosphonates or a combination of these drugs. CONCLUSIONS In a multicenter cohort of 41 children 22% started with unifocal lesion with a significant diagnostic delay. A higher proportion presented with chronic persistent disease than with a recurrent form. An osteomyelitis in the pelvic region is significantly associated with other features of juvenile spondylarthritis.
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Affiliation(s)
- Daniela Kaiser
- Department of Pediatric Rheumatology, Children's Hospital, Kantonsspital Luzern, CH-6000, Luzern 16, Switzerland.
| | - Isabel Bolt
- Department of Pediatric Rheumatology, University Children's Hospital, Berne, Switzerland
| | - Michael Hofer
- Department of Pediatric Rheumatology, CHUV, Lausanne and HUG, Geneva, Switzerland
| | - Christa Relly
- Department of Pediatric Infectious Diseases, University Children's Hospital Zurich, Zurich, Switzerland
| | - Gerald Berthet
- Department of Pediatric Rheumatology, Children's Hospital, Aarau, Switzerland
| | - Dieter Bolz
- Department of Pediatric Rheumatology, University Children's Hospital, Basel, Switzerland
| | - Traudel Saurenmann
- Department of Pediatric Rheumatology, University Children's Hospital, Zurich, Switzerland
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43
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Abstract
The SAPHO syndrome, an acronym for synovitis, acne, pustulosis, hyperostosis and osteitis, is a rare disease which affects bones, joints and the skin. The main osteoarticular features are hyperostosis and osteitis. Osteoarticular symptoms predominantly occur on the anterior chest wall but the spine and the peripheral skeleton can also be involved. The most important skin affections are palmoplantar pustulosis and severe acne. The etiology of this syndrome remains unclear but infectious, immunological and genetic factors are involved. The diagnostic features of SAPHO syndrome are clinical and radiological. The most important diagnostic procedure is Tc-99 m bone scintigraphy but conventional x-rays as well as computed tomography (CT) and magnetic resonance imaging (MRI) can also contribute to the final diagnosis. Bone histology and positron emission tomography CT (PET-CT) may help to differentiate SAPHO syndrome from malignancies and infectious osteomyelitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of treatment. The results obtained using antibiotics and disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine and methotrexate are inconsistent. Bisphosphonates and anti-tumor necrosis factor (anti-TNF) drugs have shown promising results in small studies but further research is still necessary.
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44
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Wipff J, Costantino F, Lemelle I, Pajot C, Duquesne A, Lorrot M, Faye A, Bader-Meunier B, Brochard K, Despert V, Jean S, Grall-Lerosey M, Marot Y, Nouar D, Pagnier A, Quartier P, Job-Deslandre C. A large national cohort of French patients with chronic recurrent multifocal osteitis. Arthritis Rheumatol 2015; 67:1128-37. [PMID: 25545761 DOI: 10.1002/art.39013] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/19/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To document more fully the characteristics of chronic recurrent multifocal osteomyelitis (CRMO) in pediatric patients, to collect data on the outcomes and management of the disease, and to define prognostic factors. METHODS One hundred seventy-eight patients were included (123 female patients and 55 male patients), with a mean ± SD age at diagnosis of 10.9 ± 2.9 years. Inclusion criteria were a diagnosis of CRMO, evidence of at least one lesion of osteitis confirmed by imaging, and development of the syndrome before age 18 years. RESULTS Longitudinal clinical and imaging studies revealed that only 12 of 178 CRMO patients (7%) had unifocal lesions at the last medical visit. We were able to apply the clinical chronic nonbacterial osteomyelitis score to 110 of 178 patients (62%), which indicated that bone biopsy could have been avoided in 27 cases (25%). At the last medical visit, disease was in remission in only 73 of 171 patients (43%) (41% receiving therapy) after a mean ± SD of 47.9 ± 38.9 months; 44 of 171 patients (26%) experienced sequelae. Using cluster analysis, the CRMO cohort was separated into 3 homogeneous phenotypes (severe, mild, and intermediate). Patients with the severe phenotype had the worst prognosis. This group was entirely composed of male patients, most of whom had the multifocal form of CRMO and inflammatory syndrome. Patients with the mild phenotype had the best prognosis. This group was primarily composed of female patients with a unifocal form of CRMO and infrequent clavicle involvement and inflammatory syndrome. Patients with the intermediate phenotype had a good prognosis but greater reliance on treatment. This group primarily included female patients with multifocal lesions and inflammatory syndrome. CONCLUSION This is the largest CRMO cohort described in the literature to date. Clinical evolution and imaging investigations confirmed the multifocal pattern of the disease. Three distinct subgroups of CRMO patients were distinguished, with very different prognoses.
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Affiliation(s)
- J Wipff
- Hôpital Cochin, AP-HP, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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45
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Ling E, Zeltser R, Makarov V. A case of cherubism with spondyloarthropathy. Int J Rheum Dis 2015; 18:681-4. [PMID: 25960037 DOI: 10.1111/1756-185x.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eduard Ling
- Pediatric Rheumatology Unit, Soroka University Medical Center, Beer Sheva, Israel.,Pediatrics Department B, Soroka University Medical Center, Beer Sheva, Israel
| | - Raphael Zeltser
- Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Victoria Makarov
- Radiology Department, Soroka University Medical Center, Beer Sheva, Israel
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46
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Sayılı A, Tosun O, Cobanoglu N, Bahceciler Onder N, Baba F, Kavukcu S. Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome in Childhood; A Rare Clinical Entity. IRANIAN JOURNAL OF PEDIATRICS 2015; 24:658-9. [PMID: 25793079 PMCID: PMC4359425 DOI: pmid/25793079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 04/23/2014] [Indexed: 02/08/2023]
Affiliation(s)
| | | | | | | | - Fusun Baba
- Department of Pathology, Near East University Faculty of Medicine, Turkish Republic of Northern Cyprus
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47
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Chronic recurrent multifocal osteomyelitis. Diagn Interv Imaging 2015; 96:313-6. [PMID: 25701475 DOI: 10.1016/j.diii.2014.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/22/2022]
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48
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The SAPHO syndrome revisited with an emphasis on spinal manifestations. Skeletal Radiol 2015; 44:9-24. [PMID: 25331355 DOI: 10.1007/s00256-014-2025-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 09/17/2014] [Accepted: 09/28/2014] [Indexed: 02/02/2023]
Abstract
The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome includes a group of chronic, relapsing, inflammatory musculoskeletal disorders with similar manifestations, in particular synovitis, hyperostosis, and osteitis, which may or may not be associated with neutrophilic skin eruptions such as palmoplantar pustulosis and acne conglobata. The syndrome occurs at any age, can involve any skeletal site, and its imaging appearances are variable, depending on the stage/age of the lesion and imaging method. The diagnosis is difficult if there is no skin disease. Awareness of the imaging appearances, especially in the spine, may help the radiologist in avoiding misdiagnosis (e.g., infection, tumor) and unnecessary invasive procedures, while facilitating early diagnosis and selection of an effective treatment. In this article, we provide an overview of the radiological appearances of SAPHO syndrome, focusing on the magnetic resonance imaging findings of vertebral involvement, and present relevant clinical and pathological features that assist early diagnosis.
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49
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Bachmann F, Stieler K, Garcia Bartels N, Philipp S, Minden K, Blume-Peytavi U. Skin manifestations associated with chronic recurrent multifocal osteomyelitis in a 9-year-old girl. J Am Acad Dermatol 2014; 71:e218-9. [PMID: 25438001 DOI: 10.1016/j.jaad.2014.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 07/03/2014] [Accepted: 07/11/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Frank Bachmann
- Psoriasis Research and Treatment Center, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Karola Stieler
- Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venerology, and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Natalie Garcia Bartels
- Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venerology, and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Philipp
- Psoriasis Research and Treatment Center, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kirsten Minden
- Department for Paediatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Clinical Research Center for Hair and Skin Science, Department of Dermatology, Venerology, and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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50
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Ciccarelli F, De Martinis M, Ginaldi L. An update on autoinflammatory diseases. Curr Med Chem 2014; 21:261-9. [PMID: 24164192 PMCID: PMC3905709 DOI: 10.2174/09298673113206660303] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 09/18/2013] [Accepted: 10/04/2013] [Indexed: 02/01/2023]
Abstract
Autoinflammatory diseases area group of clinical conditions other than autoimmune diseases, characterized by
recurrent inflammatory episodes. From apathogenetic point of view they are determined by a dys regulation of innate immunity,
without involvement of specific immunity (auto reactive T cells and auto antibodies). Recently, the increased
knowledge in the field of auto inflammation highlighted shared immune mechanisms in the pathogenesis of both classical
monogenetic and multifactorial auto inflammatory diseases and a broad spectrum of chronic age-related inflammatory pathologies.
The current increase in the prevalence of chronic inflammatory diseases makes this subject of topical interest.
In the light of these considerations, we propose an update of auto inflammatory diseases and a new interpretation of auto
inflammation with both theoretical and clinical implications.
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Affiliation(s)
| | | | - L Ginaldi
- Director of Post-graduated School of Allergy and Clinical Immunology, University of L'Aquila Coppito, 67100 L'Aquila, Italy.
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