CRMO
Very rare
- Mainly affects children
Characterised by multiple osteomyelitic changes
- predominantly in metaphyseal region of long bones
All cultures negative
Antibiotics do not affect course of disease
Pain is most common symptom
- Occasional soft tissue swelling
Criteria
Two or more radiologically confirmed bone lesions
Course of over 6 month, with exacerbations and remissions
Radiographic and nuclear scintigraphic evidence of osteomyelitis
Lack of response to over one month of antibiotic treatment
Lack of identifiable aetiology
Haematological Examination
ESR usually elevated (25 - 75 mm/hour)
CRP usually elevated (10 - 85 g/l)
White cell count usually unremarkable
Gamma globulins sometimes slightly elevated
Immunodeficiency tests normal
Management
NSAIDs
Steroids may be of some benefit
Interferon used in severe cases
Prognosis
Usually protracted course
Usually self limited
Differential
Viral polyarthritis
Juvenile chronic arthritis
Acute osteomyelitis
Neoplasia
- Neuroblastoma
- Leukaemia
- Rhabdomyosarcoma
Langerhans cell histiocytosis
Garre's Primary Sclerosing Osteomyelitis
Fevers
ESR raised
Usually one site
2nd lesion may occur years later
Hot on bone scan
Same age group as CRMO
Histology
- chronic osteomyelitis
- Biopsy sterile
Lesions predominantly sclerotic
Recurrent symptoms
? Unifocal form of CRMO