Chronic recurrent multifocal osteomyelitis: aspects of epidemiology, pathogenesis, clinical manifestations, diagnosis and treatment: literature review

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Abstract

The paper presents a literature review on chronic recurrent multifocal osteomyelitis. This orphan disease, which primarily affects children and adolescents, has a wide range of clinical manifestations and presents various diagnostic, pathological, and therapeutic problems. An analytical review was performed using medical literature databases and PubMed (MEDLINE), Google Scholar, and eLibrary search systems. The review addresses the following: epidemiology, clinical presentation, pathogenesis, diagnosis, treatment, and genetic factors in the pathophysiology of chronic recurrent multifocal osteomyelitis in humans. The review aimed to improve clinicians' understanding of this disease, allowing for timely diagnosis and appropriate treatment initiation.

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About the authors

Aleksandr A. Ochkurenko

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: cito-omo@mail.ru
ORCID iD: 0000-0002-1078-9725
SPIN-code: 8324-2383

MD, Dr. Sci. (Medicine), рrofessor

Russian Federation, 10 Priorova str., 127229 Moscow

Alexander A. Kuleshov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: cito-spine@mail.ru
ORCID iD: 0000-0002-9526-8274
SPIN-code: 7052-0220

MD, Dr. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127229 Moscow

Gazinur N. Tairov

Priorov National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: gazinur.vezunchik@mail.ru
ORCID iD: 0009-0002-3469-3944
SPIN-code: 8868-2577

MD

Russian Federation, 10 Priorova str., 127229 Moscow

Marchel S. Vetrile

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: vetrilams@cito-priorov.ru
ORCID iD: 0000-0001-6689-5220
SPIN-code: 9690-5117

MD, Cand. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127229 Moscow

Sergey N. Makarov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: moscow.makarov@gmail.com
ORCID iD: 0000-0003-0406-1997
SPIN-code: 2767-2429

MD, Cand. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127229 Moscow

Igor N. Lisyansky

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: lisigornik@list.ru
ORCID iD: 0000-0002-2479-4381
SPIN-code: 9845-1251

MD, Cand. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127229 Moscow

Yuriy V. Buklemishev

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: buklemishev@mail.ru

MD

Russian Federation, 10 Priorova str., 127229 Moscow

Nikolay A. Aganesov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: kolyanzer@yandex.ru
ORCID iD: 0000-0001-5383-6862
SPIN-code: 1805-5790
Russian Federation, 10 Priorova str., 127229 Moscow

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2. Fig. 1. Distribution of bone lesions in patients with chronic recurrent multifocal osteomyelitis: on the left — pediatric patients, on the right — adult patients [23].

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3. Fig. 2. Pathogenesis of osteoclast activation in chronic recurrent multifocal osteomyelitis [6].

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4. Fig. 3. Whole body MRI in STIR mode as the standard for diagnosing chronic recurrent multifocal osteomyelitis. MRI picture of multifocal bone lesions, patient K., 13 years old. Whole body STIR series reveals diffuse edema of the sternal end of the left clavicle (a), distal metaepiphysis of the right radius (b), lateral masses of the sacrum on both sides (c), adjacent parts of the bodies of the ilium and ischium on the right (d), proximal metaepiphysis of the tibia bones (more on the right), proximal metaepiphysis of the fibula on the right (e), distal metaepiphysis of the tibia and fibula (f), tarsal bones of both feet (more on the right) (g), metatarsal bones of the left foot (h). Edema of the postero-superior part of the Th8 vertebra and the anterior part of the Th10 vertebra is also determined. A decrease in the vertebral bodies of Th7 to 1/2 and Th8 in the anterior and middle sections to 1/3, and deformation of the upper endplate of Th6 are determined. The intensity of the signal from the Th6, Th7 bodies in the anterior and middle parts of the Th8 vertebral body is not changed — old consolidated compression fractures (consequences of chronic nonbacterial osteomyelitis). At this level Th6-Th8, a local increase in physiological kyphosis of the thoracic spine is determined (i).

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5. Fig. 4. Treatment regimen for chronic recurrent multifocal osteomyelitis (adapted from [4]). Note. ХРМО — chronic recurrent multifocal osteomyelitis, НПВП — non-steroidal anti-inflammatory drugs, ГКС — glucocorticoids, ФНО-α — tumor necrosis factor alpha.

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