Tsitsami Elena, Dermentzoglou Vasiliki, Moschovi Mary, Chrousos George P
Pediatric Rheumatology Unit, 1st Department of Pediatrics, Children's Hospital Aghia Sophia, University of Athens, 115 27 Athens, Greece.
Case Rep Rheumatol. 2011;2011:210795. doi: 10.1155/2011/210795. Epub 2011 Dec 29.
We report a case of a 13-year-old girl with chronic recurrent multifocal osteomyelitis (CRMO) who developed severe arthritis in four different joints within the first year from the onset of the disease. Her multiple vertebrae lesions showed significant amelioration after a 2-month treatment with prednisolone. In parallel, the initial severe symmetrical arthritis of both knees showing overt synovitis and joint effusion, in the absence of lesions in the metaphyses of the femur or the tibia, responded remarkably well in intra-articular triamcinolone hexacetonide injections. However, upon discontinuation of prednisolone, the patient developed severe arthritis of her right ankle and the proximal interphalangeal joint of her right middle finger. Thus, prednisolone was reinitiated combined with methotrexate, and the patient went into remission, which persists one year after prednisolone tapering. The appearance of arthritis in both knees in the absence of bone lesions and the emergence of severe arthritis of the ankle after remission of spinal bone lesions suggest that CRMO and juvenile idiopathic arthritis may coexist and be causally related.
我们报告一例13岁患有慢性复发性多灶性骨髓炎（CRMO）的女孩，在疾病发作后的第一年里，她在四个不同关节出现了严重关节炎。在接受泼尼松龙治疗2个月后，她的多个椎体病变有显著改善。同时，双膝最初严重的对称性关节炎表现为明显的滑膜炎和关节积液，在股骨或胫骨干骺端无病变的情况下，关节腔内注射曲安奈德六乙酸酯反应良好。然而，停用泼尼松龙后，患者出现右踝关节和右手中指近端指间关节的严重关节炎。因此，重新开始使用泼尼松龙并联合甲氨蝶呤，患者病情缓解，在泼尼松龙逐渐减量一年后仍持续缓解。双膝在无骨病变的情况下出现关节炎，以及脊柱骨病变缓解后踝关节出现严重关节炎，提示CRMO和青少年特发性关节炎可能共存且存在因果关系。
