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The autoinflammatory syndromes are a newly recognized group of immune disorders that lack the high titers of self-reactive antibodies and T cells characteristic of classic autoimmune disease. , patients with these illnesses experience unprovoked inflammatory disease in the absence of underlying infection.(Curr Top Microbiol Immunol. 2006;305:127-60).  In the category of autoinflamation this disease is a a lesion particularly known as CRMO or chronic recurrent mutifocal osteomylitis a rare condition in which bones have an lesion, inflammation and pain but without a focus of infection .the result of its inheritance pattern is still being debated and the distinguishing feature from the autoimmune pattern is still not clear.  It is classified as an auto inflammatory disease due to its recurrent out breaks and lack of any known pathogen.this disease tends to range from 4 to 14 years of age and 10 years as median. As by current statistics it occur 1:1 and primarly in girls with a 5:1 ratio.  CRMO may similar to a painful bone lesion such as arthritis , RF , bacterial osteomylitis ,ewings sarcoma, lymphoma, eosinophilic granuloma or LAH. When all the prevoious illness are ruled out and a bone biopsy turns negative for any known cancer CRMO is usually diagnosed.  As such the common medication given for reducing the inflammation are such as NSAIDS and steroids, antibiotics are not prescribed as there is no evident focus of infection. Congenital dyserthropoitic anaemia and CRMO , uncommon childhood diseases an association with sweet syndrome may be interelated .( journal of paediatrics 115 (5, part 1):730-4. Dol10.1016/S0022-3476(89)80650.  A retrospective review of autoinflamatory diseases in Saudi children at rheumatology clinic showed that of the 34 children with a mean age 118 months , consanguinity was present in 40 %. And in which FMF 50%, CRMO 23.5%, EOS 8.8%, MWS 6 %.(Ann Saudi med . 2012 ;32(1);43-8(ISSN;0975-4466).  CRMO is sometimes associated with palmoplantar pustulosis and frequent relapses may be present with remission lasting for 4-16 weeks. The most distal case if the affected series . classical Xray diagnosis reveled skeletal changes consistent with appearance of acute or chronic heamoatogenic osteomylits.morphologically CRMO begins as an acute inflammatory process either predominance of PMN leucocytes, with occasionally form absesses and osteoclastic bone resorption. At a later stage it may present as lymphocytes and inflamatoty infiltrate and occasional granulomatous foci and signs of new bone formation.

pediatric rheumatology online journal

P03-027 - A brief Case report on specific undiagnosed condition, whose provisional diagnosis on the basis of provisional lab investigation proved as one of the component of autoinflammatory disorder