Chronic recurrent multifocal osteomyelitis in children: a single center experience over five years

Özet

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare diseasecharacterized by sterile bone inflammation. It is an orphan disease with manyunclear aspects in terms of diagnosis, treatment and follow-up. The aim of thisstudy was to report our experience of pediatric CRMO patients. Children whowere diagnosed with CRMO, and were followed-up between January 2008and January 2017, were included in this study. There were 15 CRMO patients(8M/7F) with a median age at diagnosis of 9.0 years (range: 0.6-15.0). Bonepain was the most common presenting symptom. All of the patients hadmultifocal bone lesions. Vertebrae (66.7%) and femur (66.7%) were the mostcommonly affected bones. Eight of the patients also had sacroiliitis; however,only one of them was HLA-B27 positive. Whole-body magnetic resonanceimaging (MRI) was used as a diagnostic tool in 13 patients revealing bonemarrow edema (84.6%), osteitis (69.2%), and periosteal reaction (61.5%).All patients were initially treated with non-steroidal anti-inflammatorydrugs (NSAIDs), however, disease-modifying anti-rheumatic drugs, anti-TNFagents or pamidronate were added to therapy due to inadequate treatmentresponse. Clinical remission was achieved in 12 patients (1 with NSAIDs, 3with methotrexate, 1 with pamidronate and 7 with an anti-TNF agent). Duringthe follow-up period, relapses were observed in four patients who presentedwith pain and/or a newly formed bone lesion on MRI. Eventually, however,all of these patients also reached remission. CRMO is a chronic disease whichmay have a progressive or relapsing-remitting course. Improvement of theknowledge about this rare disease may help to enlighten the unknowns of thedisease.