ORIGINAL ARTICLEChronic recurrent multifocal osteomyelitis: five-year outcomes in 14 pediatric cases
Section snippets
Patients and methods
We retrospectively reviewed the medical charts of all the pediatric patients who received follow-up for CRMO at the pediatric rheumatology department of the Saint Vincent de Paul and Robert Debré teaching hospitals in Paris, France between 1993 and 1999. The diagnosis was based on presence of suggestive radiographic bone lesions with increased radionuclide uptake on bone scans and evidence of noninfectious osteomyelitis by biopsy. The following data were abstracted from the charts: age and sex;
Patient characteristics and clinical presentation
Fourteen patients met our criteria for CRMO, ten girls and four boys, with a mean age of 9.6 ± 3.4 years at disease onset. Psoriasis developed in two patients, 6 and 7 years after the first bone symptoms, respectively. Another patient had palmoplantar pustulosis coincident with the first bone symptoms. One patient had a family history of psoriasis, two with a history of ill-defined musculoskeletal disease, and one of ankylosing spondylitis. Inflammatory pain was present at onset in all 14
Discussion
Our findings are in keeping with those of earlier series showing a female predominance of about 70% and a mean age at onset of 9 to 10 years 3, 4, 5. Palmoplantar pustulosis and psoriasis seem less common in children with CRMO than in adults with SAPHO syndrome syndrome 〚30〛; furthermore, the skin lesions can occur many years after the first bone symptoms 〚6〛. Of the 22 patients studied by Carr et al. 〚7〛, only two had palmoplantar pustulosis, and one psoriasis, whereas pustulosis was present
Conclusion
As compared to SAPHO syndrome, CRMO is less likely to cause skin lesions and anterior chest wall involvement. Flares occur at variable intervals, and the disease can remain active into adulthood. Nonsteroidal anti-inflammatory drugs are the treatment of choice, as they are usually both effective and well tolerated. In severe forms refractory to nonsteroidal anti-inflammatory drugs, glucocorticoid therapy is required. However, the adverse effects of glucocorticoids, particularly on growth, are
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