Chronic recurrent multifocal osteomyelitis in children: A single center experience

Abstract

Objective – To evaluate the suitability of diagnosing chronic recurrent multifocal osteomyelitis (CRMO) according to the Bristol diagnostic criteria and the clinical outcome of the children included in the study. Materials and Methods – Retrospectiveprospective study was conducted at the Clinic for Children’s Diseases, University Clinical Center Tuzla in the period from January 2018 to January 2020. The medical records of children treated CRMO were analyzed. Results – Eight children fulfilled the Bristol diagnostic criteria. The median age at disease onset was 10.7 years. All children had multifocal lesions which relapsed in 2 children, and predominantly affected regions were the pelvis, hips, femur, spine and shoulder girdle. Hematological and biochemical parameters were unremarkable, although ESR was elevated in 6/8 children; all children had CRP<30 mg/L. For 3 children lesions on plain radiography were observed; 49 lesions were verified on MRI (4 children had whole body MRI). Bone biopsy was performed in 2 children and it showed inflammatory changes. In 6/8 children treatment with NSAIDs was sufficient to control the disease during the 8-month period. However, two children had pain resistant to NSAID therapy, so they were treated with methotrexate and sulfasalazine. The child who received sulfasalazine treatment relapsed, so TNFα inhibitor (adalimumab) was used to control disease activity. No child received pamidronate. Conclusions – Our results showed that the use of the Bristol diagnostic criteria may obviate the need for a biopsy, shorten the time of diagnosis, save the bone from destruction, and avoid unnecessary treatments.