Evolution of chronic recurrent multifocal osteitis toward spondylarthropathy over the long term

Objective. To retrospectively assess, with a sufficiently long followup (me an 11.6 years; median 9 years), the long-term outcome of chronic recurrent multifocal osteitis (CRMO), a multifocal, inflammatory bone disease. Methods, Patients included were 8 children/adolescents and 7 adults with no family history of rheumatic disease who had been diagnosed as having CRMO between 1979 and 1995. Ten patients had undergone at least 1 bone biopsy of the lesions, with histologic examination and multiple cultures. In 1996, i n addition to an in-depth interview, 12 patients underwent an extensive phy sical examination, laboratory evaluation, HLA-A, B, C, and DR typing, bone radiography and scintigraphy, and computed tomography scan of the sternocla vicular and sacroiliac joints. Results, Remission was observed in 3 patients. The other 12 patients develo ped various associations of vertebral (n = 10), sacroiliac (n = 6), anterio r thoracic (n = 7), peripheral articular (n = 2), enthesopathic (n = 4), or dermatologic (palmoplantar pustulosis in 3 cases and psoriasis in 2) invol vements. Spine involvement was the most common and occurred the earliest (m edian time to appearance after the onset of osteitis 5.63 years). Clinical sacroiliitis was always unilateral. No patients carried the HLA-B27 haploty pe, CRMO responded well to nonsteroidal antiinflammatory drugs. Twelve pati ents met the European Spondylarthropathy Study Group criteria for spondylar thopathy. Conclusion. After 10 years, CRMO had usually evolved to spondylarthropathy, but with certain features not usually seen in the latter: predominantly, u nilateral sacroiliitis, no familial form, and no link with HLA-B27.