Chronic recurrent multifocal osteomyelitis: Five-year outcomes in 14 pediatric cases

Objective. To determine the clinical presentation and outcomes of chronic r ecurrent multifocal osteomyelitis (CRMO) in pediatric patients. Patients an d methods. Ten girls and four boys were followed up between 1993 and 1999 f or CRMO diagnosed on the basis of radiographic bone lesions with, at the sa me sites, increased radionuclide uptake, negative microbiological specimens , and histological evidence of nonspecific osteomyelitis. Results. Mean age at CRMO was 9.6 +/- 3.4 years, mean disease duration was 5.3 +/- 2.5 years , and mean number of flares per patient was 5.9 +/- 3.7. Thirty-four percen t of lesions were in the metaphyses of the lower limb bones, 14% in the pel vis, and 13% in the chest wall (with clavicular lesions in four patients). Three patients had skin lesions (psoriasis in two and palmoplantar pustulos is in one). Eight patients received antibiotic therapy, for 2 months at the most, to no advantage in the shortterm. Nonsteroidal anti-inflammatory dru gs were used in all 14 patients and glucocorticoid therapy in four. Sulfasa lazine was used in five patients, to good effect in four. Mean follow-up wa s 5.3 +/- 2.5 years. At last follow-up, eight patients had active disease, including one with synovitis and one with Takayashu's disease. Conclusion. As compared to SAPHO syndrome, skin lesions and chest wall involvement are less common in CRMO. The long-term prognosis is guarded: in our study only six of 14 patients were in remission at last follow-up. Joint Bone Spine 20 01; 68: 245-51. (C) 2001 Editions scientifiques et medicales Elsevier SAS.