[Chronic recurrent multifocal osteomyelitis-- I. Review]

Area of Science:

• Pediatric rheumatology
• Orthopedic pathology
• Immunodermatology

Background:

• Juvenile and adolescent Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a systemic, non-purulent inflammatory condition.
• It primarily affects the metaphyseal regions of long bones, pelvic bones, or presents as spondylitis.
• CRMO is not as rare as previously thought, with a significant number of pediatric cases.

Purpose of the Study:

• To describe the characteristics of juvenile and adolescent CRMO.
• To analyze the distribution patterns and associated conditions of CRMO.
• To present a therapeutic approach for CRMO.

Main Methods:

• Literature review and analysis of 43 CRMO cases (23 in children/adolescents).
• Histological examination revealing plasmacellular invasion and sclerosing processes.
• Te99m-bone scintigraphy to identify lesion distribution patterns, with a focus on the common 'pelvic type'.

Main Results:

• CRMO is a chronic, sterile osteomyelitis, initially monotopic and later polytopic, possibly immune-mediated.
• Approximately 25% of pediatric CRMO patients exhibit pustulous dermatosis, increasing to over 50% in adults.
• The 'pelvic type' is the most frequent distribution pattern identified by bone scan; sympathetic arthritis is common due to proximity of lesions.

Conclusions:

• CRMO is an underrecognized inflammatory bone disease in pediatric populations.
• The association with dermatological conditions and specific bone scan patterns aids diagnosis.
• A treatment regimen involving azithromycin and calcitonin is proposed.