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Chronic non-bacterial osteomyelitis in childhood - a comprehensive review

Henner Morbach, Hermann J Girschick1

  • 1Vivantes Childrens Hospital, Berlin-Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany. m.colina@ausl.imola.bo.it.

Current Rheumatology Reviews
|September 9, 2014
PubMed

Insights

Childhood chronic recurrent multifocal osteomyelitis (CRMO) involves aseptic bone inflammation, often linked to SAPHO syndrome. Advanced treatments beyond NSAIDs, like bisphosphonates, show promise for refractory cases.

Area of Science:

  • Pediatrics
  • Rheumatology
  • Dermatology

Background:

  • Childhood chronic recurrent multifocal osteomyelitis (CRMO) presents as aseptic osteomyelitis, primarily in long bone metaphyses.
  • CRMO can be associated with skin conditions and inflammatory bowel disease, aligning it with SAPHO syndrome.
  • Dysregulated myeloid cell cytokine/chemokine expression is implicated in CRMO's chronic inflammation.

Purpose of the Study:

  • To review the clinical characteristics of CRMO.
  • To discuss the association of CRMO with SAPHO syndrome.
  • To explore treatment strategies for CRMO, including novel therapeutic options.

Main Methods:

  • Literature review of CRMO and SAPHO syndrome.
  • Analysis of clinical presentations and associated conditions.
  • Evaluation of current and emerging treatment modalities.

Main Results:

  • CRMO is characterized by chronic, aseptic osteomyelitis, frequently affecting long bone metaphyses.
  • Associated conditions include palmoplantar pustulosis, psoriasis, acne, and inflammatory bowel disease, supporting its inclusion in SAPHO syndrome.
  • NSAIDs offer symptomatic relief, but many patients require second-line therapies (DMARDs, biologics) for persistent inflammation.

Conclusions:

  • CRMO is a complex inflammatory condition often part of the SAPHO syndrome spectrum.
  • Effective management requires addressing both bone and associated extra-skeletal manifestations.
  • Bisphosphonates represent a potential therapeutic avenue for NSAID-refractory osteomyelitis in CRMO.

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