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Management of chronic recurrent multifocal osteomyelitis: review and update on the treatment protocol

Hanene Lassoued Ferjani1,2,3, Yasmine Makhlouf1,2, Kaouther Maatallah1,2,3

  • 1Department of Rheumatology, Mohammed Kassab National Institute of Orthopedics Mannouba, Tunisia.

Expert Opinion on Biological Therapy
|May 16, 2022
PubMed

Insights

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare pediatric autoinflammatory bone disorder. Current management focuses on NSAIDs, with bisphosphonates for vertebral involvement and anti-TNF agents showing promise.

Area of Science:

  • Pediatric rheumatology
  • Autoinflammatory diseases
  • Osteomyelitis

Background:

  • Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory condition primarily affecting children.
  • It typically presents with peripheral metaphyseal bone involvement, distinguishing it from other osteomyelitis types.
  • Lack of established management guidelines complicates CRMO treatment.

Purpose of the Study:

  • To review current therapeutic strategies for CRMO.
  • To discuss first-line, second-line, and emerging treatments for this condition.
  • To provide an overview of recent management protocols.

Main Methods:

  • Literature search conducted on PubMed focusing on CRMO.
  • Review of studies examining therapeutic alternatives and outcomes.
  • Categorization of treatments into first-line and second-line approaches.

Main Results:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) are the primary first-line treatment for CRMO.
  • Bisphosphonates are recommended as a first-line option for vertebral CRMO.
  • Anti-TNF agents demonstrate efficacy, particularly in CRMO with co-occurring immune-mediated diseases.

Conclusions:

  • NSAIDs form the cornerstone of CRMO management.
  • Bisphosphonates and anti-TNF agents represent important therapeutic options for specific CRMO presentations.
  • Further research is needed to clarify the role of interleukin-1 antagonists in CRMO treatment.
Abstract

Keywords:
Chronic recurrent multifocal osteomyelitisNSAIDsbiologicsbisphosphonatesmanagementtreatment

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