Not all benign: disease course, complications, and sequalae of chronic recurrent multifocal osteomyelitis in children

Area of Science:

• Pediatric rheumatology and immunology
• Skeletal imaging and diagnostics
• Inflammatory bone diseases

Background:

• Advances in understanding the pathogenesis of chronic recurrent multifocal osteomyelitis (CRMO) have influenced treatment approaches.
• Increased awareness and utilization of whole-body MRI (WBMRI) have improved the diagnosis of CRMO in children.
• CRMO diagnosis and management require a multidisciplinary approach.

Purpose of the Study:

• To review recent findings on CRMO patient cohorts.
• To describe the clinical course, complications, and long-term outcomes of CRMO.
• To emphasize the importance of recognizing potential long-term sequelae for optimized CRMO therapy.

Main Methods:

• Review of recently published CRMO cohort studies.
• Analysis of clinical data regarding disease course and complications.
• Synthesis of current understanding of CRMO pathogenesis and therapeutic strategies.

Main Results:

• Children with CRMO can experience significant complications and deformities, including spinal involvement which may be asymptomatic.
• Vertebral fractures and permanent deformities are potential outcomes, particularly with delayed diagnosis or treatment.
• A subset of patients exhibits a polycyclic disease course, with persistent active disease into adulthood, impacting quality of life.

Conclusions:

• Recent findings underscore the need for vigilant clinical practice in diagnosing, treating, and monitoring CRMO.
• Comprehensive imaging, including WBMRI, is essential for screening and disease assessment.
• Awareness of long-term sequelae is critical for optimizing patient care and preventing complications.