Chronic recurrent multifocal osteomyelitis: case series of four patients treated with biphosphonates
Authors
Ferraria N, Marques JG, Ramos F, Lopes G, Fonseca JE, Neves MC
Aim: To report and describe a series of four cases of
chronic recurrent multifocal osteomyelitis (CRMO) and
to discuss therapeutic options, particularly bisphosphonate
therapy.
Methods: Retrospective review of four CRMO cases in
two Pediatric Units in Lisbon, between 2005 and 2010.
Results: Median age of first CRMO symptoms was 11.3
years (range 9–13). The more affected sites were the metaphysis
of the long bones, pelvis and coxofemoral
joints. Median number of initial bony lesions for each
patient was 2.3 (range 1-3) at onset and 3.8 (range 2-6)
during the disease course. All patients failed to respond
to NSAIDs therapy. Two patients received corticosteroids,
with clinical disease remission in only one of
them. All patients received bisphosphonates (alendronate
in two and pamidronate in two), all with good clinical
response and induction of clinical remission in two
of them. After a median follow-up period of 4.3 years
(range 4-5), three patients are clinically asymptomatic
and one patient remains with chronic residual pain.
Conclusions: The treatment of CRMO is not standardized.
Bisphosphonate therapy can be of benefit to patients
with relapsing symptoms. Randomized controlled
multicentric trials are needed to provide better evidence for universal recommendation and definition of
bisphosphonate therapy protocol.
Section:
Original articles