Chronic Non-bacterial Osteomyelitis in Childhood – a Comprehensive Review

Abstract

The clinical picture of childhood chronic recurrent multifocal osteomyelitis (CRMO) is characterized by an aseptic chronic osteomyelitis, most often affecting the metaphyses of the long bones. Skin inflammation (palmoplantar pustulosis, psoriatic lesions, acne) and inflammatory bowel disease may be associated with CRMO and therefore subsume this disease into the entity of SAPHO syndrome. Deregulated cytokine/chemokine expression in myeloid cells seems to drive chronic inflammation of the disease. NSAIDs may reduce pain, but additional second-line treatments (DMARDs, biologicals) are needed to treat persisting or progressing inflammation in a significant number of patients. The use of bisphosphonates may be a promising option in treating NSAID-refractory osteomyelitis in CRMO.

Pediatric Chronic Nonbacterial Osteomyelitis of the Jaw: Clinical, Radiographic, and Histopathologic Features

“…1 Although no randomized controlled trials have been carried out, a variety of anti-inflammatory medications (nonsteroidal anti-inflammatory drugs, steroids), as well as methotrexate, bisphosphonates, and disease-modifying agents (tumor necrosis factor a inhibitors), have been used in the treatment of this condition. 2,5,10 Surgical intervention is reserved for contour reduction. Establishing a common terminology and better understanding of this condition may improve the clinical management and treatment outcomes of patients with this disorder.…”

“…Chronic nonbacterial osteomyelitis (CNO) is a sterile inflammatory bone disorder of unknown etiology that occurs in children. 1 The aseptic bone lesions of CNO typically present at a mean age of 10 years as localized pain and swelling 2,3 and are histologically characterized by nonspecific osseous inflammation in the absence of infection. 4 Female patients are more commonly affected than male patients, and the disease course is highly variable.…”

“…The term chronic recurrent multifocal osteomyelitis (CRMO) is used to describe the multifocal form of CNO. 2 CRMO may be associated with extraosseous manifestations involving the skin, gastrointestinal tract, eyes, or lungs. 4,6 CRMO has been linked to a number of chronic autoinflammatory disorders including Crohn's disease and seronegative spondyloarthropathies.…”

Assessment of Disease Activity Using a Whole-body MRI Derived Radiological Activity Index in Chronic Nonbacterial Osteomyelitis

“…Onset is often insidious and patients may or may not experience concomitant systemic symptoms including low-grade fever and generalized malaise [9,15]. About 30% of patients had unifocal disease at diagnosis but most of them developed new lesions during the follow-up period [16]. Only 25-40% of individuals have symmetrical bone involvement [4].…”

Chronic nonbacterial osteomyelitis involving the mandible: A case report

“…This was followed by Bjorksten’s report in 1978, which coined the term ‘chronic recurrent multifocal osteomyelitis’. The term CRMO is used to described the multifocal form of CNO [7].…”