Clinical experiences in Turkish paediatric patients with chronic recurrent multifocal osteomyelitis

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is a clinical entity which occurs mainly in children and adolescents with recurrent episodes of pain occurring over several years. Cause and physiopathology of disease is still uncertain. We aim to assess clinical characteristics and treatment options, need and response to anti-inflammatory therapies in children diagnosed chronic recurrent multifocal osteomyelitis Demographic data and clinical features of seventeen children diagnosed with CRMO in 2 pediatric rheumatology centers in Turkey were reviewed retrospectively. The diagnosis was based on clinical findings, radiological images and histopathological and microbiological studies. A total of 17 patients were included in the study. The median age of diagnosis was 9.6±4.2 years. The mean follow-up time was 31.6 months (range 6-35 months). Most patients (n: 10) had a recurrent multifocal disease course (>6 months), 6 patients had a persistent course and a patient had only one episode of CRMO. MEFV gene mutations were detected in 4 patients whose clinical features reduced with colchicine therapy. All patients had received nonsteroidal anti-inflammatory drugs but only one had complete response. Thirteen children with NSAID failure subsequently received corticosteroids, sulfasalazine, methotrexate, Anti TNF α drugs, or a combination of these drugs. This study is the largest cohort of pediatric CRMO patients in our country. Clinical evolution and imaging investigations should be closely done to avoid delays in diagnosis. Ethnic differences create changes in the presentation of the disease and response to treatment

Clinical features of children with chronic non-bacterial osteomyelitis: A multicenter retrospective case series from Turkey

“…Sözeri et al 14 reported 17 patients with CNO in their study, which included the second-largest cohort from Turkey after the present study. Their retrospective study included the demographic data and clinical features of 17 children diagnosed with CRMO in two pediatric rheumatology centers.…”

“…2 It may be speculated that MEFV mutations, mainly exon 10, may have an inflammatory stimulation of bones with CNO, and additional colchicine treatment is helpful in the disease control. Sözeri et al 14 detected MEFV gene mutations in four patients in whom severity of clinical features reduced with colchicine therapy. Soylemezoglu et al 24 also found a much higher FMF prevalence (14.8%) than expected in the Turkish population (14.8%).…”

Chronic non-bacterial osteomyelitis in children: Presentation, diagnosis, outcomes, quality of life

“…In CNO, the peak onset age was 7-12 years and commonly female predominance was reported [2,11]. The peak onset of CNO in studies from Turkey was between 9 and 10.2 years, and a male predominance was observed in 2 studies [12][13][14]. Likewise, two studies from India and Chile reported male predominance [15,16].…”

“…Another study from Turkey reported 17.6% arthritis and 58.8% arthralgia [13]. Limitations and pain in joints are observed in CNO and arthritis is reported up to 40% in studies [16].…”

“…Açarı et al [14] reported lesion sites; femur (67.9%), tibia (57.1%), and pelvic bones (32.1%). Concha et al [16] observed lesions of 21% in the upper limb, 9% in the lower limb, and 36% in the axial skeleton, and the other studies reported sites of lesions under different titles and groups [11][12][13][14][15][16].…”