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

ABSTRACT

Introduction

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder primarily affecting children. It is characterized by a peripheral involvement of the metaphysis of long bones rather than axial involvement. Due to the scarcity of the disease, there are no guidelines regarding its management.

Areas covered

This review aims to provide an overview of the different therapeutic alternatives and recent protocols. For this reason, first-line and second-line treatment, as well as the impact of new therapies, are discussed in depth. We conducted a search through PubMed on the different aspects of CRMO. Outcomes were categorized as first and second-line treatments.

Expert opinion

Non-steroidal anti-inflammatory drugs remain the keystone of CRMO management and are proposed as the first-line treatment. In the case of vertebral involvement, bisphosphonate should be considered, even as a first-line treatment. Several case series and retrospective studies highlight the efficacy of anti-TNF agents. Their use could be an optimal treatment choice for CRMO with comorbid immune-mediated diseases. The potentially favorable effect of interleukin-1 antagonists remains to be determined.

KEYWORDS:

• Chronic recurrent multifocal osteomyelitis
• treatment
• biologics
• bisphosphonates
• management
• NSAIDs

Article highlights

• Chronic recurrent multifocal osteomyelitis (CRMO) is a rare auto-inflammatory disorder that can lead to severe bone damage at a young age

• The CARRA consensus is the first developed plan to standardize CRMO management

• Non-steroidal anti-inflammatory drugs are usually used as a first-line treatment.

• Conventional disease-modifying antirheumatic drugs have divergent effects on the peripheral manifestations of CRMO with a lack of action in the vertebral lesions

• In non-responder patients or in the case of spine involvement, anti-TNF or bisphosphonates (BP) should be considered

• BP should be prescribed for vertebral involvement with crushed vertebrae; however, anti-TNF could be an optimal treatment choice for CRMO with comorbid immune-mediated diseases

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Data collection: Y Makhlouf. Data analysis: K Maatallah, W Triki, D ben Nessib, D Kaffel, W Hamdi. Writing: HL Ferjani, Y Makhlouf. Editing: HL Ferjani, K Maatallah, D Kaffel, W Hamdi. Supervision: HL Ferjani, W Triki.

Additional information

Funding

This paper was not funded.