Chronic recurrent multifocal osteomyelitis (CRMO) in children - single-centre clinical observations and experience.

BACKGROUND CRMO is characterized by chronic bone pain of recurrent nature. The onset is usually at the beginning of the second decade of life. Bony lesions may be visible on radiographs, although sometimes a CT or MRI scan is necessary to visualise them. The aim of study was analyse symptoms, diagnostic difficulties and results of accessory investigations in patients suffering from CRMO. MATERIAL AND METHODS Medical records of 42 patients with CRMO were analysed to assess: age at onset of the disease, symptoms reported, location of lesions and abnormalities in laboratory and imaging studies. RESULTS The medical records of 42 children, including 16 boys (38%) and 26 girls (62%), were analysed. The median age at onset was 10.5 years. The first symptom was bone pain in 34 patients (81%), with the remaining 8 (19%) presenting with widened bone contour in the absence of pain. Initially, only 5 (12%) subjects had multiple foci, whereas the vast majority (88%) presented with a single lesion. During exacerbations, osteocalcin levels were significantly elevated, increasing to a mean of 34 ng/ml (max. 68, min.14.6) against a reference upper limit of 13.7 ng/ml. Diagnostic difficulties and complications were found in 18 children. CONCLUSIONS 1. Familiarity with CRMO in orthopaedic clinical practice is indispensable in differential diagnosis with other bone diseases, including those suggestive of malignancy. 2. Correctly diagnosed CRMO is managed conservatively as a treatment of choice.