E40 Chronic recurrent multifocal osteomyelitis: management disease in Tunisian child population

Abstract

Abstract Introduction Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disease especially in Tunisian population and occurs more often in children. It is a bone non-microbial inflammatory disease that frequently involves long bones, pelvis and spine. The autoimmune origin seems to be the most suggested pathogenic theory. It often manifests by multifocal bone pain with insidious onset and recurrent course Objectives The aim of the study was to highlight specific symptoms, frequent localization, investigations, imaging and multidisciplinary management of CRMO Methods We retrospectively reviewed five children on follow up for CRMO in our institution on both pediatric orthopedic and rheumatology department between 2012 and 2022. We have noted epidemiology features, symptoms, clinical manifestations, medical and orthopedic management, sequallae and outcome at last follow up for each case in order to identify specificities and correlations Results Five children, including 3 female and 2 males, were treated for such disease during this period. The mean age at diagnosis was 13.2 years (9–16). Duration of symptoms prior to diagnosis was 1–6 months. Inflammatory bone pain was present in all cases and isolated swelling in one case (clavicle). CRMO involves spine, femur, foot, humerus and clavicle and only two children present more than two locations. No correlation between age and location was noted. Radiographs were normal at presentation in four cases and showed reactive hyperostosis during the course of the disease in two cases. Whole-body MRI revealed some clinically non symptomatic localizations in three cases. The differential diagnoses were osteomyelitis, inflammatory arthritis, vertebral fracture and Ewing's sarcoma in one case. Microbiological examinations were negative in all cases. Biopsy, performed in two cases (spine, clavicle) showed non-specific inflammatory bone involvement. Non-steroidal anti-inflammatory drugs were used in four cases and salazopyrine in one case with durable remission at last follow up. CRMO involved spine in two cases where brace has been used for a 6-month period. A mild progression of thoraco-lumbar kyphosis was noted in one case (local kyphosis from 6 to 10°). Conclusion Even if CRMO remains diagnosis of exclusion, it should be managed early to prevent functional sequellae especially in spine where orthosis is essential to prevent kyphosis and vertebrae collapses. Asymptomatic bone involvement can be revealed by whole body MRI. Non steroid anti-inflammatory drugs and salazopyrin in second intention seems to be effective to stabilize bone lesion. Ethics Informed consent was obtained for each patient for diffusing their imaging file in scientific congress