title: Childhood chronic recurrent multifocal osteomyelitis: pamidronate therapy decreases pain and improves vertebral shape.
abstract: OBJECTIVE
  Chronic relapsing multifocal osteomyelitis (CRMO) results in significant morbidity, especially in those with vertebral collapse. Symptomatic benefit with intravenous pamidronate (PAM) has been shown; however, few studies have demonstrated radiological benefit. We describe clinical and radiological data on 7 pediatric cases of CRMO treated with PAM.
  
  
  METHODS
  Retrospective chart review on all children with CRMO treated with PAM. Response to PAM was measured by subjective reports and radiology including vertebral morphometry.
  
  
  RESULTS
  Seven patients (1 male) presented with bone pain at a median age of 8 years (range 5-14). Symptoms had been present for a median of 18 months (range 11-51) before PAM therapy. All patients had involvement of multiple nonspinal sites, 5 children had spinal involvement with vertebral fractures, and 5 had joint involvement. Six cases had symptomatic improvement within 6 months of starting PAM, which was sustained during PAM therapy (median 26 mo, range 6-41) and persisted in the 4 cases who had ceased treatment for the duration of followup (27 mo, range 18-51). The least benefit was seen in the 3 cases with synovial joint involvement. The 3 cases with spinal radiological followup showed modeling of vertebral fractures and in one patient improvement in kyphosis. No radiological improvement in nonspinal lesions was seen.
  
  
  CONCLUSIONS
  PAM therapy was associated with symptomatic improvement and vertebral modeling in children with CRMO. We suggest that children with bone pain and/or spinal involvement be considered for PAM therapy early after diagnosis.
authors.affiliation: Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Helena
authors.initials: H
authors.lastname: Gleeson
authors.forename: Esko
authors.initials: E
authors.lastname: Wiltshire
authors.forename: Julie
authors.initials: J
authors.lastname: Briody
authors.forename: Jill
authors.initials: J
authors.lastname: Hall
authors.forename: Jeff
authors.initials: J
authors.lastname: Chaitow
authors.forename: David
authors.initials: D
authors.lastname: Sillence
authors.forename: Christopher
authors.initials: C
authors.lastname: Cowell
authors.forename: Craig
authors.initials: C
authors.lastname: Munns
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015519:Bone Density; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010019:Osteomyelitis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D000077268:Pamidronate; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D016103:Spinal Fractures; D013131:Spine / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D004164:Diphosphonates; D000077268:Pamidronate