title: An Update on the Pathogenesis and Treatment of Chronic Recurrent Multifocal Osteomyelitis in Children.
abstract: Chronic recurrent multifocal osteomyelitis (CRMO), also known as chronic non-bacterial osteomyelitis (CNO), is a rare inflammatory disorder that primarily affects children. It is characterized by pain, local bone expansion, and radiological findings suggestive of osteomyelitis, usually at multiple sites. CRMO predominantly affects the metaphyses of long bones, but involvement of the clavicle or mandible are suggestive of the diagnosis. CRMO is a diagnosis of exclusion, and its pathogenesis remains unknown. Differential diagnosis includes infection, malignancies, benign bone tumors, metabolic disorders, and other autoinflammatory disorders. Biopsy of the bone lesion is not often required but could be necessary in unclear cases, especially for differentiation from bone neoplasia. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment. Alternative therapies have been used, including corticosteroids, methotrexate, bisphosphonates, and tumor necrosis factor (TNF)-α inhibitors. No guidelines have been established regarding diagnosis and treatment options. This manuscript gives an overview of the most recent findings on the pathogenesis of CRMO and clinical approaches for patients with the condition.
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34100, Trieste, Italy. andrea.taddio@burlo.trieste.it.|University of Trieste, Piazzale Europa, 1, 34100, Trieste, Italy. andrea.taddio@burlo.trieste.it.
authors.forename: Andrea
authors.identifier: http://orcid.org/0000-0001-6817-4953
authors.initials: A
authors.lastname: Taddio
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34100, Trieste, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Zennaro
authors.affiliation: Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", via dell'Istria 65/1, 34100, Trieste, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Pastore
authors.affiliation: Rheumatology Unit, Anna Meyer Children's Hospital, University of Florence, Viale Pieraccini 24, 50139, Florence, Italy.
authors.forename: Rolando
authors.initials: R
authors.lastname: Cimaz
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006801:Humans; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D012008:Recurrence; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014409:Tumor Necrosis Factor-alpha