Hirano Daishi, Chiba Kosuke, Yamada Saya, Ida Hiroyuki
Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.
Pediatr Int. 2017 Apr;59(4):506-508. doi: 10.1111/ped.13236.
Chronic recurrent multifocal osteomyelitis (CRMO) primarily affects children and adolescents, and is characterized by episodic sterile osteomyelitis over several years. No definitive treatment is available. Non-steroidal anti-inflammatory drugs (NSAID) are common first-line agents, but provide limited improvement in bone pain and do not affect disease duration. Several agents are utilized in the case of non-response to NSAID, including corticosteroids, methotrexate, and tumor necrosis factor-blocking agents. Bisphosphonates are increasingly being used. Most case series involve cyclic i.v. pamidronate, but this restricts the social lives of children and their families. Although oral medication has advantages over cyclic i.v. infusion because it does not require repeated hospital admissions, there have been no reports on treatment with oral bisphosphonates, such as alendronate, in pediatric CRMO patients. This case report describes the use of oral bisphosphonate as an alternative treatment in CRMO patients in whom standard therapy has failed.
慢性复发性多灶性骨髓炎（CRMO）主要影响儿童和青少年，其特征是多年来反复发作无菌性骨髓炎。目前尚无确切的治疗方法。非甾体类抗炎药（NSAID）是常见的一线用药，但对骨痛的改善有限，且不影响病程。在对NSAID无反应的情况下，会使用多种药物，包括皮质类固醇、甲氨蝶呤和肿瘤坏死因子阻断剂。双膦酸盐类药物的使用越来越多。大多数病例系列涉及静脉注射帕米膦酸的周期性治疗，但这限制了儿童及其家庭的社交生活。尽管口服药物相对于静脉周期性输注有优势，因为它不需要反复住院，但尚无关于儿科CRMO患者使用口服双膦酸盐（如阿仑膦酸钠）治疗的报道。本病例报告描述了在标准治疗失败的CRMO患者中使用口服双膦酸盐作为替代治疗的情况。
