Istanbul Goztepe Prof.Dr.Suleyman Yalcin City Hospital, Department of Orthopaedics, Istanbul, Turkey.
University of Health Sciences, Ümraniye Education and Research Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey.
J Orthop Sci. 2023 Mar;28(2):438-445. doi: 10.1016/j.jos.2021.11.009. Epub 2021 Dec 8.
Chronic recurrent multifocal osteomyelitis (CRMO) is not a well known disorder among nonpediatricians. The aim of this study is to retrospectively evaluate the clinical outcomes of twenty-two CRMO patients presenting to two referral centres.
This retrospective study included twenty-two children (12 males, 10 females; mean age 13 years; range 7-17 years). The diagnosis was based on clinical, radiological, and pathological findings. Data were retrieved from hospital charts.
The mean delay in diagnosis was 26 months (range, 0-96 months). The mean follow-up after diagnosis was 27.4 months (range, 6-47 months). Symptoms included pain, limping, local swelling, morning stiffness, and fever. 18 patients had multifocal and 4 patients had unifocal disease. Bone lesions were detected with whole-body or local MRI (Magnetic Resonance Imaging). The mean number of bone lesions was 2.5 (range, 1-8). Ten cases underwent biopsy to exclude malignancy and infection. Prior to diagnosis, cast immobilization or curettage was erroneously performed in four patients. One patient suffered from vertebral compression fracture. There is no growth disturbance or deformity in any patient.
This study demonstrated that early recognition of the disease can be improved by using Bristol criteria which should be evaluated by a multidisciplinary team rather than one single specialist. In this way, the reliability of these criteria is improved and the treatment could be given earlier with decreased delay in diagnosis. This multidisciplinary approach is also important for decision for biopsy, timely aggressive medical treatment, and follow-up of the disease to minimise possible complications.
慢性复发性多灶性骨髓炎（CRMO）在非儿科医生中并不为人熟知。本研究旨在回顾性评估 22 例就诊于两个转诊中心的 CRMO 患者的临床结局。
这项回顾性研究纳入了 22 名儿童（男 12 例，女 10 例；平均年龄 13 岁；范围 7-17 岁）。诊断基于临床、放射学和病理学发现。数据从病历中提取。
平均诊断延迟时间为 26 个月（范围，0-96 个月）。诊断后平均随访时间为 27.4 个月（范围，6-47 个月）。症状包括疼痛、跛行、局部肿胀、晨僵和发热。18 例为多灶性，4 例为单灶性。骨病变通过全身或局部 MRI（磁共振成像）检测。平均骨病变数为 2.5 个（范围，1-8 个）。10 例患者行活检以排除恶性肿瘤和感染。在诊断前，4 例患者错误地接受了石膏固定或刮除术。1 例患者发生了椎体压缩性骨折。无患者出现生长障碍或畸形。
本研究表明，通过使用多学科团队而非单一专家评估布里斯托标准，可以提高对疾病的早期认识。通过这种方式，可以提高这些标准的可靠性，并更早开始治疗，减少诊断延迟。这种多学科方法对于决定是否进行活检、及时积极的药物治疗以及疾病的随访也很重要，可以最大限度地减少可能的并发症。
