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Reumatol Clin. 2017 May 19. pii: S1699-258X(17)30090-6. doi: 10.1016/j.reuma.2017.04.002. [Epub ahead of print]

Recurrent multifocal osteomyelitis in children: Experience in a tertiary care center.

[Article in English, Spanish]

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UGC Pediatría, Hospital Materno-Infantil de Málaga, Málaga, España. Electronic address:
Unidad de Reumatología Pediátrica, Hospital Materno-Infantil de Málaga, Málaga, España.
UGC Pediatría, Hospital Materno-Infantil de Málaga, Málaga, España.
UGC Reumatología, Hospital Regional Universitario de Málaga, Málaga, España.



Chronic recurrent multifocal osteomyelitis is a rare aseptic bone inflammation that affects pediatric patients. Its management and treatment have not yet been standardized.


Retrospective, descriptive study of patients under 14 years of age diagnosed with chronic nonbacterial osteomyelitis (CNBO) in a tertiary hospital. We included patients diagnosed over the last 6 years (2010-2015) who met the Jansson criteria. The clinical and radiological characteristics of CNBO were analyzed, as was the outcome after different therapeutic options.


We report 12 patients, with a mean age of 11 years (±1.6 standard deviation [SD]) and female predominance (10:2). The mean number of foci was 3.5 (±2.2 SD). The most common locations were ankle (58%), clavicle (50%), sternum (33%) and hip (25%). The mean disease duration was 10.5 months (±10.3 SD), and the median time to diagnosis was 2.38 months (range 0.17-16). Bone scintigraphy detected asymptomatic foci in 33% and we detected lytic lesions in 50% through magnetic resonance imaging. Biopsy was performed in 60%; 2/12 (16%) were associated with inflammatory disease and 1/12 (8.3%) later developed lymphoma. In all, 58% received antibiotic therapy with little response, 100% anti-inflammatory agents, 50% systemic corticosteroids, 41.6% methotrexate/pamidronate and 16% anti-tumor necrosis factor (TNF) α. The mean duration of treatment was 14.8 months (±12.4 SD) and 66% had recurrences. Currently, 83% are in clinical remission without treatment.


When CNBO is refractory to treatment with anti-inflammatory drugs, intravenous pamidronate can be an alternative. Anti-TNF drugs can be considered in patients who fail with pamidronate, as can agents associated with other autoimmune conditions.


Children; Chronic recurrent multifocal osteomyelitis; Niños; Nonbacterial osteomyelitis; Osteomielitis multifocal crónica recurrente; Osteítis no bacteriana; Pamidronate; Pamidronato; Tratamiento antifactor de necrosis tumoral alfa; Tumor necrosis factor α inhibitor therapy

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