A proposed treatment scheme for chronic recurrent multifocal osteomyelitis (CRMO): a case series of nine patients

Results The median age of symptom onset was 8,2 years, while the patients were diagnosed to have CRMO at a median of 10 years of age. Eight out of nine patients presented with extremity pain, while five of the patients had back pain on presentation. Eight out of nine patients presented with extremity pain, while five had back pain on presentation. The patients had a median of three lesions at the time of diagnosis. There was sacroiliitis in seven patients. Four out of nine patients were treated with nonsteroidal antiinflammatory drugs (NSAID) and methotrexate (MTX). Five patients did not respond to these treatments, thus etanercept therapy was started at an initial dose of 0,8 mg/ kg/week after a median of 24 months from diagnosis. Acute phase reactants returned to normal, physician and patient/parent visual analogue scales significantly improved in all patients after etanercept treatment. We were able to show healing of lesions in imaging that correlated with the improvement of VAS and pain in the patients, suggesting that anti-TNF was effective on the bone inflammation. We have extended the time interval between two doses of etanercept from one week to two weeks after six months of remission with maintenance of the complete response in four of these patients.