Chronic Recurrent Multifocal Osteomyelitis: What is it and how Should it be Treated?

Hermann J Girschick; Christiane Zimmer; Guenter Klaus; Kassa Darge; Anke Dick; Henner Morbach


Nat Clin Pract Rheumatol. 2007;3(12):733-738. 

In This Article

Treatment and Management

There is a consensus that NSAIDs are beneficial for patients with CNO. Since naproxen is widely used,[4] it is important to recognize pseudoporphyria as a typical side effect of this drug.[20] A considerable number of patients receive antibiotics; however, these agents should be discontinued if the biopsy proves to be sterile. DMARDs, particularly sulfasalazine, are usually considered in patients with frequent relapses or if NSAIDs must be discontinued because of ineffectiveness or adverse effects. Oral glucocorticoids can be used as a bridging agent for a limited period of time or low-dose concomitant treatment. In this patient, the combination of a DMARD and prednisone seemed reasonable because the disease manifestations were severe. If chronic inflammatory bowel disease is present concomitantly with CNO, the treatment strategies must focus on both clinical entities. For CNO, multiple therapies have been used, including immunosuppressants (corticosteroids, methotrexate and TNF blockers,[17])immunomodulators (intravenous immunoglobulins, interferon γ, interferon ∝, colchicine and dapsone) and hyperbaric oxygen, in addition to NSAIDs. A combination of azithromycin, calcitonin and bisphosphonates has also been tried.[21] Bisphosphonates or TNF blockers currently seem to be the next choice if the treatment concept mentioned above is unsuccessful. There is an urgent need for controlled and randomized trials that evaluate treatment strategies and compare their short- and long-term effects.


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