From the Research
For pediatric patients with Chronic Recurrent Multifocal Osteomyelitis (CRMO), the recommended liquid NSAID option is ibuprofen suspension (100mg/5mL) at 30-40mg/kg/day divided into 3-4 doses (maximum 2400mg/day). This recommendation is based on the most recent and highest quality study available, which suggests that ibuprofen is a safe and effective option for pediatric patients with CRMO 1. The following key points should be considered when prescribing NSAIDs for CRMO:
- Ibuprofen is often the first-line choice due to its favorable safety profile and availability.
- Naproxen suspension (125mg/5mL) at 10-20mg/kg/day divided into 2 doses (maximum 1000mg/day) may also be considered, but it has a higher risk of major toxicity compared to ibuprofen 2.
- Treatment duration is typically long-term, with regular monitoring of symptoms and inflammatory markers to assess response.
- Periodic liver and kidney function tests are recommended during extended therapy.
- NSAIDs work by inhibiting cyclooxygenase enzymes, reducing prostaglandin production and decreasing inflammation in affected bones.
- If symptoms persist despite adequate NSAID therapy for 4-6 weeks, consultation with a pediatric rheumatologist is warranted to consider additional treatment options such as bisphosphonates or biologics. Some studies have shown that bisphosphonates, such as pamidronate, can be effective in treating CRMO, especially in cases refractory to NSAIDs 3. However, the use of bisphosphonates should be carefully considered and monitored due to potential side effects. In terms of cardiovascular safety, celecoxib has been shown to be noninferior to ibuprofen or naproxen, but this may not be directly applicable to pediatric patients with CRMO 4. Overall, the choice of NSAID and treatment duration should be individualized based on the patient's response and tolerance to the medication.