Chronic recurrent multifocal osteomyelitis (CRMO) – advancing the diagnosis

Abstract

BackgroundChronic recurrent multifocal osteomyelitis (CRMO) is a little known inflammatory bone disease occurring primarily in children and adolescents. Delays in referral and diagnosis may lead to prolonged courses of antibiotics with in-patient care, unnecessary radiation exposure from multiple plain radiographs or bone scans and repeated surgery including bone biopsies.Children (aged < 18 years) diagnosed with CRMO between January 2005 and December 2012, reviewed at Bristol Royal Hospital for Children were included and all available data collected. Information regarding CRMO was sent to all orthopaedic surgeons in the region in 2009.The aim of the study was to examine the features of the cohort, to examine the length of time to diagnosis and to explore the criteria used for diagnosis with and without biopsy.FindingsOver an 8 year period, 41 patients were diagnosed with CRMO. Symptom onset occurred at a median of 9 years of age and time to diagnosis had a median of 15 months (range 0–92). Correlation coefficient analysis for time to diagnosis by year showed statistical significance with a decreasing trend. From the cohort data, diagnostic criteria were developed; applied retrospectively, 34 (83 %) children may have been diagnosed using the criteria, without a biopsy.ConclusionsThe data suggest that increasing knowledge of this condition may shorten time to diagnosis. Use of the Bristol diagnostic criteria by an experienced clinician may obviate the need for biopsy in some patients.

P35 Improved survival in rare recessive osteogenesis imperfecta through multidisciplinary team support and early bisphosphonate use

“…Diagnosis of CRMO was then confirmed by a specialist from tertiary hospital on bone biopsy of lytic lesions. Discussion CRMO is an uncommon diagnosis, cases are reported to have months to years' time interval between presentation to diagnosis (2). Through this case, we aim to raise awareness amongst clinicians to shorten time to make diagnosis and to avoid unnecessary admissions.…”

Chronic non-bacterial osteitis: imaging review and management implications

“…Score values between 29-38 were indeterminate and require close clinical monitoring 18 also created the Bristol diagnostic criteria based off a cohort study from children diagnosed with CRMO at Bristol Royal Hospital for Children to reduce delay in diagnosis. 19 Based off this criteria, CNO can be diagnosed with the 1) presence of typical clinical findings, 2) the presence of typical radiological findings and either 3)>1 bone lesion with CRP<30 g/L or 4) unifocal disease and/or CRP>30 with negative bacterial growth on bone biopsy, 19 (Figures 1-4). c. Figure 4C: Axial T1 shows cortical thickening and bone marrow edema.…”

“…20 While patients may initially present with a single site of painful bone involvement, studies have shown that patient have, on average, ~3.5 bony lesions. [15][16][17][18][19][20][21] To evaluate these silent lesions, bone scintigraphy and/or whole-body MRI are used. Bone scintigraphy uses Technetium 99 m to identify areas of bone remodeling.…”

A Pilot Study of Infrared Thermal Imaging to Detect Active Bone Lesions in Children With Chronic Nonbacterial Osteomyelitis

“…Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease, which may evolve to bony destruction and deformity. The diagnosis of CNO is based on clinical bone pain, lytic and/or sclerotic bone lesion by radiography, and/or edema on magnetic resonance imaging (MRI) once malignancy and infection have been excluded . The disease is most common in long bones .…”