Clinical score for nonbacterial osteitis in children and adults

Abstract

Objective. To accurately differentiate nonbacterial osteitis (NBO) from other bone lesions by applying a clinical score through the use of validated diagnostic criteria.Methods. A retrospective study was conducted to assess data on patients from a pediatric clinic and an orthopedic tertiary care clinic, using administrative International Classification of Diseases codes as well as laboratory and department records from 1996 to 2006. Two hundred twenty-four patients older than age 3 years who had either NBO (n ‫؍‬ 102), proven bacterial osteomyelitis (n ‫؍‬ 22), malignant bone tumors (n ‫؍‬ 48), or benign bone tumors (n ‫؍‬ 52) were identified by chart review. Univariate logistic regression was used to determine associations of single risk factors with a diagnosis of NBO, and multivariable logistic regression was used to assess simultaneous risk factor associations with NBO. Conclusion. The proposed scoring system helps to facilitate the diagnostic process in patients with suspected NBO. Use of this system might spare unnecessary invasive diagnostic and therapeutic procedures. Results. NBO was best predicted by a normal blood cell count (odds ratio

Typical Patterns of Bone Involvement in Whole-Body MRI of Patients with Chronic Recurrent Multifocal Osteomyelitis (CRMO)

“…Regarding the differential diagnoses, we would therefore consider the WB-MRI of these patients as suspicious but less specific for CRMO. Although each single MR finding is not entirely specific to CRMO, our study indicates that combinations and typical patterns of lesions are important diagnostic clues towards the right clinical diagnosis [17,18]. Together with its superior sensitivity for the total number, the location and the possible symmetry of lesions, WB-MRI appears to be more suitable as a major radiological criterion for the diagnosis of CRMO than radiographs which were negative in 50 % of cases.…”

“…Patients had presented with pain in their lower extremities (27 patients), their upper extremities and shoulder girdle (12), their lower back and hips (11), and/or in their back (17) including limited mobility or swelling of painful joints. 26 patients had a history of multifocal or changing complaints, 27 had unifocal symptoms.…”

Combination Therapy with Methotrexate and Etanercept for Refractory Chronic Recurrent Multifocal Osteomyelitis: Figure 1.

“…Direct biopsy was not performed at request of the family. However, the clinical and radiographic findings were compatible with presumed CRMO 3 . A bone marrow aspirate showed normal cytology.…”

Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

“…However, the use of a clinical chronic non-bacterial osteitis score may avoid biopsies in 25 % of cases [18,19]. Histologically, CRMO begins as an acute inflammatory process with a predominance of polymorphonuclear lymphocytes, and at later stages, feature predominantly lymphocytes in the inflammatory infiltrates [20].…”