Date: Sunday, November 8, 2020
Session Type: Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Chronic nonbacterial osteomyelitis (CNO)/chronic recurrent multifocal osteomyelitis (CRMO) predominantly affects children and young adults. Classification criteria are not available and diagnostic criteria that have been suggested have not been validated. We previously identified candidate items for the development of classification criteria.
Methods: We aimed to refine candidate items for pediatric classification criteria for CNO by comparing clinical, laboratory and imaging features of CNO against mimicking conditions. International multicentre collection of clinical and investigational features of cases with CNO or mimicker diseases with at least 12 months follow-up was conducted through a REDCap online database. Prevalence ratios of each collected item between CNO and mimickers were calculated. A p value of <.05 was considered significant.
Results: 450 cases were collected from 20 centers in 7 countries and 4 continents. Cases were filtered based on indicated confidence levels of diagnosis for CNO or mimickers using a cut-off of +/- 2 (moderately confident). 264 (59%) CNO cases and 145 (32%) mimicker controls were used for analysis. 41 (9%) cases were excluded. Key findings are summarized in Table 1.
When compared to mimicker diagnoses, CNO patients were predominantly female, more frequently exhibited intermittent versus continued pain (especially of neck, back and upper torso), but less commonly had fever. Clavicular swelling was more common in CNO, while active arthritis was less common as compared to controls. CNO patients more frequently had whole body imaging (usually whole-body MRI). Symmetric patterns of bone lesions were more common in CNO. CNO frequently involved the thoracic spine, clavicle, sternum/manubrium, pelvic bones, bilateral femur, bilateral tibia, unilateral fibula, and foot bones. Imaging features that are concerning for infection or malignancy (including cortical bone disruption, disorganized bone formation, mass structure, marrow infiltrate, abscess or geographic appearance) were less common in CNO. Lastly, complete and sustained response to antibiotic treatment was less frequent in CNO patients.
Conclusion: Using a case-based approach, key features of CNO were identified to support the development of classification criteria. Next steps will include expert panel discussions and a 1000Minds exercise.
To cite this abstract in AMA style:Zhao Y, Naden R, Oliver M, Wang Z, Wu E, Aguiar C, Akikusa J, Basaran O, Cain K, Capponi M, Donaldson N, Fox E, Insalaco A, Jansson A, Kaya Akca U, Lee T, Marrani E, Mahmood K, Murray E, Nuruzzaman F, Onel K, Pardeo M, Potts L, Rogers N, Schnabel A, Simonini G, Soep J, Stern S, Theos A, Zhang Y, Ferguson P, Hedrich C, Dedeoglu F, Girschick H, Laxer R, Ozen S. Comparison of Clinicopathologic and Imaging Features Between Chronic Nonbacterial Osteomyelitis and Its Mimickers: A Multi-national 450 Case-Control Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/comparison-of-clinicopathologic-and-imaging-features-between-chronic-nonbacterial-osteomyelitis-and-its-mimickers-a-multi-national-450-case-control-study/. Accessed September 27, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-clinicopathologic-and-imaging-features-between-chronic-nonbacterial-osteomyelitis-and-its-mimickers-a-multi-national-450-case-control-study/