Background/Purpose:

Recurrent Multifocal Osteomyelitis (CRMO) is an aseptic inflammatory bone disease that typically affects the metaphases of the long bones. It affects children, adolescents and young adults. The main presenting feature is local bone pain and/or swelling. It has a protracted course for years with exacerbations and improvement with treatment. The diagnosis of CRMO can be made on clinical presentation and confirmed by magnetic resonance imaging (MRI) and bone biopsy. On MRI examination there are mostly multifocal, and symmetrical lesions (especially in the metaphysics of tubular long bones, flat bones and spine). CRMO can be associated with skin, gut involvement and other rheumatological conditions.

Methods:

We reviewed reports of whole body MRI scans of 300 children, done in last 5 years between January 2012 and December 2016. Patients with MRI scan results consistent with CRMO were included in the study. Retrospective analysis of electronic clinical records of these patients was done and we recorded their clinical symptoms at presentation, any associated illnesses and Family history. Histopathological/ microbiological findings of bone biopsies were reviewed to rule out haematological, infectious or malignant causes.

Results:

Twenty three patients were included in the study.Five were male and eighteen female. These children were 8-18 years old with median age of 15 years. The clinical features of CRMO at first presentation are as under.All patients presented with musculoskeletal symptoms like backache, clavicular involvement, or joint pain.Five patients (21%) presented with abdominal pain and blood in stool. These patients were diagnosed as Inflammatory bowel disease(IBD) on the endoscopic and histopathological findings. Three patients presented with gut symptoms first and later on they developed joint pain and swelling. However one patient presented with joint pain to start with and diagnosed as CRMO. This patient later on developed gut symptoms. One patient presented with simultaneous onset of diarrhoea, blood in stool, abdominal pain and joint pain with swelling.There is significantly more raised inflammatory markers in the IBD/CRMO group than in the CRMO alone groupHistory of trauma was present in 13% of patients who presented with musculoskeletal symptoms.Hyper mobility was present in four patients. Juvenile idiopathic arthritis was an associated diagnosis in three patients. One patient was diagnosed as Enthesitis related arthritis (ERA) and CRMO overlap. Psoriasis, palmoplantar pustulosis , acne, atopic dermatitis, dermatitis artefacta were the skin conditions associated with CRMO but not in IBD/CRMO overlap group.There was family history of connective tissue disorders in six (26%) out of 23 patients, including systemic lupus erythematosus, ankylosing spondylitis, Crohn’s disease, rheumatoid arthritis, antiphospholipid syndrome and psoriasis. Only one patient (4%)out of 23 was HLAB27 positive.

Conclusion:

CRMO has a varied presentation. We identified that CRMO is associated with IBD in 21% of the patients. Further studies are needed to identify whether the CRMO/IBD overlap group has a separate phenotype.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/phenotype-of-chronic-recurrent-multifocal-osteomyelitis-in-a-tertiary-referral-centre-the-great-ormond-street-hospital-experience/