Background/Purpose: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, non-infectious inflammatory bone disorder in children. Knowledge about the disorder is limited secondary to its rare prevalence, often resulting in delayed diagnosis and unnecessary treatments. The purpose of this study is to report on one of the largest cohorts yet gathered for CRMO in order to provide more information about the presentation, diagnosis, and treatment.

Methods: Retrospective chart review was performed in 57 patients diagnosed with suspected CRMO (n = 32) or biopsy-confirmed (n = 25) at our institution over a 2-year period at a single tertiary referral center. Collected outcome measures included: gender, age at symptom onset, age at CRMO diagnosis, prior diagnosis, secondary diagnosis, antibiotic use, radiographic, laboratory and histology findings, treatment type and outcome, complications, duration of symptoms, and follow-up.

Results: The average age at symptom onset was 6.1 years (Range: 0.7-12.3 years). The average delay in diagnosis was 13.4 months (Range: 0.8-62.5 months). Incorrect initial diagnoses occurred in 56% of cases, resulting in 44% of patients unnecessarily treated with antibiotics prior to CRMO diagnosis. In 63% of cases, normal radiographs at presentation were observed. However, abnormal MRI findings were present in 100% of patients, with multifocal involvement in 75% of those studies. Average white blood cell count, erythrocyte sedimentation rate, and C-reactive protein at presentation were 11,600 /µL, 40.1 mm/hr, and 2.4 mg/dL, respectively. All biopsy cultures were negative. Non-steroidal anti-inflammatory drugs (NSAIDs) provided complete symptomatic relief in 66% of patients, while 33% of patients required further treatment with methotrexate, steroids and/or TNF inhibitors. 

Conclusion: Awareness of defining features of CRMO such as indolent onset of pain, multifocal involvement, presence of early MRI findings, inflammatory pathologic findings with sterile cultures, and marked clinical response to NSAIDs may assist with earlier diagnosis. Understanding of the clinical presentation of CRMO will assist healthcare providers in avoiding unnecessary treatments and lead to a quicker resolution of symptoms in patients diagnosed with this rare disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/presentation-diagnosis-and-treatment-of-chronic-recurrent-multifocal-osteomyelitis/