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Musculoskeletal
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Non-Trauma
Infection
Conditions of Unknown Etiology
Chronic Recurrent Multifocal Osteomyelitis
Chronic Recurrent Multifocal Osteomyelitis
Lauren M. Ladd, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Chronic recurrent multifocal osteomyelitis (CRMO)

            • Synonyms

              • Chronic nonbacterial osteomyelitis (CNO), nonbacterial osteomyelitis (NBO), chronic symmetric osteomyelitis

            • Definitions

              • Aseptic autoinflammatory bone disease, generally in children and adolescents and most commonly multifocal
              • CRMO is multifocal version of CNO; terms occasionally used interchangeably in literature

            IMAGING

            • General Features

              • Radiographic Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  Selected References

                                  1. Capponi M et al: Assessment of disease activity using a whole-body MRI derived radiological activity index in chronic nonbacterial osteomyelitis. Pediatr Rheumatol Online J. 19(1):123, 2021
                                  2. Zhao DY et al: Chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO). J Transl Autoimmun. 4:100095, 2021
                                  3. Mahady S et al: Clinical and diagnostic considerations for atypical, adult onset presentation of chronic recurrent multifocal osteomyelitis (CRMO). Case Rep Rheumatol. 2019:8206892, 2019
                                  4. Hofmann SR et al: Chronic recurrent multifocal osteomyelitis (CRMO): presentation, pathogenesis, and treatment. Curr Osteoporos Rep. 15(6):542-54, 2017
                                  5. Handly B et al: Bisphosphonate therapy for chronic recurrent multifocal osteomyelitis. Skeletal Radiol. 42(12):1741-2, 1777-8, 2013
                                  6. Iyer RS et al: Chronic recurrent multifocal osteomyelitis: review. AJR Am J Roentgenol. 196(6 Suppl):S87-91, 2011
                                  7. Fritz J et al: Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data. Radiology. 252(3):842-51, 2009
                                  8. Gikas PD et al: Nonbacterial osteitis: a clinical, histopathological, and imaging study with a proposal for protocol-based management of patients with this diagnosis. J Orthop Sci. 14(5):505-16, 2009
                                  9. Khanna G et al: Imaging of chronic recurrent multifocal osteomyelitis. Radiographics. 29(4):1159-77, 2009
                                  10. Miettunen PM et al: Dramatic pain relief and resolution of bone inflammation following pamidronate in 9 pediatric patients with persistent chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J. 7:2, 2009
                                  11. Catalano-Pons C et al: Clinical outcome in children with chronic recurrent multifocal osteomyelitis. Rheumatology (Oxford). 47(9):1397-9, 2008
                                  12. Hobolth L et al: Chronic recurrent multifocal osteomyelitis demonstrated by Tc-99m methylene diphosphonate bone scan. Clin Nucl Med. 33(1):61-3, 2008
                                  13. Abril JC et al: Successful treatment of chronic recurrent multifocal osteomyelitis with indomethacin: a preliminary report of five cases. J Pediatr Orthop. 27(5):587-91, 2007
                                  14. Girschick HJ et al: Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated? Nat Clin Pract Rheumatol. 3(12):733-8, 2007
                                  15. Jurik AG: Chronic recurrent multifocal osteomyelitis. Semin Musculoskelet Radiol. 8(3):243-53, 2004
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Chronic recurrent multifocal osteomyelitis (CRMO)

                                            • Synonyms

                                              • Chronic nonbacterial osteomyelitis (CNO), nonbacterial osteomyelitis (NBO), chronic symmetric osteomyelitis

                                            • Definitions

                                              • Aseptic autoinflammatory bone disease, generally in children and adolescents and most commonly multifocal
                                              • CRMO is multifocal version of CNO; terms occasionally used interchangeably in literature

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • MR Findings

                                                  • Nuclear Medicine Findings

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Microscopic Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  Selected References

                                                                  1. Capponi M et al: Assessment of disease activity using a whole-body MRI derived radiological activity index in chronic nonbacterial osteomyelitis. Pediatr Rheumatol Online J. 19(1):123, 2021
                                                                  2. Zhao DY et al: Chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO). J Transl Autoimmun. 4:100095, 2021
                                                                  3. Mahady S et al: Clinical and diagnostic considerations for atypical, adult onset presentation of chronic recurrent multifocal osteomyelitis (CRMO). Case Rep Rheumatol. 2019:8206892, 2019
                                                                  4. Hofmann SR et al: Chronic recurrent multifocal osteomyelitis (CRMO): presentation, pathogenesis, and treatment. Curr Osteoporos Rep. 15(6):542-54, 2017
                                                                  5. Handly B et al: Bisphosphonate therapy for chronic recurrent multifocal osteomyelitis. Skeletal Radiol. 42(12):1741-2, 1777-8, 2013
                                                                  6. Iyer RS et al: Chronic recurrent multifocal osteomyelitis: review. AJR Am J Roentgenol. 196(6 Suppl):S87-91, 2011
                                                                  7. Fritz J et al: Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data. Radiology. 252(3):842-51, 2009
                                                                  8. Gikas PD et al: Nonbacterial osteitis: a clinical, histopathological, and imaging study with a proposal for protocol-based management of patients with this diagnosis. J Orthop Sci. 14(5):505-16, 2009
                                                                  9. Khanna G et al: Imaging of chronic recurrent multifocal osteomyelitis. Radiographics. 29(4):1159-77, 2009
                                                                  10. Miettunen PM et al: Dramatic pain relief and resolution of bone inflammation following pamidronate in 9 pediatric patients with persistent chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J. 7:2, 2009
                                                                  11. Catalano-Pons C et al: Clinical outcome in children with chronic recurrent multifocal osteomyelitis. Rheumatology (Oxford). 47(9):1397-9, 2008
                                                                  12. Hobolth L et al: Chronic recurrent multifocal osteomyelitis demonstrated by Tc-99m methylene diphosphonate bone scan. Clin Nucl Med. 33(1):61-3, 2008
                                                                  13. Abril JC et al: Successful treatment of chronic recurrent multifocal osteomyelitis with indomethacin: a preliminary report of five cases. J Pediatr Orthop. 27(5):587-91, 2007
                                                                  14. Girschick HJ et al: Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated? Nat Clin Pract Rheumatol. 3(12):733-8, 2007
                                                                  15. Jurik AG: Chronic recurrent multifocal osteomyelitis. Semin Musculoskelet Radiol. 8(3):243-53, 2004