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Chronic Recurrent Multifocal Osteomyelitis
Arthur B. Meyers, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Chronic recurrent multifocal osteomyelitis (CRMO)
              • Synonyms

                • Chronic nonbacterial osteomyelitis, subacute & chronic recurrent osteomyelitis, chronic multifocal symmetric osteomyelitis, chronic multifocal cleidometaphyseal osteomyelitis of childhood
              • Definitions

                • Idiopathic disorder with multifocal nonpyogenic inflammatory bone lesions & relapsing/remitting course
              • Associated Syndromes

                • May be in spectrum of diseases with SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis)
                • Chronic sclerosing osteitis of tubular diaphyses may also be in spectrum of CRMO & SAPHO
                  • Chronic sclerosing osteomyelitis of GarrĂ© may be synonymous when involving long bones
                • Associated with other inflammatory conditions [e.g., psoriasis, inflammatory bowel disease (IBD)]

              IMAGING

              • General Features

                • Radiographic Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Laboratory Tests

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Leclair N et al: Whole-body diffusion-weighted imaging in chronic recurrent multifocal osteomyelitis in children. PLoS One. 11(1):e0147523, 2016
                                              2. Voit AM et al: Whole-body magnetic resonance imaging in chronic recurrent multifocal osteomyelitis: clinical longterm assessment may underestimate activity. J Rheumatol. 42(8):1455-62, 2015
                                              3. Falip C et al: Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review. Pediatr Radiol. 43(3):355-75, 2013
                                              4. Nguyen MT et al: The SAPHO syndrome. Semin Arthritis Rheum. 42(3):254-65, 2012
                                              5. Eisenstein EM et al: Combination therapy with methotrexate and etanercept for refractory chronic recurrent multifocal osteomyelitis. J Rheumatol. 38(4):782-3, 2011
                                              6. Eleftheriou D et al: Biologic therapy in refractory chronic non-bacterial osteomyelitis of childhood. Rheumatology (Oxford). 49(8):1505-12, 2010
                                              7. Costelloe CM et al: Imaging chronic sclerosing osteitis of the diaphysis of tubular bones. AJR Am J Roentgenol. 192(3):736-42, 2009
                                              8. 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
                                              9. Khanna G et al: Imaging of chronic recurrent multifocal osteomyelitis. Radiographics. 29(4):1159-77, 2009
                                              10. Rozin AP: SAPHO syndrome: is a range of pathogen-associated rheumatic diseases extended? Arthritis Res Ther. 11(6):131, 2009
                                              11. Suresh S et al: Unveiling the 'unique bone': a study of the distribution of focal clavicular lesions. Skeletal Radiol. 37(8):749-56, 2008
                                              12. Deutschmann A et al: Successful treatment of chronic recurrent multifocal osteomyelitis with tumor necrosis factor-alpha blockage. Pediatrics. 116(5):1231-3, 2005
                                              13. Jurik AG et al: MRI in chronic recurrent multifocal osteomyelitis. Skeletal Radiol. 26(4):230-8, 1997
                                              14. Manson D et al: Physeal involvement in chronic recurrent multifocal osteomyelitis. Pediatr Radiol. 20(1-2):76-9, 1989
                                              15. Mortensson W et al: Chronic recurrent multifocal osteomyelitis in children. A roentgenologic and scintigraphic investigation. Acta Radiol. 29(5):565-70, 1988
                                              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

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Chronic recurrent multifocal osteomyelitis (CRMO)
                                                          • Synonyms

                                                            • Chronic nonbacterial osteomyelitis, subacute & chronic recurrent osteomyelitis, chronic multifocal symmetric osteomyelitis, chronic multifocal cleidometaphyseal osteomyelitis of childhood
                                                          • Definitions

                                                            • Idiopathic disorder with multifocal nonpyogenic inflammatory bone lesions & relapsing/remitting course
                                                          • Associated Syndromes

                                                            • May be in spectrum of diseases with SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis)
                                                            • Chronic sclerosing osteitis of tubular diaphyses may also be in spectrum of CRMO & SAPHO
                                                              • Chronic sclerosing osteomyelitis of GarrĂ© may be synonymous when involving long bones
                                                            • Associated with other inflammatory conditions [e.g., psoriasis, inflammatory bowel disease (IBD)]

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • MR Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Laboratory Tests

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Leclair N et al: Whole-body diffusion-weighted imaging in chronic recurrent multifocal osteomyelitis in children. PLoS One. 11(1):e0147523, 2016
                                                                                          2. Voit AM et al: Whole-body magnetic resonance imaging in chronic recurrent multifocal osteomyelitis: clinical longterm assessment may underestimate activity. J Rheumatol. 42(8):1455-62, 2015
                                                                                          3. Falip C et al: Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review. Pediatr Radiol. 43(3):355-75, 2013
                                                                                          4. Nguyen MT et al: The SAPHO syndrome. Semin Arthritis Rheum. 42(3):254-65, 2012
                                                                                          5. Eisenstein EM et al: Combination therapy with methotrexate and etanercept for refractory chronic recurrent multifocal osteomyelitis. J Rheumatol. 38(4):782-3, 2011
                                                                                          6. Eleftheriou D et al: Biologic therapy in refractory chronic non-bacterial osteomyelitis of childhood. Rheumatology (Oxford). 49(8):1505-12, 2010
                                                                                          7. Costelloe CM et al: Imaging chronic sclerosing osteitis of the diaphysis of tubular bones. AJR Am J Roentgenol. 192(3):736-42, 2009
                                                                                          8. 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
                                                                                          9. Khanna G et al: Imaging of chronic recurrent multifocal osteomyelitis. Radiographics. 29(4):1159-77, 2009
                                                                                          10. Rozin AP: SAPHO syndrome: is a range of pathogen-associated rheumatic diseases extended? Arthritis Res Ther. 11(6):131, 2009
                                                                                          11. Suresh S et al: Unveiling the 'unique bone': a study of the distribution of focal clavicular lesions. Skeletal Radiol. 37(8):749-56, 2008
                                                                                          12. Deutschmann A et al: Successful treatment of chronic recurrent multifocal osteomyelitis with tumor necrosis factor-alpha blockage. Pediatrics. 116(5):1231-3, 2005
                                                                                          13. Jurik AG et al: MRI in chronic recurrent multifocal osteomyelitis. Skeletal Radiol. 26(4):230-8, 1997
                                                                                          14. Manson D et al: Physeal involvement in chronic recurrent multifocal osteomyelitis. Pediatr Radiol. 20(1-2):76-9, 1989
                                                                                          15. Mortensson W et al: Chronic recurrent multifocal osteomyelitis in children. A roentgenologic and scintigraphic investigation. Acta Radiol. 29(5):565-70, 1988