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Pediatr Int 2021 Feb 10. Epub 2021 Feb 10.

Department of Clinical Sciences and Community Health, University of Milan, Italy, Milano.

Background: Whole Body Magnetic Resonance Imaging (WBMRI) is a multiregional imaging technique suitable to investigate the extent of multisystemic diseases without exposure to radiation, with a high sensitivity to bone alterations. The aim of our study was to evaluate the role of WBMRI in the workup of children with non-specific musculoskeletal features, and non-indicative laboratory and instrumental data, suspected to have a rheumatologic disease.

Methods: We retrospectively analysed medical records, including laboratory tests and radiological data of 34 children who have been evaluated due to non-specific musculoskeletal manifestations, for which a WBMRI was prescribed. Read More

Spine Deform 2020 10 18;8(5):1001-1008. Epub 2020 Apr 18.

Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.

Study Design: Retrospective case series.

Objectives: To describe how pediatric patients with spinal and pelvic osteomyelitis are diagnosed and treated and assess the diagnostic value of magnetic resonance imaging (MRI), needle aspiration biopsy (NAB), and blood cultures in this population. Spinal and pelvic osteomyelitis de novo are uncommon in children and minimal literature exists on the subject. Read More

Pediatr Rheumatol Online J 2020 Jan 15;18(1). Epub 2020 Jan 15.

Pediatric Oral and Maxillofacial Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.

Background: Studies evaluating treatment responses for chronic nonbacterial osteomyelitis (CNO) are lacking. We aimed to measure and compare response rates of medical treatments, time to response of medical treatments among patients with CNO of the mandible, and describe bacterial contamination rates from biopsy.

Methods: We conducted a retrospective chart review of all patients diagnosed with CNO of mandible between 2003 and 2017 and extracted demographic, clinical, laboratory, imaging and surgical data. Read More

Turk J Pediatr 2019 ;61(3):386-391

Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Sağ E, Sönmez HE, Demir S, Bilginer Y, Ergen FB, Aydıngöz Ü, Özen S. Chronic recurrent multifocal osteomyelitis in children: a single center experience over five years. Turk J Pediatr 2019; 61: 386-391. Read More

Rheumatol Int 2020 Jan 18;40(1):49-56. Epub 2019 Nov 18.

AlSabah Hospital, Al Asimah, Kuwait.

To define the spectrum and phenotypic characteristics of systemic autoinflammatory diseases (SAIDs) other than familial Mediterranean fever (FMF) in Arab children and to delineate diagnostic evaluation. Data retrospectively collected on patients with clinical and/or genetically proven SAIDs other than FMF at 10 tertiary Arab pediatric rheumatology clinics from 1990 to 2018. The collected data comprised the clinical findings and diagnostic evaluation including genetic testing, the provided treatment and the accrual damage related to SAIDs. Read More

Rheumatol Int 2020 Jan 2;40(1):115-120. Epub 2019 Aug 2.

Department of Infectious Diseases and Pediatric Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362 Of. 807, Santiago, 8330077, Chile.

Chronic nonbacterial osteomyelitis (CNO) is a primary autoinflammatory bone disease that presents more frequently in children and is characterized by inflammatory bone lesions in the absence of an infectious etiology. There is little information of this disease in Latin America. The objective of the study was to evaluate demographic, clinical, laboratory, imaging, histopathology characteristics, and treatment responses of pediatric CNO patients. Read More

Pediatr Rheumatol Online J 2019 Jul 23;17(1):49. Epub 2019 Jul 23.

Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University Graz, Graz, Austria.

Background: To compare clinical presentation, diagnostic and treatment strategies, and outcome between pediatric and adult patients with chronic non-bacterial osteomyelitis (CNO).

Methods: Retrospective single-centre comparative study of pediatric and adult patients diagnosed with chronic recurrent multifocal osteomyelitis (CRMO)/CNO or synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome treated at the Medical University of Graz.

Results: 24 pediatric patients diagnosed with CRMO/CNO and 10 adult patients diagnosed with SAPHO syndrome were compared. Read More

J Rheumatol 2019 11 15;46(11):1515-1523. Epub 2019 Apr 15.

From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Objectives: Chronic nonbacterial osteomyelitis (CNO) is a sterile inflammatory bone disorder with an unpredictable disease course. The objective was to assess clinical and radiological disease activity in children with CNO including response to early-onset pamidronate treatment.

Methods: A single-center retrospective study was conducted of children fulfilling the Bristol Criteria for CNO. Read More

World Allergy Organ J 2019 14;12(3):100019. Epub 2019 Mar 14.

Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Germany.

Background: Systemic autoinflammatory diseases (SAIDs) are rare debilitating disorders of which there is limited awareness and a significant delay in diagnosis. There is no uniform approach in the diagnosis and treatment of these disorders and the real life state of SAID patient care is poorly characterized. The aim of this study was to obtain data on the epidemiology, state of care and the perception of physicians who are involved in the care of SAID patients. Read More

J Shoulder Elbow Surg 2019 Jul 28;28(7):1411-1421. Epub 2019 Feb 28.

Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address:

Background: It is usually difficult to diagnose clavicular osteomyelitis (OM), and treatment is delayed because of its rarity. This study aimed to summarize clinical characteristics and treatment of this disease.

Methods: We searched the PubMed and Embase databases to identify English studies that reported on clavicular OM from January 1980 through December 2016. Read More

Turk J Pediatr 2019 ;61(6):879-884

Divisions Pathology, Ege University Faculty of Medicine, İzmir, Turkey.

Sözeri B, Aktay Ayaz N, Yıldız Atıkan B, Karadağ ŞG, Çakan M, Argın M, Sezak M. Clinical experiences in Turkish paediatric patients with chronic recurrent multifocal osteomyelitis. Turk J Pediatr 2019; 61: 879-884. Read More

Pediatr Rheumatol Online J 2018 Dec 14;16(1):78. Epub 2018 Dec 14.

Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.

Background: Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder that if left untreated can result in bone destruction and severe continuing pain due to persistent inflammation. The impact this chronic disease has on the daily lives of affected children and their families is not well known. The purpose of this study is to understand the disease burden and socioeconomic and psychological impact of CNO from the patients' and families' perspectives and identify areas of improvement for patient care and reduced disease burden based on patients' and families' responses. Read More

Indian J Orthop 2018 Nov-Dec;52(6):672-677

Pediatric Rheumatology Clinic, Indira Gandhi Institute of Child Health and Columbia Asia Hospital, Bengaluru, Karnataka, India.

Background: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare auto-inflammatory disease of the bone. It tends to be multifocal and usually the symptoms tend to run for months and years before diagnosis is usually made. The objective of our study was to understand the clinical presentation and short-term response to treatment of CRMO patients. Read More

Arthritis Care Res (Hoboken) 2019 11;71(11):1430-1435

Seattle Children's Hospital and University of Washington, Seattle.

Objective: Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease. An inexpensive and rapid imaging tool, infrared thermal imaging, was evaluated for its utility to detect active bone lesions in extremities of children with CNO.

Methods: Children with suspected active CNO and healthy controls were enrolled. Read More

J Postgrad Med 2018 Jul-Sep;64(3):170-173

Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Chronic nonbacterial osteomyelitis (CNO) is a little known autoinflammatory bone disorder primarily affecting children and sometimes young adults. Diagnosis is often delayed due to its varied and nonspecific initial symptoms. Very few cases are reported from India. Read More

Reumatol Clin 2018 Nov - Dec;14(6):334-338. Epub 2017 May 19.

UGC Pediatría, Hospital Materno-Infantil de Málaga, Málaga, España.

Introduction: Chronic recurrent multifocal osteomyelitis is a rare aseptic bone inflammation that affects pediatric patients. Its management and treatment have not yet been standardized.

Methods: Retrospective, descriptive study of patients under 14 years of age diagnosed with chronic nonbacterial osteomyelitis (CNBO) in a tertiary hospital. Read More

J Rheumatol 2017 07 1;44(7):1058-1065. Epub 2017 May 1.

From the Pediatric Rheumatology and Immunology Section, Department of Pediatrics, and Department of Radiology, and the Institute for Medical Informatics and Biometry, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.

Objective: The autoinflammatory bone disorder chronic nonbacterial osteomyelitis (CNO) covers a wide clinical spectrum, ranging from mild self-limited presentations to chronically active or recurrent courses, which are then referred to as chronic recurrent multifocal osteomyelitis (CRMO). Little is known about treatment options and longterm outcomes. We investigated treatment responses and outcomes in children with CNO. Read More

Int J Rheum Dis 2017 Sep 9;20(9):1286-1296. Epub 2016 Nov 9.

Section of Pediatric Rheumatology, Hamad General Hospital, Doha, Qatar.

Aim: We aim to report the clinical manifestations, genetic testing results, magnetic resonance imaging (MRI) findings and biologics used in the management of non-bacterial osteomyelitis in our center.

Methods: We conducted a retrospective review of medical records. A previously proposed classification was implemented as follows: chronic recurrent multifocal osteomyelitis (CRMO), chronic non-bacterial osteomyelitis (CNBO) and acute non-bacterial osteomyelitis. Read More

Pediatr Rheumatol Online J 2016 Aug 30;14(1):47. Epub 2016 Aug 30.

Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK.

Background: Chronic recurrent multifocal osteomyelitis (CRMO) is a little known inflammatory bone disease occurring primarily in children and adolescents. Delays in referral and diagnosis may lead to prolonged courses of antibiotics with in-patient care, unnecessary radiation exposure from multiple plain radiographs or bone scans and repeated surgery including bone biopsies. Children (aged < 18 years) diagnosed with CRMO between January 2005 and December 2012, reviewed at Bristol Royal Hospital for Children were included and all available data collected. Read More

J Breath Res 2016 Apr 19;10(2):021001. Epub 2016 Apr 19.

Department of Pediatrics, University Children's Hospital, Technical University Dresden, Dresden, Germany. Division of Pulmonary Medicine, University Children's Hospital, Technical University Dresden, Dresden, Germany. These authors contributed equally to this work.

We aimed to evaluate the fraction of exhaled nitric oxide (FENO50) and deaerated exhaled breath condensate pH (dEBCpH) as non-invasive markers of subclinical airway inflammation in pediatric patients with rheumatologic disorders. We determined FENO50 and dEBCpH in a prospective study spanning at least 12 months, comprising 85 pediatric patients with rheumatologic disorders, including juvenile idiopathic arthritis (JIA, n  =  63), chronic recurrent multifocal osteomyelitis (CRMO, n  =  6), systemic lupus erythematosus (SLE, n  =  3), juvenile dermatomyositis (JDM, n  =  1) and other rheumatic disorders (n  =  12). dEBCpH was determined once in a group of children without evidence of rheumatologic or pulmonary disease (controls, n  =  90). Read More

PLoS One 2016 22;11(1):e0147523. Epub 2016 Jan 22.

Department of Paediatric Radiology, Leipzig University Hospital, Leipzig, Germany.

Objective: Chronic recurrent multifocal osteomyelitis/ chronic non-bacterial osteomyelitis (CRMO/ CNO) is a rare auto-inflammatory disease and typically manifests in terms of musculoskeletal pain. Because of a high frequency of musculoskeletal disorders in children/ adolescents, it can be quite challenging to distinguish CRMO/ CNO from nonspecific musculoskeletal pain or from malignancies. The purpose of this study was to evaluate the visibility of CRMO lesions in a whole-body diffusion-weighted imaging (WB-DWI) technique and its potential clinical value to better characterize MR-visible lesions. Read More

An Pediatr (Barc) 2016 Jul 23;85(1):18-25. Epub 2015 Oct 23.

Unidad de Reumatología Pediátrica, Hospital Universitario 12 de Octubre, Madrid, España.

Introduction: Non-bacterial chronic osteomyelitis (NBCO) is an autoinflammatory disease that presents with recurrent bouts of bone inflammation in the absence of microbiological isolation. It is a diagnosis of exclusion. Its treatment was classically based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, although nowadays bisphosphonates or anti-tumour necrosis factor-α (anti-TNF) drugs are frequently used with good results. Read More

Rheumatology (Oxford) 2015 Sep 3;54(9):1688-91. Epub 2015 May 3.

Rheumatology Department, Princess Margaret Hospital for Children, Perth,

Objective: To describe the clinical features, management and outcome of 34 children with chronic recurrent multifocal osteomyelitis (CRMO) diagnosed at a single centre over 9 years.

Methods: All children identified with CRMO for the period 2005-13 were identified from a prospectively collected database, with additional data from hospital records.

Results: Thirty-four patients, 21 female and 13 male, were identified. Read More

Ortop Traumatol Rehabil 2014 May-Jun;16(3):297-305

Orthopaedic and Trauma Department, University Children's Hospital of Cracow, Poland.

Background: CRMO is characterized by chronic bone pain of recurrent nature. The onset is usually at the beginning of the second decade of life. Bony lesions may be visible on radiographs, although sometimes a CT or MRI scan is necessary to visualise them. Read More

Minerva Pediatr 2014 Jun;66(3):169-76

Unit of Pediatric Radiology Department of Radiology Geneva University Hospital HUG Geneva, Switzerland -

Aim: Whole-body MRI (WBMRI) is a non-irradiating imaging technique, suitable to investigate the extent of multisystemic diseases in pediatric patients. However its real impact on diagnosis and management of non-oncological pediatric diseases remains unclear. We present our experience of pediatric WBMRI in various pathologies. Read More

Acta Reumatol Port 2014 Jan-Mar;39(1):38-45

Aim: To report and describe a series of four cases of chronic recurrent multifocal osteomyelitis (CRMO) and to discuss therapeutic options, particularly bisphosphonate therapy.

Methods: Retrospective review of four CRMO cases in two Pediatric Units in Lisbon, between 2005 and 2010.

Results: Median age of first CRMO symptoms was 11. Read More

Autoimmunity 2014 Sep 10;47(6):389-94. Epub 2014 Apr 10.

Unit of Internal Medicine, Allergy and Clinical Immunology, Department of Medical Sciences "M. Aresu", University of Cagliari , Monserrato , Italy .

To assess whether the immune derangement previously observed in SAPHO syndrome could be linked to variations in blood TH1, TH2 or TH17 lymphocytes frequency. Seven SAPHO patients with a protracted course of the disease were studied ex-vivo for intracellular cytokines production by means of flow-cytometry and compared with matched groups of Psoriatic Arthritis patients and healthy controls. The Kruskal-Wallis test on the median of the three categories showed that there is a significant association between the TH17 levels and the category (p value = 0. Read More

Radiology 2009 Sep 30;252(3):842-51. Epub 2009 Jun 30.

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA.

Purpose: To describe whole-body magnetic resonance (MR) imaging appearance of chronic recurrent multifocal osteomyelitis (CRMO) and assess the role of MR imaging versus radiography in diagnosis of disease and correlation with clinical findings and laboratory data.

Materials And Methods: Institutional review board approved this retrospective HIPAA-compliant study; informed consent was waived. T1-weighted, short inversion time inversion-recovery, and contrast material-enhanced T1-weighted whole-body MR imaging was performed and two-plane radiographs, clinical findings, and laboratory data were reviewed in 13 children (median age, 13 years) with CRMO. Read More

Pediatr Rheumatol Online J 2009 Jan 12;7. Epub 2009 Jan 12.

Department of Pediatrics, Alberta Children's Hospital and University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada.

Background: Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory, non-infectious osteopathy that affects predominantly patients Read More

Rheumatology (Oxford) 2008 Sep 11;47(9):1397-9. Epub 2008 Jul 11.

Service de Pédiatrie Générale, Centre hospitalier d'Avignon, 305, rue Raoul Follereau, 84902 Avignon cedex 9, France.

Objective: To determine the clinical outcome of children with chronic recurrent multifocal osteomyelitis (CRMO).

Methods: We retrospectively reviewed clinical, biological and radiological data of children with CRMO at five French paediatric centres. Outcome data were obtained through review of hospital charts and questionnaires sent to all patients to assess disease activity and educational and vocational achievement. Read More