Job-Deslandre C, Krebs S, Kahan A: Chronic recurrent multifocal osteomyelitis: five-year outcomes in 14 pediatric cases. Joint Bone Spine 68: 245, 2001.
El-Shanti HI, Ferguson PJ: Chronic recurrent multifocal osteomyelitis: a concise review and genetic update. Clin Orthop Relat Res 462: 11, 2007.
Mandell GA, Contreras SJ, Conard K, et al: Bone scintigraphy in the detection of chronic recurrent multifocal osteomyelitis. J Nucl Med 39: 1778, 1998.
Girschick H, Huppertz H-I, Harmsen D, et al: Chronic recurrent multifocal osteomyelitis in children: diagnostic value of histopathology and microbial testing. Hum Pathol 30: 59, 1999.
Girschick H, RaabP, Surbaum S, et al: Chronic non-bacterial osteomyelitis in children. Ann Rheum Dis 64: 279, 2005.
Catalano-Pons C, Comte A, Wipff J, et al: Clinical outcome in children with chronic recurrent multifocal osteomyelitis. Rheumatology (Oxford) 47: 1397, 2008.
Brown T, Wilkinson R: Chronic recurrent multifocal osteomyelitis. Radiology 166: 493, 1988.
Chick C, Singh V: Chronic recurrent multifocal osteomyelitis of the 1st metatarsal bone: a case report. J Orthop Surg 17: 119, 2009.
Jurik A, Helmig O, Ternowitz T, et al: Chronic recurrent multifocal osteomyelitis: a follow-up study. J Pediatr Orthop 8: 49, 1988.
Martin J, Desoya R, O'Sullivan M, et al: Chronic recurrent multifocal osteomyelitis spinal involvement and radiographic appearance. Br J Rheumatol 35: 1019, 1996.
Jansson A, Renner ED, Ramser J, et al: Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients. Rheumatology (Oxford) 46: 154, 2007.
Haydar AA, Gikas P, Saifuddin A: Chronic recurrent multifocal osteomyelitis: a case report and role of whole-body MRI. Clin Radiol 64: 641, 2009.
Armitage P, Berry G: “Kappa Measure of Agreement,” in Statistical Methods in Medical Research, 3rd Ed, p 447, Blackwell Science Ltd, Oxford, England, 1994.
Rogers S: England and Wales' population broken down by race, sex, age and place. The Guardian website. Available at: http://www.guardian.co.uk/news/datablog/2010/feb/26/population-ethnic-race-age-statistics. Accessed February 2012.
Fritz J, Tzaribatchev N, Claussen CD, et al: Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data. Radiology 252: 842, 2009.
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory condition. The lesions are reported to present most frequently in the long bones. This study aimed to review the presenting features of CRMO in a cohort of children diagnosed as having CRMO and to compare the level of agreement between the clinical and published diagnostic criteria.
A case notes review was undertaken of patients with a clinical diagnosis of CRMO. Patients were younger than 16 years at the time of diagnosis. Features were identified in each patient that agreed or disagreed with the published diagnostic criteria. The location of bone lesions in the lower limb at onset and disease progression was recorded.
A total of 37 patients were included. There was a high prevalence in white individuals. Agreement with the diagnostic criteria of Jansson et al and El-Shanti and Ferguson was poor, with levels of agreement of 40.5% and 43%, respectively, and low kappa scores (κ = 0.07 and 0.09, respectively). The lower limb was affected in 49% of patients at onset and in 72% overall.
This study presents one of the largest published cohorts of pediatric patients with CRMO and also presents racial/ethnic group data that have not previously been reported in other studies. Despite being a condition considered to affect the metaphysis of long bones, the ankle area and foot bones were also frequently affected. The agreement between the clinical diagnosis and the published diagnostic criteria was weak.