Learning objectives
To understand the aetiology of chronic recurrent osteomyelitis (CRMO) and SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome.
To be able to distinguish key imaging features of aseptic inflammatory bone disease in different age groups.
To quickly sift out CRMO and SAPHO from other causes of osteomyelitis.
Background
Chronic recurrent multifocal osteomyelitis (CRMO) as a type or another designation of CNO (chronic non-bacterial osteomyelitis) is a rare aseptic inflammatory disorder that primarily affects children and adolescents, with prevalence ranging from 1:160,000 to 1:2,000,000 [9]. CRMO is considered to be the paediatric form of the adult SAPHO syndrome, which stands for synovitis, acne, pustulosis, hyperostosis, and osteitis [4].
It is believed that CRMO/SAPHO are induced by Propionibacterium acnes infection, which in genetically predisposed individuals results in an impaired immune reaction with overproduction of IL-1β....
Findings and procedure details
3 steps to WHO?
CRMO usually affects children on average 10 yo with predilection to girls (twice as high as boys). SAPHO syndrome usually affects adults (defined by us as completed skeletal growth). More than ⅔ of CNO patients are female [4].
CRMO or SAPHO syndrome may coexist with autoinflammatory diseases, for example inflammatory bowel diseases, giant cell vasculitis or granulomatosis with polyangiitis.
Sporadically, CRMO may be part of syndromes, such as Majeed syndrome, Sweet syndrome or PAPA syndrome.
3 steps to WHERE?
Inflammation can...
Conclusion
Despite the rare occurrence of CRMO / SAPHO, properly planned imaging and laboratory diagnostics paired with a knowledge of typical imaging features allow differentiation with diseases that may give a similar clinical picture, avoiding delayed diagnosis or unnecessary medical procedures.
Personal information and conflict of interest
M. N. Byrdy-Daca:
Nothing to disclose
P. Palczewski:
Nothing to disclose
M. Duczkowski:
Nothing to disclose
J. Świątkowski:
Nothing to disclose
K. Piłat:
Nothing to disclose
K. Błasińska:
Nothing to disclose
I. Sudoł-Szopińska:
Nothing to disclose
M. Gołębiowski:
Nothing to disclose
References
Andronikou S, Mendes da Costa T, Hussien M, Ramanan AV. Radiological diagnosis of chronic recurrent multifocal osteomyelitis using whole-body MRI-based lesion distribution patterns. Clin Radiol. 2019 Sep;74(9):737.e3-737.e15.
Berthelot JM, Corvec S, Hayem G. SAPHO, autophagy, IL-1, FoxO1, and Propionibacterium (Cutibacterium) acnes. Joint Bone Spine. 2018 Mar;85(2):171-176.
Depasquale R, Kumar N, Lalam RK, Tins BJ, Tyrrell PN, Singh J, Cassar-Pullicino VN. SAPHO: What radiologists should know. Clin Radiol. 2012 Mar;67(3):195-206.
Girschick, H., Finetti, M., Orlando, F., Schalm, S., Insalaco, A., Ganser, G.et al. The multifaceted presentation...