Chronic Nonbacterial Osteomyelitis (CNO): Chronic Recurrent Multifocal Osteomyelitis (CRMO); and Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis Syndrome (SAPHO)

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Acronym:
CNO/CRMO/SAPHO

SAID group:
Inflammatory Bone Diseases

Gene:
Currently unknown. No genetics tests available (link has OMIM info about genetic research for CRMO.)

Inheritance:
Currently unknown.

Ethnicity:
Affects all races, but the majority of patients have European ancestry. There are more female patients than males. [21] [22]

Frequency:
Unknown, but rare.

Timing of symptoms:
At least 6 months with chronic or relapsing symptoms. Often patients suffer for 7-25 years with symptoms. Many bone lesions heal completely. [19] [22]

Age of onset:
Mostly affects children – some adult onset. Peak incidence of flares is around 10 years of age. [22]

Skin cutaneous:
Some patients have acne, and/or pustulosis on the palms and/or soles of their extremities (palmoplantar pustulosis – often associated with SAPHO). 23% have psoriasis.[19] [22] [54]

Neurologic:
Fevers affect a number of patients during flares of CRMO. Other neurological symptoms are not noted. Some with impaired bone growth, or overall impaired growth.[19] [22] [54]

Auditory:
Not noted. [19] [21] [22] [54]

Ophthalamic:
Some cases of uveitis. [19]

Cardiopulmonary:
Not common–some patients also have ANCA+ vasculitis that can affect the lungs. [18] [54]

Abdominal:
Some patients also have inflammatory bowel diseases. [19]

Lymphatic:
Some cases of ANCA+ vasculitis that can affect the kidneys. [19]

Joints bones muscles cartilage:
Joint swelling, limp, severe bone pain over affected bones (mostly the long bones). Some have jawbone involvement. 2-18 bone lesions are commonly found. Earlier age of onset along with many bone lesions is associated with more severe disease. Bone biopsy and cultures show no infection. [19] [22] Chronic nonbacterial osteomyelitis (CNO) is considered part of the spectrum of bone diseases with CRMO and SAPHO, but may be more self-limiting, and less chronic than CRMO or SAPHO. [115]

Vasculitis:
Some with Takayasu arteritis, or ANCA+ vasculitis. [54]

Amyloidosis:
Not noted. [19] [22] [54]

Abnormal labs:
Whole body MRI can reveal multifocal bone lesions. [20] Normal or elevated WBC, ESR, CRP. [19], [22], [54] Radiographs may appear normal at the start of CNO/CRMO, but an MRI will detect lesions. [81]

Search Keywords:
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Photo credit:

CRMO: Pr Daniel Wendling (Service de Rhumatologie, Hôpital Jean Minjoz - Besançon) and Pr René-Marc Flipo (CHRU de Lille)

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