Eighty-five percent of the CRMO cases have occurred in girls with a median onset age of 10 years old.
Elevated TNF-[alpha] (> 25 pg/ml) occurs in 66% of cases of CRMO, (1) and an increase in acute phase protein (1), (2) suggests a flare-up.
No similarity exists between CRMO and tuberculous spondylitis, in which infection begins on the anterior parts of vertebral bodies and progresses to the intervertebral disc.
A bone biopsy is necessary for the differential diagnosis of CRMO in order to exclude malignancy and infection, and pyogenic osteomyelitis, if found, is a reliable indicator of this disease.
The empirical diagnostic criteria for CRMO includes the following: multifocal bone lesions, a clinical course extended for months with remissions and exacerbations, a lack of response to antimicrobial treatment, and osteolytic-sclerotic bone lesions on X-ray.
1) Although the study involving TNF-[alpha] was not placebo-controlled, sufficient evidence still exists to justify the use of bisphosphonates and TNF-[alpha] blockers (1) in for the treatment of CRMO when the use of NSAIDs and steroids has failed.
Unfortunately, the small number of clinical trials involving CRMO limits the use of new management approaches.
A follow-up study on 23 children with CRMO over a five-year period showed that most were able to complete their schooling, get jobs, and have some emotional stability.