Spinal disorders have been found to be more common in CRMO patients than previously thought

Spinal disorders have been found to be more common in CRMO patients than previously thought

New research presented this week at ACR Convergence 2022, the annual meeting of the American College of Rheumatology, shows that spinal disorders, once considered rare in chronic recurrent multifocal osteomyelitis, affect up to 10-35% of patients and are asymptomatic in a third (Abstract #1942).

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease that primarily affects young girls, although it can also affect boys. Long-term clinical outcomes for most children with CRMO are generally good. However, the widespread use of whole-body MRI has led to increased reports of spinal disorders in CRMO patients with varying degrees of severity and vertebral fractures. Although the reported incidence of spinal disorders is 10 to 35%, little is known about risk factors for this disorder. The researchers conducted this study to characterize the clinical features of spinal disorders and identify patients at risk of CRMO who require more frequent screening and immediate therapeutic interventions to prevent fractures and deformities.

Using a retrospective chart review, researchers identified 36 cases of spinal disease in CRMO patients based on MRI findings and compared them to 36 controls (CRMO patients without spinal disease). Most patients with spinal disorders were Caucasian and 57% were boys. The majority (92%) had thoracic vertebral involvement, 20% had advanced compression fractures (vertebra plana), and 42% had an associated autoimmune disease.

Almost half had no back pain at the start of CRMO, while 69% complained of back pain shortly before they were diagnosed with a spinal disorder. More than a third (31%) were asymptomatic, with spinal disease incidentally detected during whole-body MRI. Night pain and sleep disturbances were significantly higher compared to controls. More than a third of patients were taking nonsteroidal anti-inflammatory drugs (NSAIDs) when they developed spinal disease, but the majority reported pain and poor disease control despite medication.

Since we only have a few previous studies, the results were not expected, but in retrospect made a lot of sense. Nevertheless, the finding of a higher proportion of men with spinal disorders in CRMO is new and surprising. This may reflect the fact that men are more likely to develop severe disease complicating CRMO compared to women and may indicate the need for more frequent screening and treatment protocols for men with CRMO. This would be another area of ​​research to better understand the disease.”

Shima Yasin, MD, MSc, assistant professor of pediatrics and rheumatology, University of Iowa Carver College of Medicine and lead author of the study

She adds that complaints of back pain, nighttime pain and sleep disturbances are risk factors and should prompt immediate screening for spinal disorders in CRMO patients. Despite resistance from some insurers, Dr. Yasin that all CRMO patients should have a full-body MRI every six months and more often if there are any changes.

"We have no serum or urine biomarkers that have been proven to assess disease activity. MRIs are very sensitive in detecting active lesions and guiding treatment. In patients with asymptomatic lesions, the only way to prevent deterioration and progression is to detect lesions using MRIs to begin early and initiate treatment," says Dr. Yasin.

"At our center, we have created a protocol called CRMO Whole-Body MRI STIR [short tau inversion recovery] that is faster and very informative in CRMO cases. This protocol saves time and may be more cost-effective. Based on this and other studies, we encourage all providers to provide whole-body MRIs of confirmed CRMO cases for close monitoring and therapeutic decision making receive."

Dr. Yasin adds that this study is just a starting point. Because CRMO is so rare, it is difficult for a single center to treat enough patients to answer research questions.

"We hope to enroll more CRMO patients in our study to better understand the disease and treat it effectively to improve outcomes. Patient participation is crucial; collaboration with our colleagues would be extremely helpful," says Dr. Yasin.

Source:

American College of Rheumatology

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