CRMO Explained: The Paediatric Bone Disease Everyone Misses

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The Paediatric Bone Disease Everyone Misses: CRMO Explained"

Are you a paediatrician, trainee, or medical student who cares for children with unexplained bone pain? Chronic Recurrent Multifocal Osteomyelitis (CRMO), also known as Chronic Non-bacterial Osteomyelitis (CNO), is a rare but important paediatric bone disease that is often misdiagnosed or overlooked. Missing CRMO can lead to delayed care and long-term complications for children with chronic bone pain.

In this video, I break down CRMO in paediatrics, covering the pathophysiology, presentation, diagnose, and manage CRMO. Learn how to distinguish CRMO from infection, malignancy, and other causes of paediatric bone pain. We need to rule out the differential dianosis. Early recognition is key to preventing permanent damage and improving outcomes for young patients.

What you’ll learn:

What is CRMO/CNO? Understand the pathophysiology of this autoinflammatory bone disease, who is most affected (typically girls aged 9-11), and why it’s often confused with bacterial osteomyelitis or malignancy.
When to suspect CRMO: Chronic, relapsing bone pain—often multifocal—in classic locations like the clavicle, metaphyses of long bones (femur, tibia), the spine, pelvis, jaw, ribs, hands, and feet. Associated symptoms may include swelling, tenderness, and links to other inflammatory conditions (psoriasis, IBD).
Diagnosing CRMO: Why CRMO is a diagnosis of exclusion, the importance of ruling out infection and malignancy, and which investigations to order. Learn about the role of blood tests (ESR, CRP), whole-body MRI (WBMRI) for detecting multifocal lesions, and when to consider a bone biopsy.
Management strategies: First-line treatment with NSAIDs, escalation to DMARDs, TNF-alpha inhibitors, or bisphosphonates for refractory or spinal disease. The importance of a multidisciplinary team in managing paediatric bone disease.
Prognosis and long-term outcomes: Early diagnosis and treatment can prevent severe complications like limb length discrepancy, vertebral fractures, and bone deformity. Most children do well with proper care, but vigilance is needed, especially with spinal or jaw involvement.
Key Takeaways for Paediatricians:

Always consider CRMO (CNO) in children with chronic or recurrent, unexplained bone pain.
Use whole-body MRI to uncover multiple bone lesions—clinical pain may be just the tip of the iceberg.
Rigorously exclude infection and malignancy before making a CRMO diagnosis.
Treat early and escalate as needed to prevent irreversible bone damage.
Educate families about the relapsing course, prognosis, and importance of follow-up.
If you found this CRMO/CNO video helpful, please like, subscribe, and share to raise awareness of paediatric bone disease. Share your experiences or questions about paediatric bone pain in the comments below!
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Disclaimer:
This presentation is for educational purposes only. The content is not a substitute for professional medical advice, diagnosis, or treatment from a qualified provider. It should not be used by non-medical personnel for self-diagnosis or treatment. Clinical guidelines and medical knowledge are subject to change. Always consult the most recent official publications for clinical decision-making. The views and opinions expressed in this presentation are my own and do not necessarily reflect the official policy or position of my employer or any affiliated institutions. I have no relevant financial conflicts of interest to disclose.