Voit Agnes M, Arnoldi Andreas P, Douis Hassan, Bleisteiner Felicitas, Jansson Moritz K, Reiser Maximilian F, Weckbach Sabine, Jansson Annette F
From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; Institute for Clinical Radiology, Ludwig Maximilians University of Munich, Munich; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; and the Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK.A.M. Voit*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; A.P. Arnoldi*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; H. Douis, MD, Department of Radiology, Royal Orthopaedic Hospital; F. Bleisteiner, MD; M.K. Jansson, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University; M.F. Reiser, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich; S. Weckbach*, MD, Institute for Clinical Radiology, Ludwig Maximilians University of Munich, and Diagnostic and Interventional Radiology, University Hospital Heidelberg; A.F. Jansson*, MD, Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig Maximilians University.
J Rheumatol. 2015 Aug;42(8):1455-62. doi: 10.3899/jrheum.141026. Epub 2015 May 15.
(1) To examine how many patients have clinically and/or radiologically active chronic recurrent multifocal osteomyelitis (CRMO) ≥ 10 years after first onset of symptoms, and (2) to compare clinical and whole-body magnetic resonance imaging (WB-MRI) findings.
Seventeen patients (82% women) who were diagnosed with childhood-onset CRMO at least 10 years (average 12) before reexamination were reevaluated. Patients completed a standardized questionnaire, and underwent clinical and laboratory investigation and WB-MRI. Clinical features were compared with imaging findings.
Five patients were found to be in clinical and radiological remission. One of these patients demonstrated 1 radiologically inactive lesion on WB-MRI. Four patients showed radiologically active lesions despite full clinical remission, 2 of them in 3 vertebral bodies. Spinal involvement in 6 patients (35%) caused vertebral compression fractures, vertebra plana, or vertebral hemifusion. Eight patients presented with ongoing clinical disease activity. When applying a CRMO activity score based on clinical and imaging findings, 2 patients were identified as having pain amplification. Overall, 22/55 known CRMO lesions were identified; 11 of them were radiologically active lesions. Additionally, 14 so far unknown clinically silent lesions were detected: 8 radiologically active lesions and 6 radiologically inactive lesions.
CRMO activity on longterm followup might have been underestimated. Our study demonstrates that clinical remission does not necessarily mean radiological remission. We therefore propose that all patients with CRMO, including patients in clinical remission, require longterm clinical followup and should undergo evaluation with WB-MRI on a regular basis until radiological remission or a steady state of disease is achieved.
（1）检查有多少患者在首次出现症状后≥10年患有临床和/或放射学上活跃的慢性复发性多灶性骨髓炎（CRMO），以及（2）比较临床和全身磁共振成像（WB-MRI）结果。
对17例患者（82%为女性）进行重新评估，这些患者在重新检查前至少10年（平均12年）被诊断为儿童期起病的CRMO。患者完成一份标准化问卷，并接受临床和实验室检查以及WB-MRI检查。将临床特征与影像学结果进行比较。
发现5例患者处于临床和放射学缓解状态。其中1例患者在WB-MRI上显示1个放射学不活跃病灶。4例患者尽管临床完全缓解，但仍显示放射学活跃病灶，其中2例累及3个椎体。6例患者（35%）的脊柱受累导致椎体压缩骨折、扁平椎体或椎体半融合。8例患者表现为持续的临床疾病活动。当应用基于临床和影像学结果的CRMO活动评分时，2例患者被确定为有疼痛放大现象。总体而言，共识别出55个已知CRMO病灶中的22个；其中11个为放射学活跃病灶。此外，还检测到14个此前未知的临床无症状病灶：8个放射学活跃病灶和6个放射学不活跃病灶。
CRMO的长期随访活动可能被低估了。我们的研究表明，临床缓解并不一定意味着放射学缓解。因此，我们建议所有CRMO患者，包括临床缓解的患者，都需要长期临床随访，并应定期接受WB-MRI评估，直到达到放射学缓解或疾病稳定状态。
