Nearly one-third of patients with spine disease asymptomatic at CRMO diagnosis
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PHILADELPHIA — Nearly half of patients with spine disease reported no back pain at CRMO onset, and one-third were asymptomatic despite active lesions on whole body MRI at diagnosis, according to data presented at ACR Convergence 2022.
“Spine involvement in CRMO can lead to devastating complications such as fractures, permanent damages and long-term sequalae,” Shima Yasin, MD, MSc, an assistant professor at the University of Iowa Carver College of Medicine, said during a press conference.
To investigate the clinical and radiographic features of spine disease in patients with chronic recurrent multifocal osteomyelitis (CRMO), Yasin and colleagues conducted a large-scale, retrospective chart review. They first identified cases of CRMO with “any degree” of spine disease present, then matched those cases with an equal number of control patients with CRMO, but no spine disease. The authors extracted data from medical records and used Fischer exact and T.tests to make comparisons between patients.
In total, the analysis included 72 patients, 36 of which had at least some degree of spine disease based on MRI. The proportion of boys with spine disease was higher than that of girls with spine disease (57% vs. 47%). Additionally, 92% of patients with spine disease had thoracic vertebra involvements, and 20% had vertebra plana involvement. In 24% of patients with spine disease, there was also associated autoimmune disease. Finally, cases of spine disease did not present at significantly different ages in the CRMO and control groups.
According to study results, 47% of patients with spine disease did not have back pain at CRMO onset, and just 69% reported back pain prior to spine disease diagnosis. Yasin and colleagues noted that 31% of patients were asymptomatic, with spinal disease incidentally on whole body MRI.
The researchers also observed that 33% of patients were receiving NSAIDs when spinal disease developed, of whom 89% had reported pain and poor CRMO control; this “might suggest that treatment with NSAIDs might not be adequate for patients at risk of development for spine disease,” Yasin said.
“Our study shows insight to the risk factors for the development of spine disease in CRMO and really opens the door for more evidence-based guidelines and individualized treatment in CRMO,” she said. “Selecting patients at higher risk for development of spinal disease and screening them more frequently should really be the standard of care, and should really help decrease the risk of complications.”
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Yasin S. Abstract #1942. Presented at: ACR Convergence 2022; Nov. 10-14, 2022 (hybrid meeting).
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