CRMO Calculator

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📄 Terms & Conditions for CNO or CRMO Calculator * This field is required.By using this tool, you acknowledge and agree to the following: 1. This tool is intended for informational and preliminary screening purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. 2. Completion of this assessment does not constitute a formal diagnosis of Chronic Nonbacterial Osteomyelitis (CNO) or Chronic Recurrent Multifocal Osteomyelitis (CRMO). 3. All information provided through this tool is based on the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) classification criteria for pediatric CNO and is intended for use by healthcare professionals, researchers, or individuals under the supervision of a licensed medical provider. 4. By using this assessment, you consent to the collection of your de-identified data for quality improvement and usage tracking purposes, in accordance with applicable privacy and ethical guidelines. If you choose to provide contact information, it may be used to follow up about your experience with the tool. 5. The organization hosting this form assumes no responsibility or liability for any actions taken or decisions made based on the results of this assessment. The tool is provided “as is” without warranties of any kind, either express or implied, including but not limited to fitness for a particular purpose or accuracy of results. 6. Users are strongly encouraged to consult a qualified healthcare provider for a comprehensive evaluation and diagnosis. By proceeding, you confirm that you have read, understood, and agree to these terms.
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The first three questions will determine if you are eligible to use the calculator. For primary care physicians looking for more information, please refer to this resource detailing the flow of a CRMO referral. Diagnostic tests ordered by physicians may include but are not limited to the following:- Complete blood cell count (CBC) with differential count - Alkaline phosphatase (ALP) - Vitamin C - Vitamin D - Parathyroid Hormone (PTH) - Calcium - Phosphorus - Lactate dehydrogenase (LDH) - Uric acid - Erythrocyte sedimentation rate (ESR) - C reactive protein (CRP) - Blood culture or other tests concerning infection - Bone biopsy and/or bone marrow biopsy if indicated - Radiograph (X ray), advanced imaging such as MRI - Magnetic resonance imaging (MRI) – whole body MRIs are the most helpful in the diagnosis and treatment of CRMO
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✅ Step 1 Inclusion Criteria* This field is required.Please check all items that are applicable to you or your patient. ALL the following conditions must be met to proceed with this calculator/the classification criteria.
🦴 Bone pain and/or musculoskeletal functional limitation lasting 6 weeks or longer
👶 Age of onset under 18 years
⚠️ Abnormal findings from radiograph and/or advanced imaging, including MRI, CT, bone scintigraphy at nonarthritic bone sites
⬆️ All of above
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🚫 Step 2 Exclusion Criteria* This field is required.If any of the first four conditions below apply, the patient does not meet the classification criteria. Otherwise, please select "None of Above".
🧬 Confirmatory evidence of a mimicker disease (e.g., infection, malignancy)
🩸 Platelet count less than 100,000 per mm³
⚠️ Pathological serum lactate dehydrogenase (LDH) concerning for malignancy
💊 Complete and sustained clinical and laboratory response to antimicrobial treatment alone
🙅 None of Above
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1. What was the patient’s age at the onset of symptoms?* This field is required.
👶 3 years or older → 17 points
🍼 Under 3 years → 0 points
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2. Prior to diagnosis of CRMO, has the patient been diagnosed with any of the following (coexisting conditions prior to diagnosis)?* This field is required.
💩 Inflammatory bowel disease (IBD) → 9 points
✨ Cutaneous condition (without IBD) → 8 points
🦿 Axial arthritis (without CNO-associated cutaneous condition or IBD) → 5 points
🚫 None → 0 points
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3. Has the patient experienced a fever 🤒🌡️ (oral/temporal temperature above 38°C) not related to common infections?* This field is required.
No → 8 points
Yes → 0 points
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4. Sites of bone 🦴 lesions based on imaging* This field is required.What is the site of bone lesion distribution?
Clavicle and/or mandible → 16 points
Sites other than clavicle, mandible, skull, or hand → 9 points
Skull or hand without clavicle or mandible → 0 points
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5. Distribution pattern of bone lesions based on imaging* This field is required.What is the pattern of bone lesion distribution?
Multifocal lesions (in ≥2 bones) with symmetrical pattern (bilateral involvement of at least one bone) → 9 points
Multifocal without symmetrical pattern of bone involvement → 7 points
Unifocal without whole-body imaging such as WBMRI, PET/CT performed → 3 points
Unifocal with whole-body imaging performed → 0 points
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6. Hemoglobin level 🩸* This field is required.What is the patient's hemoglobin (Hb) level? (normal range varies by age)
10 g/dL or higher → 8 points
Less than 10 g/dL → 0 points
Not done → 0 points
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7. Erythrocyte sedimentation rate 🧪* This field is required.What is the patient's ESR result? (ESR, normal range: 0-20 mm/h)
Less than 60 mm/hour → 8 points
60 mm/hour or higher → 0 points
Not done → 0 points
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8. C-Reactive protein 🧫 (CRP, normal range: 0-10 mg/L)* This field is required.What is the patient's CRP result?
Less than 30 mg/L → 8 points
30 mg/L or higher → 0 points
Not done → 0 points
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9. Bone biopsy findings* This field is required.What did the bone biopsy show? Inflammation includes: the presence of neutrophils, lymphocytes, monocytes, plasma cells, etc.
Signs of inflammation AND fibrosis → 17 points
Signs of fibrosis only → 11 points
Signs of inflammation only → 9 points
No signs of inflammation or fibrosis → 0 points
Not done → 0 points
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🧮 Score Summary🔹 Total Score ≥ 55: ✅ Based on the total score, the patient meets the classification criteria for CNO/CRMO. 🔹 Total Score < 55: ❌ Based on the total score, the patient does not meet the classification criteria for CNO/CRMO.
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Summary of Assessment and Results

Score Summary

Your score: {Score} points

Step 3 Scoring Section Breakdown

1. Age at Symptom Onset: {typeA14} points

2. Coexisting Conditions Prior to Diagnosis: {2Prior} points

3. Fever: {3Has} points

4. Sites of Bone Lesions (based on Imaging): {sitesOf24} points

5. Distribution Pattern of Bone Lesions: {5Distribution} points

6. Hemoglobin Level: {distributionPattern} points

7. Erythrocyte Sedimentation Rate (ESR): {hemoglobinLevel} points

8. C-Reactive Protein (CRP): {erythrocyteSedimentation} points

9. Bone Biopsy Findings: {creactiveProtein} points

If total score < 55: X Based on the total score, the patient does not meet the classification criteria for CNO/CRMO.

If total score ≥ 55: √ Based on the total score, the patient meets the classification criteria for CNO/CRMO.
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❌ Not Eligible for CRMO Classification Scoring

Based on your responses, the patient does not meet the necessary entry criteria or meets one or more exclusion criteria according to the EULAR/ACR classification standards for Chronic Nonbacterial Osteomyelitis (CNO) / Chronic Recurrent Multifocal Osteomyelitis (CRMO).

As a result, the CRMO scoring assessment is not applicable at this time.

If you have any questions about these criteria or believe an error was made during the assessment, we encourage you to consult with a healthcare provider or pediatric rheumatologist for a comprehensive clinical evaluation.
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📢 Notice About Submission Limits

Due to current funding limitations, this platform can only support up to 100 submissions per month.

If you experience issues submitting the form, it may be because we have temporarily reached the monthly submission limit.

💖 Your support can help us expand this tool’s accessibility.
If you would like to help, please consider making a donation to support the maintenance and growth of this platform.

🙏 Thank you for your understanding and support.

💖DONATE💖

💙 Every donation helps increase the monthly submission limit beyond 100. 💙
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💡Suggestions and Feedback ✍️We are always looking to improve this self-assessment tool. If you have any suggestions, comments, or feedback about your experience, please share them below. Your input helps us make this tool better for future users.
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Reference: EULAR/ACR classification criteria for paediatric CNO/CRMO
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⚠️ Final Reminder (Legal & Clinical Disclaimer)⚠️ Important Reminder This tool is intended for educational and research purposes only. It does not provide a medical diagnosis or treatment recommendation. Results should not be used as a substitute for professional medical advice, diagnosis, or care. By using this form, you acknowledge that any decisions made based on its results are at your own discretion and risk. Please consult a qualified healthcare provider for a comprehensive clinical evaluation.
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🎉 Thank You! & 📬 Contact Us

Your responses have been submitted successfully. Thank you for using this tool. If you have any questions, please feel free to reach out.

📧 Email: crmoresearch@seattlechildrens.org

🏥 Institution: Seattle Children's Hospital

Please feel free to check our CRMO guild via https://give.seattlechildrens.org/campaign/crmo-warriors-guild/c467210
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