Case 46 of the ASAS Online Case Library // CNO, CRMO, or atypical axSpA? скачать в хорошем качестве

Case 46 of the ASAS Online Case Library // CNO, CRMO, or atypical axSpA?

ASAS Online Case Library – Case 46 | Chronic back pain with fluctuating spinal inflammation: CNO vs infection? In this episode of the ASAS Online Case Library, Prof. Kay G. Hermann (Berlin, Germany) discusses Case 46 together with Prof. Denis Poddubnyy (Toronto, Canada). We walk through a fascinating long-term course in a 60-year-old woman with chronic back pain starting in her early 50s, elevated inflammatory markers, and imaging findings that raise an important—and very real—diagnostic dilemma: infection vs immune-mediated inflammation. The case highlights how careful, pattern-based MRI interpretation (including disc signal changes, erosions, sclerosis/ankylosis, and soft-tissue assessment) plus longitudinal follow-up can shift the differential and support the final working diagnosis. What you’ll learn in this case • How to approach “red-flag” spinal MRI patterns that can mimic infection • Why follow-up imaging can be the key to confident interpretation • Imaging clues that help differentiate septic spondylodiscitis / TB-like infection from chronic non-infectious osteitis • A practical rheumatology perspective: labeling, treatment logic, and why some patients may be managed pragmatically as axial SpA when escalation is needed Case snapshot (clinical) • 60-year-old woman, chronic back pain onset ~53 years • Pain not classically inflammatory; fluctuating course • HLA-B27 negative • CRP persistently elevated (fluctuating over years) Imaging snapshot (high level) • SI joints on radiographs: no typical structural sacroiliitis • Spine: localized destructive/erosive changes with inflammatory signal on MRI, initially raising concern for infection • Follow-up: spontaneous improvement without specific antimicrobial therapy, later a new inflammatory flare at a different level—supporting immune-mediated disease • Final conclusion discussed: CNO (chronic non-infectious osteitis/osteomyelitis; spectrum historically designated as SAPHO/CRMO/CMO) ▶ View/scroll through the full case (ASAS Online Case Library): https://cases.asas-group.org/501121.html About the ASAS Online Case Library The ASAS Online Case Library is a curated collection of real-world spondyloarthritis and differential diagnosis cases designed for learning and discussion. You can scroll through cases and review imaging step by step. Speakers • Prof. Kay G. Hermann – Musculoskeletal Radiologist, Berlin • Prof. Denis Poddubnyy – Rheumatologist, Toronto Disclaimer This video is for medical education only and does not constitute medical advice. Patient details are presented in an anonymized/educational format. The ASAS Online Case Library is based on BerlinCaseViewer technology. Create a free account and dive into the full case series: 🌐 https://cases.asas-group.org/ #ASAS #Spondyloarthritis #AxialSpA #MSKRadiology #Rheumatology #SpineMRI #CNO #CaseBasedLearning