Analysis of the fecal and oral microbiota in chronic recurrent multifocal osteomyelitis

Arthritis Res Ther. 2022 Feb 22;24(1):54. doi: 10.1186/s13075-021-02711-8.


Background: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory bone disease for which a lack of bacterial involvement is a key diagnostic feature to distinguish it from other symptomatically related diseases. However, the growing evidence suggesting an involvement of the host-associated microbiota in rheumatic disorders together with the now wide accessibility of modern culture-independent methods warrant a closer examination of CRMO.

Methods: In this study, we show through bacterial 16S rRNA gene profiling that numerous features of the oral- and fecal microbial communities differentiate children with and without CRMO.

Results: Notably, communities in diseased children are characterized by a lack of potential probiotic bacteria in the fecal community and an overabundance of known pathobionts in the oral microbial communities. Of special interest is the HACEK group, a set of commonly known oral pathogens that are implicated in the development of several acute and chronic diseases such as osteitis and rheumatoid arthritis. Furthermore, we observe that gut bacterial communities in the diseased children appear to reflect an altered host physiology more strongly than the oral community, which could suggest an oral disease origin followed by propagation and/or responses beyond the oral cavity.

Conclusions: Bacterial communities, in particular the oral microbiota, may serve as an indicator of underlying susceptibility to CRMO, or play a yet undefined role in its development.

Keywords: CMO; CNO; CRMO; Chronic multifocal osteomyelitis; Chronic non-bacterial osteomyelitis; Chronic recurrent multifocal osteomyelitis; HACEK; Microbiome; Pediatric bone inflammation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Chronic Disease
  • Humans
  • Microbiota* / genetics
  • Osteitis*
  • Osteomyelitis* / diagnosis
  • RNA, Ribosomal, 16S / genetics


  • RNA, Ribosomal, 16S

Supplementary concepts

  • Chronic recurrent multifocal osteomyelitis