When Chronic recurrent multifocal osteomyelitis is a special form of osteomyelitis that is not caused by bacteria. The disease is characterized by the fact that it takes a chronic course. Chronic recurrent multifocal osteomyelitis is also known in many cases by the abbreviation CRMO. Basically, osteomyelitis is an inflammation of the bones, whereby the responsible germs cannot usually be determined.
What is Chronic Recurrent Multifocal Osteomyelitis?
The chronically recurrent multifocal osteomyelitis manifests itself in the majority of cases in the so-called metaphyses on the long tubular bones, the pelvis, the spine and the shoulder girdle. The disease was first described in 1972 by the doctor Andres Giedion.
Basically, chronic recurrent multifocal osteomyelitis is either a monofocal or a multifocal osteitis. The disease usually occurs in children or adolescents and has a relapsing course.
Basically, chronic recurrent multifocal osteomyelitis is a disease that occurs very rarely. The frequency of the disease in childhood patients is estimated at four in 1,000,000 people.
In the majority of cases, chronic recurrent multifocal osteomyelitis appears for the first time in the age of ten. A disease with similar symptoms exists in adult patients. This is not, however, a chronic recurrent multifocal osteomyelitis, but the so-called SAPHO syndrome.
In principle, it is not yet possible to make any reliable statements with regard to the causes of the development of chronically recurrent multifocal osteomyelitis. This is because medical research has not yet found sufficient results with regard to the pathogenesis of the disease.
However, there is a presumption that a special immunopathological process is involved in the development of chronic recurrent multifocal osteomyelitis. In addition, genetic factors are also under discussion about the causes of the disease. In addition, latent infections may also be partly responsible for the development of chronically recurrent multifocal osteomyelitis in some cases.
The causes of chronic recurrent multifocal osteomyelitis have not yet been conclusively clarified. However, the disease is closely linked to psoriatic arthritis and arthritis. Indications of mutations as the cause of chronic recurrent multifocal osteomyelitis have not yet been found. It is also still unclear whether chronic recurrent multifocal osteomyelitis is an autoimmune disease.
Symptoms, ailments & signs
Chronic recurrent multifocal osteomyelitis is associated with a multitude of different complaints and symptoms. These focus primarily on the metaphyses of the long tubular bones. Symptoms around the vertebral body, foot or pelvis are less common.
In addition, there are numerous cases of inflammation in the neighboring joints. In addition, about 10 to 20 percent of all affected patients develop a so-called palmoplantar pustulosis in childhood. This disease is a special type of psoriasis. Generally, chronic recurrent multifocal osteomyelitis occurs in several attacks. This leads to symptoms such as chronic pain, restricted mobility and local swelling.
There are many different methods of investigation that can be used to diagnose chronic recurrent multifocal osteomyelitis. The treating specialist selects the use of the examination methods after weighing up the individual case. As a rule, the diagnosis of chronic recurrent multifocal osteomyelitis is made after various radiological, clinical and possibly also histological examinations.
Chronic recurrent multifocal osteomyelitis can be diagnosed by exclusion. The anamnesis, which the attending physician carries out with the sick patient, usually comes first. This is usually followed by x-ray and laboratory tests. It is also possible to carry out a magnetic resonance tomography.
In most cases, the whole body is examined. In the context of the differential diagnosis, chronic recurrent multifocal osteomyelitis must primarily be differentiated from juvenile idiopathic, bacterial osteomyelitis, arthritis or hypophosphatasia. Ewing sarcoma, osteosarcoma and Langerhans cell histiocytosis must also be excluded. In addition, patients should be examined for aseptic bone necrosis.
This disease is usually chronic because it is not triggered by bacteria. The complaints and complications can be quite different. In most cases, they show up on the long bones. Inflammation also occurs in the joints and can lead to restricted mobility and severe pain.
The pain can occur either in the form of resting pain or in the form of relapses. Often those affected suffer from a general feeling of illness and swelling in the affected areas. If the restriction of movement becomes relatively severe, the person affected can also be dependent on walking aids. The quality of life decreases significantly as a result of the disease.
A treatment is carried out causally, whereby mainly drugs are used. There are no further complaints or complications. Not infrequently, however, the patients also suffer from complaints in the stomach and intestines. Most of the sick people also need psychological care or physiotherapy. Strong restrictions on movement can lead to depression and other psychological complaints. As a rule, life expectancy is not affected.
When should you go to the doctor?
With this disease, a visit to the doctor is definitely necessary. Self-healing does not occur and the disease develops into a chronic course. As a rule, the doctor should always be consulted if there is frequent inflammation in the joints or bones. The inflammation can occur in different joints and persist over a longer period of time.
Persistent pain in the joints and bones and the associated restrictions in movement can also indicate the disease and must be examined by a doctor. Swellings in the affected regions also indicate the disease. As a rule, an orthopedic surgeon should always be consulted with these complaints.
In an emergency or if the pain is very severe, a visit to the hospital is also advisable. Further treatment is then also carried out by various specialists. In most cases, this condition will not limit or reduce the patient’s life expectancy.
Treatment & Therapy
Chronic recurrent multifocal osteomyelitis is usually treated with anti-inflammatory drugs that are non-steroidal. TNF blockers and bisphosphonates are an alternative. In some cases, sintering forms on the vertebral bodies, whereby a vertebra plana is usually also formed. Treat these symptoms individually.
Chronic recurrent multifocal osteomyelitis has an intermittent course, with spontaneous remissions. The disease is often associated with autoimmune diseases, such as inflammatory bowel disease with a chronic course. Physiotherapy is usually indicated to support drug treatment. In principle, the prognosis for chronic recurrent multifocal osteomyelitis is relatively good.
Outlook & forecast
The chronic recurrent multifocal osteomyelitis progresses in flares and has a good prognosis. If no medical care is used, the impairments in everyday life are significantly increased. In addition, the risk that further inflammatory diseases break out increases. This lengthens the healing process and leads to a deterioration in the general quality of life.
As well-being is reduced, there is an increase in vulnerability to the development of mental disorders. With drug treatment, the symptoms are alleviated. The drugs used have a good effect, with which the patient normally does not experience any further side effects or other irregularities. Spontaneous healing is often observed between the intermittent symptoms. The symptom-free time between attacks can be several months.
Participation in physiotherapy is helpful for improving health. If the patient uses the exercises taught there independently, even outside of the therapy, further stabilization occurs. The prospect of an improvement in symptoms increases significantly with a healthy lifestyle and a stable psyche. It is essential to reduce the general stress experience. With a healthy immune system and early treatment after the first symptoms appear, the disease can be treated quickly and effectively.
At this point in time, there are no known effective preventive measures for chronic recurrent multifocal osteomyelitis. The main reason for this is that the causes are so far largely unknown. It is therefore particularly important to take complaints and symptoms seriously and to inform a suitable specialist.
Chronic recurrent multifocal osteomyelitis is often accompanied by drug treatment during follow-up care. This is to relieve pain and tenderness. In addition, physiotherapy is useful, as it promotes stabilization when carried out independently.
As a result, symptoms improve significantly, which also has an impact on mental health. A healthy, resilient immune system also helps to optimize the quality of life. Therefore, patients should pay attention to a balanced diet rich in vitamins as part of the aftercare. This is particularly useful for sick children who are better protected against pain and relapses with a comprehensive therapy and aftercare plan.
Follow-up care and prevention are closely linked here. The treating doctors are familiar with the effective methods and can recommend a self-help group to those affected. This support makes the patient feel more comfortable. Physiotherapy training methods, including swimming, are also helpful.
In everyday life, compresses and baths also help to relieve the swollen joints. Those affected can also take these measures themselves. Integration into the social environment plays a major role here, as it ensures good psychological stability.
You can do that yourself
Chronic recurrent multifocal osteomyelitis is based on bone marrow inflammation that is not caused by bacteria. For patients, the symptom often takes an acute course, which severely affects everyday life with increasing age. The symptom already occurs in an episode in childhood or adolescence.
In the area of self-help, parents of affected children as well as adult patients can take useful measures in addition to the medical therapy plan. Since the disease manifests itself in the vertebrae, shoulder girdle, and pelvis, those affected should take pain prevention measures.
Likewise, psychotherapy or artistic activity in a self-help group can make dealing with the disease more acceptable. A gentle physiotherapeutically supported movement training as well as swimming strengthens the muscles and relieves pain in the joints and in the back area. If the joints are too swollen, baths and compresses help, which the person concerned can do himself.
In order to maintain and strengthen the immune system, a low-fat, vitamin-rich and omega-3 fatty acid-containing diet must be adhered to. Chronic recurrent multifocal osteomyelitis is sometimes associated with arthritis and psoriasis. With this in mind, a diet adapted menu is an extremely important aid. Smoking and alcohol should generally be avoided. If mobility is restricted significantly with increasing age, assisted living should be sought.