Chronic Recurrent Multifocal Osteomyelitis

These websites have reliable, up-to-date information. If you have questions about your child’s condition or care, please speak with a member of the health care team.

Pediatric Rheumatology International Trials Organization – PRINTO

(Europe)

www.printo.it/pediatric-rheumatology/information/UK/pdf/13_4_CRMO_UK.pdf

Provides information about symptoms, diagnosis and treatment.
Answers practical questions in way that is easy to understand.
Few references or links to other organizations related to CRMO.

Great Ormond Street Hospital and UCL Institute of Child Health
(United Kingdom) http://www.ich.ucl.ac.uk/gosh_families/information_sheets/chronic_recurrent_multifocal_osteomyelitis/chronic_recurrent_multifocal_osteomyelitis_children.html

Provides an overview of CRMO with information sheets in many languages.

BoneTumour.org (United States)

www.bonetumor.org/tumors/pages/CRMO.htm

This website is written by an orthopedic surgeon.
Provides an overview of CRMO and up-to-date information about symptoms, diagnosis, treatments (medical and surgical) and prognosis. Includes examples of X-ray and MRI results with CRMO.
Some medical knowledge is needed to understand the information on this website.

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This picture is of an incredible boy with such heart! He suffers from CRMO, He will be sharing his story soon on our home page. We want to give children with CAID a voice, they need to be heard! He wants to use his voice to help others and make them more aware of this debilitating disease. We are PROUD of him!

Chronic Recurrent Multifocal Osteomyelitis

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory (NOT autoimmune) disorder that mostly affects children. It comprises periodic bone pain, fever, and the appearance of multiple bone lesions that can occur in any skeletal site. The origin of this disease is unclear, but genetics appears to play a role. The clinical and radiological features on the disease are variable and the diagnosis can be difficult.

This disease is rare, and often affects children, more commonly girls than boys. The peak age of incidence is around 10 years, with the range being four to 55 years. Adults can be affected. The number of affected areas varies from 2 to 18.
Children present with pain, deep aching pain, limping, and may also present with fever. The metaphyseal area of long bones, the clavicle, and the shoulder girdle are common locations. Other sites such as the spine, ankle, and foot have been reported. Dermatological manifestations may occur and include psoriasis, acne, and pustules on the palms of the hands and soles of the feet. Uveitis, and inflammatory bowel disease have also been described. Majeed syndrome consists of CRMO and congenital dyserythropoietic aneama, has been reported in families. Te LPIN2 gene appears to play a role in these cases.
Skeletal manifestations include multiple synchronous or metachronous lesions appearent on plain radiographs. The lesions are lytic and destructive in the early phase, and sclerotic and reactive in the late phase, occurring in any bone.
A large number of drugs and treatments have been tried with variable success in recurrent or unresponsive cases. Medical management options include nonsteroidal anti-inflammatory drugs, bisphosphates, and oral steroids. Antibiotics do not seem to be helpful. Surgical treatment has been used, but its role is not yet clearly defined.
*Bonetumor.org

-Clinicians should be aware of CRMO, because it typically occurs during childhood and should be included in the differential diagnosis of patients with signs and symptoms of recurrent osteomyelitis and granulomatous pyoderma to avoid prolonged antibiotic treatment.

-Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, systemic, noninfectious, inflammatory disorder that is characterised by recurrent, nonsuppurative, multiple osteolytic bone lesions. It accounts for 2% to 5% of all osteomyelitis cases

what is chronic recurrent multifocal osteomyelitis?
Chronic recurrent multifocal osteomyelitis (CRMO) involves inflammation of the bone.

Usually, inflammation is a normal process. It causes pain, redness, and swelling. It is the way our immune system protects itself from infection and germs. In CRMO, however, there is no infection. Instead, the immune system wrongly attacks normal bone. This causes inflammation.

CRMO is slightly more common in girls than boys. It usually starts around the ages of eight to 14 years.

signs and symptoms of crmo
Most often there is pain and swelling of the long bones. There may be one or many sites involved. The most commonly affected areas are near the knee, ankle, or wrist. Bones of the back (vertebrae), pelvis, and collarbone can also be involved. The areas may be red, warm to touch, and difficult to move. Fever may be present with the bone inflammation. Attacks may last a few weeks to months. Treatment can help reduce the length of the attack.

causes of crmo
We do not know the cause of CRMO. Sometimes children with other diseases such as bowel inflammation (colitis) or psoriasis (a skin condition) also develop CRMO. Since the other diseases seem to run in families, CRMO may also be genetic. Researchers are looking into this.

diagnosis of crmo
CRMO is a “diagnosis of exclusion.” This means that other diseases must be excluded before the diagnosis can be made. Many tests are often required. These include blood tests, X-rays, bone scans, MRI, and often a bone biopsy.

treatment of crmo
The goals for treatment are to:

reduce pain
improve the ability to move
allow the child to lead a normal life
Most attacks of CRMO can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines are taken by mouth. They are called the first line of treatment. The two most common NSAIDs are naproxen and indomethacin.

If NSAIDs are not effective, there are other drugs called second line treatments. These include:

corticosteroids (prednisone)
bisphosphonates (pamidronate)
biologics (etanercept, infliximab, adalimumab, anakinra)
Studies are being done to determine the best second line treatment.

how your health care team can help
Medications can help. So can other types of treatment.
Physiotherapists help keep the muscles strong and the joints moving properly. Occupational therapists help make daily life easier. They may suggest changes at school or at home. A social worker, nurse, or child life specialist can help your child cope with the emotional challenges of having a chronic illness.

outlook for children with crmo
Attacks may come and go over several years. Fortunately, attacks usually decrease over time. Studies have shown that children with CRMO can safely take part in normal physical activities. They can usually attend school.

Regular clinic visits help determine the amount of bone inflammation. These visits can also help determine whether your child needs more tests and medications. If other diseases are found , a referral will be made to the appropriate specialist.

school, gym, and other activities
If your child is having an attack of CRMO, it may be difficult to do gym class and sports. Most children can figure out what they are able to do. You can help by letting their teachers and coaches know.

Sometimes the pain may make it difficult for children to concentrate. This can make going to school a challenge. Medications will usually enable a child with CRMO to go to school. Let the school know about your child’s condition. They can make accommodations if needed.

follow-up care
Your child will be referred to a rheumatology clinic for follow-up care. Usually, a rheumatology clinic will have a team of doctors and nurses who have experience treating children with CRMO.

Other members of the rheumatology team may include:

A physical therapist and an occupational therapist. They will help with your child’s movement of joints. They may teach your child different ways of doing things.
A social worker and a child life specialist. They will help with emotional and behavioural problems that might result from the disease.
A dietitian to help with your child’s diet and nutrition
Your child may need a blood test during a clinic visit. This will help doctors monitor the disease. They will also check for side effects of the medicine your child is taking. If your child needs to prepare for clinic visits in any other way, the rheumatology team will tell you before the visit.

After you have met the rheumatology team, you will know more about how to care for your child. They will tell you how to plan for future clinic visits.

key points
CRMO causes bone pain and swelling.
Some children will have a few attacks. Others may have many attacks of bone inflammation.
CRMO can be treated with medications.

 

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