Chronic recurrent multifocal osteomyelitis is a specific form of osteomyelitis that is not caused by bacteria. The disease is characterized by taking a chronic course. Chronic recurrent multifocal osteomyelitis is also referred to by the abbreviation CRMO in many cases. Basically, osteomyelitis is an inflammation of the bones, and the responsible germs are usually undetectable.
What is chronic recurrent multifocal osteomyelitis?
Chronic recurrent multifocal osteomyelitis presents in the majority of cases in the so-called metaphyses on the long bones, pelvis, spine, and shoulder girdle. The disease was first described in 1972 by the physician Andres Giedion. Basically, chronic recurrent multifocal osteomyelitis is either monofocal or 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. For example, the incidence of the disease in childhood patients is estimated at four per 1,000,000 individuals. In the majority of cases, chronic recurrent multifocal osteomyelitis first presents in the tenth year of life. In adult patients, a disease with similar symptoms exists. However, this is not chronic recurrent multifocal osteomyelitis but the so-called SAPHO syndrome.
Causes
In principle, no definite statements are possible at the present time with regard to the causes of chronic 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 suggestion that a specific immunopathological process is involved in the development of Chronic Recurrent Multifocal Osteomyelitis. In addition, genetic factors are also under discussion for the causes of the disease. In addition, latent infections may also be partly responsible for the development of chronic recurrent multifocal osteomyelitis in some cases. The causes of chronic recurrent multifocal osteomyelitis have not yet been conclusively determined. However, there is a close association of the disease with psoriatic arthritis and arthritis. Evidence for mutations as a cause of chronic recurrent multifocal osteomyelitis has not yet been demonstrated. It is also unclear to date whether chronic recurrent multifocal osteomyelitis is an autoimmune disease.
Symptoms, complaints, and signs
Chronic recurrent multifocal osteomyelitis is associated with a variety of different complaints and symptoms. These are primarily concentrated in the metaphyses of the long tubular bones. Somewhat less frequently, symptoms manifest in the region of the vertebral body, foot, or pelvis. In addition, inflammation of the adjacent joints occurs in numerous cases. In addition, a so-called palmoplantar pustulosis develops in about 10 to 20 percent of all affected patients in childhood. This disease is a special type of psoriasis. In general, chronic recurrent multifocal osteomyelitis occurs in several episodes. This results in symptoms such as chronic pain, limitations of mobility, and local swelling.
Diagnosis
With regard to the diagnosis of chronic recurrent multifocal osteomyelitis, there are many different methods of examination to choose from. The treating specialist selects the use of the examination methods after considering the individual case. As a rule, the diagnosis of chronic recurrent multifocal osteomyelitis is made after various radiological, clinical and possibly also histological examinations. In this process, chronic recurrent multifocal osteomyelitis can be established by diagnosis of exclusion. The first step is usually to take the patient’s medical history, which is performed by the treating physician. This is usually followed by X-ray and laboratory examinations. Magnetic resonance imaging is also possible.In most cases, the whole body is examined. In the differential diagnosis, chronic recurrent multifocal osteomyelitis should primarily be distinguished from juvenile idiopathic osteomyelitis, bacterial osteomyelitis, arthritis, or hypophosphatasia. Ewing’s sarcoma, osteosarcoma, and Langerhans cell histiocytosis should also be excluded. In addition, patients should be evaluated for aseptic necrosis of bone.
Complications
This disease usually has a chronic course because it is not caused by bacteria. The symptoms and complications can be quite varied. In most cases, they manifest themselves in the long bones. Inflammations also occur in the joints and can thus lead to restricted movement and severe pain. The pain can occur either in the form of pain at rest or in the form of episodes. Those affected often suffer from a general feeling of illness and swelling of the affected areas. If the restriction of movement becomes relatively severe, the affected person may also be dependent on walking aids. The quality of life decreases considerably due to the disease. Treatment is carried out causally, with medication being used in particular. No further complaints or complications occur. However, it is not uncommon for patients to suffer from complaints in the stomach and intestines. Likewise, most sufferers require psychological care or physiotherapy. Severe movement restrictions can lead to depression and other psychological complaints. Life expectancy is not usually affected.
When should you see a doctor?
With this disease, a visit to the doctor is definitely necessary. Self-cure does not occur and a chronic course of the disease is formed. As a rule, the doctor should be visited whenever there is frequent inflammation in the joints or bones. The inflammations can occur in different joints and persist for a long period of time. Permanent pain in the joints and bones and associated restrictions in movement can also indicate the disease and must be examined by a doctor. Similarly, swellings in the affected regions also indicate the disease. As a rule, an orthopedist should always be consulted for these complaints. In emergencies or in case of very severe pain, a visit to the hospital is also advisable. Further treatment is then also carried out by various specialists. In most cases, the patient’s life expectancy is not limited or reduced by this condition.
Treatment and therapy
Chronic recurrent multifocal osteomyelitis is usually treated with anti-inflammatory drugs that are nonsteroidal. TNF blockers as well as bisphosphonates are an alternative. In some cases, sintering forms on the vertebral bodies, and vertebra plana usually develops as well. These symptoms must be treated individually. Chronic recurrent multifocal osteomyelitis is relapsing, with spontaneous remissions occurring. The disease is often associated with autoimmune diseases, for example, inflammatory bowel disease with a chronic course. Physiotherapy is usually indicated to support drug treatment. In general, the prognosis of chronic recurrent multifocal osteomyelitis is relatively good.
Outlook and prognosis
Chronic recurrent multifocal osteomyelitis progresses in episodes and has a good prognosis. If medical care is not sought, impairment in daily life is significantly increased. In addition, the risk of further inflammatory diseases breaking out increases. This prolongs 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, relief of the symptoms is achieved. The medications used have a good effect, with the patient normally experiencing no further side effects or other irregularities. Spontaneous healing is often observed between episodes of discomfort. The symptom-free period between relapses can span several months. Helpful for improving health is participation in physical therapy.If the patient applies the exercises taught there independently outside of therapy, further stabilization occurs. The prospect of an improvement in symptoms increases significantly with a healthy lifestyle and a stable psyche. An essential factor is the reduction of the general stress experience. With a healthy immune system and early treatment after the appearance of the first symptoms, the disease can be treated quickly and well.
Prevention
At the present time, there are no known effective preventive measures regarding chronic recurrent multifocal osteomyelitis. The main reason for this is that the causes are largely unknown to date. It is therefore particularly important to take complaints and symptoms seriously and to inform an appropriate specialist.
Aftercare
Chronic recurrent multifocal osteomyelitis is also often accompanied by drug treatment during follow-up. This is used to relieve pain and tenderness. In addition, physiotherapy is useful, which promotes stabilization when performed independently. As a result, symptoms improve significantly, which also affects mental health. A healthy, resilient immune system also helps optimize quality of life. Therefore, patients should pay attention to a balanced, vitamin-rich diet as part of their follow-up care. This is particularly useful for children with the disease, who are better protected from pain and relapses with a comprehensive treatment and aftercare plan. Here, aftercare and prevention are closely linked. The treating physicians are familiar with effective methods and can recommend a self-help group to those affected. This support makes patients feel more comfortable. Also helpful are physiotherapeutic training methods, which include swimming. In everyday life, wraps and baths also help to relieve the swollen joints. Patients can also take these measures themselves. Integration into the social environment plays a major role, as it ensures good psychological stability.
What you can do yourself
Chronic recurrent multifocal osteomyelitis is based on bone marrow inflammation, which is not bacterial. For patients, the symptom often takes an acute course, which severely interferes with daily life as they age. The symptom already occurs in childhood or in adolescence in relapses. In the field of self-help, parents of affected children as well as already adolescent patients can exercise meaningful measures in addition to the medical therapy plan. Since the disease manifests itself in the vertebrae, the shoulder girdle and the pelvis, affected persons should carry out pain prevention. Likewise, psychotherapy or artistic pursuits in a support group can make coping with the disease more acceptable. Gentle exercise training supported by physiotherapy, as well as swimming, strengthens the muscles and relieves pain in the joints as well as in the back. If the joints are too swollen, baths and compresses can be applied by the patient. To maintain and strengthen the immune system, a low-fat diet rich in vitamins and omega-3 fatty acids should be followed. Chronic recurrent multifocal osteomyelitis is sometimes accompanied by arthritis and psoriasis. Especially in view of this, a diet adapted to the patient’s needs is an extremely important aid. Smoking and alcohol should generally be avoided. If mobility becomes significantly limited with age increase, assisted living should be sought.
