Chronic recurrent multifocal osteomyelitis explained

Also known as Chronic recurring multifocal osteomyelitis

CRMO

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition (1:1,000,000), in which the bones have lesions, inflammation, and pain. Its definition is evolving. Many doctors and articles described CRMO as an autoimmune disease that has symptoms similar to osteomyelitis, but without the infection. Some doctors thought CRMO was related to SAPHO syndrome. Cutting edge research now classifies CRMO as an inherited auto-inflammatory but have yet to isolate the exact gene responsible for it. Some specialists believe they have discovered a link between CRMO with a rare allele of marker D18S60, resulting in a haplotype relative risk (HRR) of 18. Clearly the professionals do not agree and have conflicting theories. One thing is undisputed, its main characteristic is inflammation. Rid (or reduce) the body of inflammation and that should ameliorate (or lessen) CRMO.

Due to its inflammatory nature, its recurrent outbreaks, its lack of any known pathogen, CRMO has been reclassified as an inflammatory diseases. This particular classification, autoinflammatory diseases, encompasses both hereditary types (Familial Mediterranean Fever, FMF; Mevalonate Kinase Deficiency, MKD; TNF Receptor Associated Periodic Syndrome, TRAPS; Cryopyrin Associated Periodic Syndrome, CAPS; Blau syndrome; Pyogenic sterile Arthritis, Pyoderma gangrenosum and Acne syndrome, PAPA; Chronic Recurrent Multifocal Osteomyelitis, CRMO) and multifactorial disorders (Crohn's and Behçet's diseases). CRMO is not longer considered an autoimmune but rather an inherited, autoinflammatory disease. Chronic: because it does not go away for a long time. Recurrent: because it comes back. It cycles between active and dormant, symptoms and no symptoms, exacerbation and remission. Multifocal: because it can erupt in different sites, primarily bones. Each outbreak can be in a different part of the body. Osteomyelitis: because it is very similar to that disease but appears to be without any infection.

CRMO was once considered strictly a childhood disease, but adults have been diagnosed with it. The disease tends to range from 4 to 14 years old, with 10 years old as its median age. As stated above, CRMO occurs 1:1,000,000 and primarily in girls with a 5:1 ratio. That means out of six million, there will probably be 5 girls and 1 boy with the condition. Yet, it may be more widespread than this.

Laboratory tests may help discover the inflammation: C-reactive protein level, erythrocyte sedimentation rate, level of peripheral leukocytes, ferritin level, Anti-nuclear antibody, antinuclear antibody level, and rheumatoid factor status. Most commonly, however, it is an MRI or bone scan that reveals the inflammation and/or lesions.

A doctor could easily misdiagnose CRMO as muscle spasms or simple inflammation and routinely prescribe anti-inflammatory medicines, which is the normal treatment for CRMO. Many childhood aches and pains are dismissed as growing pains. Parents might not even realize that the child needs to see a doctor. CRMO has deep pain, swelling, and a possible fever but not always. A limp may be falsely considered as the result of an over-active lifestyle. A parent or doctor may not associate a longer limb with CRMO. Without an xray, mri, or bone scan, the bone lesions will go undetected. A child could be misdiagnosed or undiagnosed; take over the counter anti-inflammatory medicines; and live past the illness.

Parents, with sick children, want a diagnosis, and doctors want to give them one. CRMO may be a catch-all medical phrase for painful, bone lesions that do not have a better diagnosis such as arthritis, rheumatic fever, bacterial osteomyelitis, ewing sarcoma, leukemia, lymphoma, rhabdomyosarcoma, neuroblastoma metastasis, eosinophilic granuloma or Langerhans cell histiocytosis. When all the previous illnesses are ruled out and a bone biopsy turns up negative for any known cancer, bacteria, or fungus, CRMO is usually diagnosed.

Regardless of the diagnosis or lack of diagnosis, the patient is suffering from inflammation and possibly intense pain. As such, the most common prescription is for anti-inflammatory medicines such as NSAIDs and steroids. Antibiotics are not commonly prescribed because there is no bacterial or fungal infection.

But some doctors do prescribe the antibiotic azithromycin because, in addition to its antibacterial properties, azithromycin also has anti-inflammatory and immuno-modulatory properties.

Schilling and Wagner wrote an article that CRMO (Chronic Recurring Multifocal Osteomyelitis) patients seem to improve greatly with Azithromycin. “In one study, 7 out of 13 patients, mainly teenager, showed a fast clinical improvement after they were started on Azithromycin. The immediate therapeutic effect of Azithromycin in patients with CRMO was surprising and lead to the hypothesis that Azithromycin could have an antiphlogistic in addition to its antibiotic effect in this disease setting…”http://www.medscape.com/medline/abstract/11142932

Fortunately, CRMO usually resolves itself. Most children do not suffer any lingering or long term disability. Symptoms can be managed. In most cases, the acute outbursts will pass. In the long run, the child can have a normal adult life.

Consider and investigate

It is never too late to improve one’s diet. Eat lots of vegetables; avoid sweets and junk foods. Read books and articles on reducing inflammation. Keep a food diary to see if a particular food improves or worsen the condition.

Physical therapy has helped some CRMO patients. Physical therapy works to maintain and/or restore movement and flexibility. A chiropractor can also be a great resource. If one leg is affected, it can become shorter or longer than the other leg. One mother used a chiropractor because a step-sibling had been cured of uneven legs through a chiropractor. That step-sibling was never diagnosed with CRMO. Still the mother was trying whatever might help. Using a professional that specializes in bones, like a chiropractor, can help monitor the patient’s condition.

How could … (a naturopath, chiropractor, herbalist, traditional Chinese medicine, Ayurveda, yoga, biofeedback, bodywork, homeopathy, physical therapy, red light therapy, dark therapy, laugh therapy, food supplements, massage, or diet) help reduce inflammation and/or pain?

There are many books and websites on ‘how to reduce inflammation.’ Go to amazon.com and look for inflammation.Then, do a web search for inflammation. Then combine that with cure, remedy, and other such words for example: inflammation cures, anti-inflammation foods, etc.

Commonly used anti-inflammatory supplements are: omega 3 (fish oils and flax seed oil), curcurmin (turmeric), Gamma-linolenic acid known as GLA (Evening primrose oil and borage oil), Serrapeptase (an enzyme), Bromelain (pineapples), St. Johns Wort (herb used for depression but has anti-inflammatory properties), green tea, ginger, vitamin C and E. Some studies show that cutting back on animal protein and grains reduce inflammation. As said earlier, keep a food diary so that a correlation can be established.

References

"Chronic recurrent multifocal osteomyelitis," Radiology, 166 (2): 493, 1988

http://www.medscape.com/medline/abstract/11142932"Azithromycin: Eine anti-inflammatorische Wirksamkeit im Einsatz bei der chronischen rekurrierenden multifokalen Osteomyelitis? Eine vorläufige Mitteilung" Zeitschrift für RheumatologieVolume, 59, Number 5 / October, 2000

"Treatment of chronic recurrent multifocal osteomyelitis (CRMO) with interferon-gamma." J. Pediatr., 131:470-472, 1997.

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