Chronic recurrent multifocal osteomyelitis

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Chronic recurrent multifocal osteomyelitis
File:A Bone Scan of Chronic Recurrent Multifocal Osteomyelitis in the clavicle bone of a 12 year old female, April 2007.jpg
Synonyms	CRMO, chronic nonbacterial osteomyelitis (CNO)
Pronounce	N/A
Specialty	N/A
Symptoms	Bone pain, swelling, fever
Complications	Bone deformity, growth disturbances
Onset	Typically in childhood or adolescence
Duration	Chronic, with periods of remission and exacerbation
Types	N/A
Causes	Unknown, possibly autoimmune
Risks	Family history, genetic factors
Diagnosis	Clinical examination, imaging studies, biopsy
Differential diagnosis	Infectious osteomyelitis, bone tumors, Langerhans cell histiocytosis
Prevention	N/A
Treatment	Nonsteroidal anti-inflammatory drugs, corticosteroids, biologics
Medication	N/A
Prognosis	Variable, often improves with age
Frequency	Rare
Deaths	N/A

Alternate names

CRMO; Multifocal osteomyelitis, chronic; Chronic multifocal osteomyelitis; CMO; Chronic nonbacterial osteomyelitis/Chronic recurrent multifocal osteomyelitis; CNO/CRMO

Definition

Chronic recurrent multifocal osteomyelitis (CRMO) causes abnormal inflammation to occur in and around the bones.

Epidemiology

• It can be difficult to estimate the exact number of people affected by a rare condition. Some people may go undiagnosed or may be diagnosed incorrectly. Others may not seek medical care.
• The following estimates are based on the best information available in the scientific literature.
• These estimates can change based on new information.
• It has been estimated that about 1-2 people in 1,000,000 has chronic recurrent multifocal osteomyelitis.
• The exact number is unknown.
• Females tend to be affected more often than males.

Cause

• The exact cause of chronic recurrent multifocal osteomyelitis (CRMO) is unknown.
• It is thought that genetics may play a role.
• In rare cases, CRMO can occur as part of Majeed syndrome, DIRA, or PAPA syndrome. All of these conditions occur due to a genetic variant in a single gene.

Onset

Symptoms usually begin in childhood but can occur at any age.

Signs and symptoms

Symptoms may include:

• Bone and joint pain
• Skin redness and/or swelling
• Inflammatory bowel disease
• Psoriasis
• Blister-like lesions on the palms and/or soles of the feet (palmoplantar pustulosis)

Symptoms typically start in childhood but can occur in any age. Symptoms range in severity from mild to severe. The bones most affected are the long bones, pelvis, shoulder girdle, and spine. CRMO can last from one to twenty years. In severe cases, bone deformities and fractures may occur. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. 80%-99% of people have these symptoms Bone pain

• Hyperostosis(Bone overgrowth)
• Osteomyelitis(Bone infection)

30%-79% of people have these symptoms

• Abnormal vertebral morphology
• Abnormality of epiphysis morphology(Abnormal shape of end part of bone)
• Abnormality of the metaphysis(Abnormality of the wide portion of a long bone)
• Arthritis(Joint inflammation)
• Craniofacial osteosclerosis
• Edema(Fluid retention)
• Elevated C-reactive protein level
• Elevated erythrocyte sedimentation rate(High ESR)
• Fatigue(Tired)
• Osteolysis(Breakdown of bone)
• Poor appetite(Decreased appetite)
• Weight loss

5%-29% of people have these symptoms

• Abnormality of the sacroiliac joint
• Acne
• Anemia(Low number of red blood cells or hemoglobin)
• Cranial nerve paralysis
• Fever
• Inflammation of the large intestine
• Palmoplantar pustulosis
• Pruritus(Itching)
• Psoriasiform dermatitis
• Scoliosis
• Skin rash
• Vasculitis(Inflammation of blood vessel)

Diagnosis

• Diagnosis of chronic recurrent multifocal osteomyelitis (CRMO) is based on the symptoms, clinical exam, and imaging studies.
• Other more common conditions may need to be excluded before CRMO can be diagnosed.
• Sometimes a bone biopsy is necessary to remove a small piece of bone for examination under the microscope.

Treatment

• Treatment for chronic recurrent multifocal osteomyelitis (CRMO) is focused on managing the symptoms.
• Treatment may include non-steroidal anti-inflammatory drugs, corticosteroids, and other drugs designed to control inflammation and prevent bone loss.

NIH genetic and rare disease info

• NIH info on Chronic recurrent multifocal osteomyelitis

Chronic recurrent multifocal osteomyelitis is a rare disease.