CRMO refers to Chronic Recurrent Multifocal Osteomyelitis. CRMO is a rare disease that affects children of around the age of 10. Females are found to be much more commonly affected than males. CRMO is believed to be the most severe form of Chronic non-bacterial Osteomyelitis.
Why does CRMO occur?
CRMO is an auto-inflammatory disease. This means that the normal inflammatory system of the body goes haywire and starts to cause damage to the normal structures of the body. While the exact mutation is still unknown, a genetic link in the TR4/MAPK signaling system of the body is believed to have been identified. Some researchers have also noted the presence of a mutation on chromosome 18q to be closely associated with the occurrence of CRMO.
Researchers are also fairly certain that there are unidentified environmental factors which could lead to the expression of this mutation.
Symptoms associated with CRMO
Affected individuals will complain of a deep aching pain, tenderness in the affected areas, feeling tired very easily, limping, and develop fevers frequently. As you may have noticed, none of these symptoms can be called out as being particularly indicative of CRMO only.
Lesions in the affected bones are visible on MRI’s and so full body scans are often advised by the doctors to confirm the presence of multiple lesions.
Some patients may also develop skin lesions like psoriasis, acne, or other pustules on their body.
The most commonly affected bones are collarbone, the shoulder bone (clavicle), spine, ankles, and feet.
Treatment of CRMO
The treatment of CRMO usually involves the use of non-steroidal anti-inflammatory drugs, corticosteroids, bisphosphonates, anti-rheumatic drugs, or anti- TNF agents. Research has shown that NSAIDs are effective as the first line of treatment and will be able to provide short-term remission in a large percentage of the cases.
However, around 2 years after the completion of the treatment, lesions may start to reappear in the body.
Corticosteroids are also found to be very effective in the short term but rarely cause long-term remission.
While more research is needed in the use of anti-TNF agents, published data show that these agents are able to provide long-term relief in a significant percentage of the patients.
The reality is this that set parameters on the best way to treat patients with CRMO is lacking. Simply not enough research has been done on the subject to conclusively say which approach is the best. This is why doctors will tend to follow the latest published data and try to tweak the regimen as per the response of the patient.
Monitoring the patient with clinical investigations and MRI scans every 3-6 months is also advisable. Auto-immune diseases are usually considered to be manageable but they are rarely ever treatable. The reason for the symptoms appearing in the first place has to do with an abnormal functioning of a normal biological process and so eliminating it completely is very difficult.
The lack of knowledge about CRMO also suggests that a large number of cases around the world go undiagnosed simply because doctors are unaware of the existence of such a condition.
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