Chronic recurrent multifocal osteomyelitis

Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory condition that mainly affects children around the age of ten. Chronic because it lasts for years, usually six to ten. Recurrent because the condition comes and goes. Multifocal because it affects different areas. Osteomyelitis because the bones have lesions. Although the bones have legions, there is no no infection. A bone biopsy will come back negative for bacteria. CRMO usually affects the long bones but can affect any bone in the body. Some believe that SAPHO is the adult version of the same condition, but that is disputed by others.

CRMO is rare in that it only affect one in a million, usually children (average mean age 10), and usually girls. The lack of a large study group makes it difficult to outline and detail the condition. The rarity also explains the shortage of experts in the field. For this reason, there are probably some children who have CRMO but are never diagnosed, or better said the children are not correctly diagnosed. Currently, more cases are diagnosed in Europe and Scandinavia when compared to all other areas of the world.

Some children have fever, but some do not. Most have painful skeletal (bone) areas. Some children have stomach aches. Antibiotics do not help. A diet that reduces inflammation along with antiinflammatory medicines such as NSAIDS, in particular naproxen (aleve), appear to help the most.

CRMO can easily be mistaken for other illnesses or diseases. CRMO can be mistaken for growing pains. Since CRMO does resolve itself over the years, a child could go undiagnosed. Another example of misdiagnosis, one neurosurgeon did a biopsy on a seven year old's cervical vertebrae. He thought it was cancer and considered removing the bone immediately. Fortunately, he decided to confer with the other doctors first. The child was in the hospital for about one month before diagnosed with CRMO. Over time, the vertebra healed. In another case, an eleven year old boy was home bound on antibiotic IVs, which do not help CRMO patients. After a year, CRMO was diagnosed.

Laboratory tests may help discover the inflammation: C-reactive protein level, erythrocyte sedimentation rate, level of peripheral leukocytes, ferritin level, antinuclear antibody level, and rheumatoid factor status. BUT usually, it is just an MRI that reveals the legions.