Chronic recurrent multifocal osteomyelitis

Title

Other Names:

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

Categories:

Musculoskeletal Diseases; Skin Diseases

Summary Summary

Chronic recurrent multifocal osteomyelitis (CRMO) causes abnormal inflammation to occur in and around the bones. Symptoms usually begin in childhood but can occur at any age. Symptoms may include episodes of pain and joint swelling, skin redness, and sometimes a fever. In some cases, CRMO leads to abnormal bone growth, bone deformity, and fractures. Symptoms can last for years, and may go away on their own. CRMO may occur alone or with other skin or bowel inflammation conditions. In rare cases, CRMO occurs as part of one of these genetic syndromes: Majeed syndrome, DIRA or PAPA syndrome. The cause of CRMO is unknown, but a genetic influence is thought to be involved. Diagnosis of CRMO is based on the symptoms, clinical exam, and imaging studies. Other more common conditions may need to be excluded before a diagnosis of CRMO can be made. Treatment is focused on managing the symptoms and include medications such as non-steroidal anti-inflammatories, corticosteroids, and other drugs that reduce inflammation.^[1]^[2]^[3]

Last updated: 12/15/2020

Symptoms Symptoms

The following list includes the most common signs and symptoms in people with chronic recurrent multifocal osteomyelitis (CRMO). These features may be different from person to person. Some people may have more symptoms than others, and they can range from mild to severe. This list does not include every symptom that has been described in the condition.

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.^[1]^[2]^[3]

Last updated: 12/15/2020

This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom.

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Medical Terms	Other Names	Learn More: HPO ID
80%-99% of people have these symptoms
Bone pain		0002653
Hyperostosis	Bone overgrowth	0100774
Osteomyelitis	Bone infection	0002754
30%-79% of people have these symptoms
Abnormal vertebral morphology		0003468
Abnormality of epiphysis morphology	Abnormal shape of end part of bone	0005930
Abnormality of the metaphysis	Abnormality of the wide portion of a long bone	0000944
Arthritis	Joint inflammation	0001369
Craniofacial osteosclerosis		0005464
Edema	Fluid retention Water retention [ more ]	0000969
Elevated C-reactive protein level		0011227
Elevated erythrocyte sedimentation rate	High ESR	0003565
Fatigue	Tired Tiredness [ more ]	0012378
Osteolysis	Breakdown of bone	0002797
Poor appetite	Decreased appetite	0004396
Weight loss		0001824
5%-29% of people have these symptoms
Abnormality of the sacroiliac joint		0100781
Acne		0001061
Anemia	Low number of red blood cells or hemoglobin	0001903
Cranial nerve paralysis		0006824
Fever		0001945
Inflammation of the large intestine		0002037
Palmoplantar pustulosis		0100847
Pruritus	Itching Itchy skin Skin itching [ more ]	0000989
Psoriasiform dermatitis		0003765
Scoliosis		0002650
Skin rash		0000988
Vasculitis	Inflammation of blood vessel	0002633
Percent of people who have these symptoms is not available through HPO
Autosomal recessive inheritance		0000007

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Do you have more information about symptoms of this disease? We want to hear from you.

Last updated: 2/1/2021

Cause 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.^[1]

Last updated: 12/15/2020

Diagnosis 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.^[1]^[2]

Last updated: 12/15/2020

Treatment 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.^[1]^[3]

Last updated: 12/15/2020

Statistics Statistics

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.^[2]^[4]

Last updated: 12/15/2020

Do you have updated information on this disease? We want to hear from you.

Find a Specialist Find a Specialist

If you need medical advice, you can look for doctors or other healthcare professionals who have experience with this disease. You may find these specialists through advocacy organizations, clinical trials, or articles published in medical journals. You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments.

If you can’t find a specialist in your local area, try contacting national or international specialists. They may be able to refer you to someone they know through conferences or research efforts. Some specialists may be willing to consult with you or your local doctors over the phone or by email if you can't travel to them for care.

You can find more tips in our guide, How to Find a Disease Specialist. We also encourage you to explore the rest of this page to find resources that can help you find specialists.

Healthcare Resources

To find a medical professional who specializes in genetics, you can ask your doctor for a referral or you can search for one yourself. Online directories are provided by the American College of Medical Genetics and the National Society of Genetic Counselors. If you need additional help, contact a GARD Information Specialist. You can also learn more about genetic consultations from MedlinePlus Genetics.

Related Diseases Related Diseases

Related diseases are conditions that have similar signs and symptoms. A health care provider may consider these conditions in the table below when making a diagnosis. Please note that the table may not include all the possible conditions related to this disease.

Conditions with similar signs and symptoms from Orphanet
Differential diagnosis includes mainly acute or subacute bacterial osteomyelitis, juvenile idiopathic arthritis, hypophosphatasia, Langerhans cell histiocytosis, and malignancies like osteosarcoma, Ewing sarcoma, neuroblastoma, rhabdomyosarcoma, leukemia, and lymphoma. Rare monogenetic syndromes with CNO/CRMO as a component must also be excluded, such as Majeed syndrome, PAPA syndrome and DIRA syndrome (sterile multifocal osteomyelitis with periostitis and pustulosis). Visit the Orphanet disease page for more information.

Conditions with similar signs and symptoms from Orphanet

Differential diagnosis includes mainly acute or subacute bacterial osteomyelitis, juvenile idiopathic arthritis, hypophosphatasia, Langerhans cell histiocytosis, and malignancies like osteosarcoma, Ewing sarcoma, neuroblastoma, rhabdomyosarcoma, leukemia, and lymphoma. Rare monogenetic syndromes with CNO/CRMO as a component must also be excluded, such as Majeed syndrome, PAPA syndrome and DIRA syndrome (sterile multifocal osteomyelitis with periostitis and pustulosis).

Visit the Orphanet disease page for more information.

Research Research

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

Orphanet lists European clinical trials, research studies, and patient registries enrolling people with this condition.

Organizations Organizations

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

CRMO Foundation
2827 Sunset View Drive
Fort Collins, CO 80528
E-mail: https://crmofoundation.org/contact-us/
Website: https://crmofoundation.org/
FMF & AID Global Association
Schüracherstrasse 25a
8306 Brüttisellen
Switzerland
Telephone: +41 76 415 4010
E-mail: info@fmfandaid.org
Website: https://www.fmfandaid.org/

Organizations Providing General Support

American Autoimmune Related Diseases Association (AARDA)
19176 Hall Road, Suite 130
Clinton Township, MI 48038
Toll-free: 800-598-4668
Telephone: 586-776-3900
Fax: 586-776-3903
E-mail: aarda@aarda.org
Website: https://www.aarda.org/

Do you know of an organization? We want to hear from you.

Learn More Learn More

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

In-Depth Information

The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine.
Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
PubMed is a searchable database of medical literature and lists journal articles that discuss Chronic recurrent multifocal osteomyelitis. Click on the link to view a sample search on this topic.

GARD Answers GARD Answers

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know.

Have a question? Contact a GARD Information Specialist.

References References

Hofmann SR, Kaplusch F, Girschick HJ, Morbach H, Pablik J, Ferguson PJ, et al. Chronic Recurrent Multifocal Osteomyelitis (CRMO): Presentation, Pathogenesis, and Treatment. Curr Osteoporos Rep. Dec 2017; 15(6):542-554. https://pubmed.ncbi.nlm.nih.gov/29080202/.
Buch K, Thuesen ACB, Brøns C, Schwarz P. Chronic Non-bacterial Osteomyelitis: A Review. Calcif Tissue Int. May 2019; 104(5):544-553. https://pubmed.ncbi.nlm.nih.gov/30456556/.
Girschick H, Finetti M, Orlando F, Schalm S, Insalaco A, Ganser G, et al. The multifaceted presentation of chronic recurrent multifocal osteomyelitis: a series of 486 cases from the Eurofever international registry.. Rheumatology (Oxford). Jul 1, 2018; 57(7):1203-1211. https://pubmed.ncbi.nlm.nih.gov/29596638/.
Zhao Y, Ferguson PJ. Chronic Nonbacterial Osteomyelitis and Chronic Recurrent Multifocal Osteomyelitis in Children. Pediatr Clin North Am. Aug 2018; 65(4):783-800. https://pubmed.ncbi.nlm.nih.gov/30031498/.