Does your child have frequent bone pain? Could this be CRMO? (Chronic Recurrent Multifocal Osteomyelitis)

Does your child often complain that their leg, arm, or back hurts? Sometimes we think it's just a simple case of running around or "growing pains." But if this pain lasts for days or weeks, subsides after a few days, and then comes back, we should be a little concerned. Today we're going to talk about a rare but important condition that can cause recurring bone pain.

Simply put, what is CRMO?

Chronic Recurrent Multifocal Osteomyelitis, also known as CRMO, is an autoimmune disease . Now you may be wondering what it is. Think of our body's immune system as an army that protects a country. The job of this army is to protect us from diseases by fighting off foreign enemies, such as viruses and bacteria.

But in an autoimmune disease, our own immune system makes a mistake and attacks healthy parts of our own body instead of foreign invaders. In CRMO, this "mistaken attack" is directed at our own bones . The immune system, for no apparent reason, attacks one or more bones in the body, causing inflammation, which is swelling and pain.

Is there a specific reason for the formation of CRMO?

In fact, doctors still don't know exactly what causes CRMO. It's not caused by a bacterial or viral infection. It's just the immune system acting up for no apparent reason.

However, there is some suspicion that there may be a genetic link to this. Sometimes, several members of the same family have been reported to have this condition. However, further research is needed on this.

Who is most likely to get this disease?

CRMO is most commonly seen in children and young adults.The disease is usually diagnosed around the age of 9-10 years. The condition is slightly more common in girls than boys.

This is not a very common disease, but as doctors and the general public become more aware of this disease, the number of people being diagnosed with the disease has increased slightly.

What are the main symptoms of CRMO?

CRMO can affect any bone in the body. But it most commonly affects the long bones in children's legs, hips, and spine . Symptoms may come on suddenly, subside after a few days, and then come back. This is called a flare-up and a remission.

Let's look at the main symptoms like this.

How to accurately diagnose CRMO disease?

Because this is a rare disease, diagnosing it can sometimes be challenging. The doctor will examine your child thoroughly and ask you about your symptoms. It can usually take several months or even more than a year to diagnose the disease.

Several tests are performed to confirm the diagnosis.

• Imaging tests: Tests such as X-rays and MRI scans can clearly show inflammation and other changes in the bones.
• Blood tests: These help to check the level of inflammation in the body (such as ESR, CRP) and rule out other infections or diseases.
• Genetic tests: In some cases, these tests may also be necessary to rule out other genetic diseases.

What are the treatments for CRMO?

At this time, there is no cure for CRMO. But don't worry. Available treatments can control symptoms, reduce inflammation, and help your child live a completely normal life .

The doctor may recommend the following treatments:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These are the painkillers and anti-inflammatory drugs we all know, like Ibuprofen. This is the first treatment to try. About 50% of children respond well to these. However, if you take these drugs for a long time, your doctor will regularly check your kidney and liver function.
• Disease-modifying antirheumatic drugs (DMARDs): If NSAIDs alone do not control the disease, this class of drugs is the next group of drugs used. These drugs work by suppressing the immune system to some extent, helping to stop the wrong attacks that cause the disease. Before starting these drugs, your doctor will explain all the pros and cons to you.
• Lifestyle changes:During times of pain, your child may need to limit their running and jumping activities. A physical therapist or occupational therapist can help you learn how to do daily activities with pain, including exercises.

Are there other diseases that can occur together with CRMO?

Yes, children with CRMO are at some risk of developing several other autoimmune diseases.

• Inflammatory Bowel Disease (IBD): This is also a condition caused by the immune system attacking the digestive system.
• Psoriasis: This is an autoimmune disease that affects the skin.
• Amplified musculoskeletal pain: This is a slightly more complicated condition. Even when CRMO is in remission, there may be ongoing muscle pain for an unexplained reason. This pain is not relieved by ordinary painkillers.

What is the prognosis of this disease?

The good news is that about 40% of patients achieve complete remission within the first 1-5 years of treatment. This means that the pain and other symptoms are completely gone, with no inflammation or immune system dysfunction. The child can then live a normal, active life.

However, even if the disease is completely cured, regular medical monitoring is very important. You will have to continue to go to the clinic under the supervision of a rheumatologist. You may also need to do tests such as MRI scans to see if the disease has recurred. This is because about 50% of people have a relapse within the first two years after stopping treatment. If that happens, you will have to start treatment again.