Chronic Recurrent Multifocal Osteomyelitis
Description
Background and Overview of the Disease
Rare and non-infectious, CRMO is an autoinflammatory bone disease that typically affects children and teenagers.
Giedion et al. initially described it in 1972
SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) is thought to have a juvenile counterpart.
It is a diagnosis of exclusion once infection and cancer have been ruled out; there is no conclusive diagnostic test.
Disease: an imbalance between
TNF-α and IL-6 are pro-inflammatory cytokines.
IL-10 is an anti-inflammatory cytokine.
Presentation in Clinical Settings
Signs and symptoms
Bone ache (sometimes intense, sometimes dull, painful)
Redness, pain, and swelling around the afflicted bone
may occasionally have a low-grade temperature.
Frequently impacted bones:
All patients in this series have tibia and fibula.
Metatarsals, tarsals, and femur (4/6 patients)
Vertebral body, ribs, pelvis, clavicle, and mandible (1/6 patients each)
Additionally, some patients have:
The psoriasis
Bowel inflammation
Acne
Majeed syndrome is an uncommon condition that combines congenital dyserythropoietic anemia, neutrophilic dermatosis, and CRMO.
Details of the Study (India Case Series)
Time frame: 2011–2016
Patients: 6 boys (mostly male, despite reports from throughout the world that show more girls)
8 years old was the median age upon onset (range 2–10).
The median age at diagnosis was 13 years old, and there was a 3.5-year delay because of ignorance.
Symptoms include bone pain and swelling, and some people have fever.
Follow-up duration: 31.5 months on average
Research and Diagnosis
Five out of six patients had elevated ESRs (median 61.5 mm/h).
MRI:
Five patients underwent this procedure; each displayed many osteolytic lesions.
Due to financial concerns, just one patient received a whole-body MRI.
Biopsies of bones:
In two patients, sterile cultures were used to treat persistent inflammation.
Genetic research:
Majeed syndrome was confirmed in two relatives who had an LPIN2 mutation.
Criteria for exclusion: Malignancy and infections were ruled out.
Protocol
Therapy and Results
First line:
NSAIDs for pain and inflammation, such as ibuprofen and naproxen
The second line:
Added methotrexate when NSAIDs are not enough
Cases that are resistant:
Two individuals reacted effectively to intravenous bisphosphonates (Pamidronate), which are administered every three months.
With weekly injections of TNF-α blockers (Etanercept), one patient experienced extremely good symptom management.
Reactions:
3/6 => Methotrexate + NSAIDs managed symptoms
2/6 → Pamidronate was effective.
1/6 => Etanercept provided the greatest long-term enhancement.
Issues Patients Face:
After orthopedic procedures, there is a chance of wound infections and inadequate incision healing.
Psychosocial challenges such as anxiety, depression, and stress before and after surgery.
High risk of pressure ulcers due to prolonged immobilization.
Pain management and impaired mobility in the postoperative phase.
Poor communication and cooperation due to unclear instructions or lack of patient education.
Preventing Infections and Promoting Incision Healing:
In order to prevent infections, strict aseptic procedures and sterilization of tools and prosthesis are required before to, during, and following surgery.
Control of the operating room environment includes reducing people flow, regulating humidity, and keeping the air
clean and at a set temperature to maintain sterility.
Maintaining clean and dry incisions, changing dressings on time using high-absorption materials, and keeping an eye
out for early infection symptoms are all part of postoperative wound care.
Prevention of Pressure Ulcers:
Regular bed shifting, the use of cotton pads and other materials to reduce pressure points, and teaching family
members basic nursing skills like turning and massaging are all components of a comprehensive nursing intervention.
The risk of ulceration can be decreased by applying skin care products like petroleum jelly and skin care powder and by keeping the skin clean and dry.
Interventions in Psychology:
Psychological evaluation both before and after surgery to identify patients' anxiety or despair.
To foster collaboration and trust, offer emotional support, counseling, and thorough descriptions of surgical processes and recuperation.
Throughout the care period, maintain regular contact with patients and their families to address concerns and promote mental wellness.
Management of Pain and Mobility:
Frequent evaluation and prompt pain medication administration.
To lower the hazards connected with immobilization, incremental bed exercises should be encouraged as tolerated and safe movement instruction should be provided.
To increase comfort and reduce trauma, local massage and cautious support during transfers and positioning are recommended.
Dietary and Excretion Care:
Dietary guidance to ensure adequate nutrition, focusing on high-protein, high-vitamin, and low-fat foods to promote healing.
To preserve smooth bowel movement and avoid constipation, a high fluid intake and a diet low in hot, irritant meals are encouraged.
To lower the risk of bacterial contamination, promptly attend to excretory demands while maintaining hygiene.
Notes
For more information visit: https://pmc.ncbi.nlm.nih.gov/articles/PMC6241066/?utm_source=chatgpt.com
