Chronic Recurrent Multifocal Osteomyelitis Homeopathy Treatment | Symptoms & Diet

Introduction:

Chronic recurrent Multifocal Osteomyelitis (CMO) is a rare, non-infectious inflammatory bone disorder characterized by bone inflammation. It affects children and adolescents, more than adults.

Causes of Chronic Multifocal Osteomyelitis (CMO)

Chronic Multifocal Osteomyelitis (CMO) is a non-infectious inflammatory bone disorder. 

1. Immune System Dysfunction

CMO is an autoinflammatory disease, where the immune system attacks healthy bone tissue, leading to chronic inflammation.

2. Genetic Factors
   Genetic mutations, involved in immune regulation (such as IL-1 and LPIN2 mutations) related to autoinflammatory bone diseases.
3. Cytokine Imbalance

Overproduction of pro-inflammatory cytokines (e.g., IL-1, IL-6, TNF-α) leads to excessive bone inflammation.

This inflammation occurs without any infection, differing from bacterial osteomyelitis.

Types of Chronic Recurrent Multifocal Osteomyelitis (CRMO):

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a rare autoinflammatory bone disease characterized by recurrent episodes of bone inflammation without infection.

1. Syndromic CRMO – 
2. Majeed Syndrome Caused by mutations in the LPIN2 gene. It’s an autosomal recessive inheritance. It features, early-onset CRMO.Congenital dyserythropoietic anemia (a rare blood disorder) and Neutrophilic dermatosis (inflammatory skin disease).
3. Deficiency of Interleukin-1 Receptor Antagonist (DIRA) Caused by mutations in the IL1RN gene leading to excessive inflammation due to unregulated IL-1 activity with severe neonatal-onset osteomyelitis, Pustular skin rash and Joint deformities.
4. Chronic Non-Bacterial Osteomyelitis (CNO) with Genetic Predisposition and mutation.(e.g., FBLIM1, IL1, TNF pathways).
5. CRMO with SAPHO Syndrome-  (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis)
   Sapho Syndrome is an inflammatory disorder, mainly in adults but affects children too. It affects the clavicle, sternum, and spine, with skin conditions (e.g., acne, palmoplantar pustulosis).
6. Autoinflammatory Syndromes such as Chronic Recurrent Multifocal Osteomyelitis (CRMO) – a relapsing form of the disease. SAPHO Syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) is a disorder affecting bones, joints, and skin.
7. Environmental Triggers like infections or stress may trigger genetically predisposed individuals.

Symptoms of Chronic Recurrent Multifocal Osteomyelitis (CRMO) are: 

1. Bone Pain with Intermittent or persistent pain,which worsens at night.
2. Skin Swelling and Tenderness appearing warm or swollen with recurrent episodes appear and subsides or may persist for years.
3. Multiple bones such as  long bones (tibia, femur), clavicle, pelvis, and vertebrae are affected.
4. Patients feel Feverish with difficulty in movement, pain and inflammation.Patient feels tired and has reduced energy.

General Approach to Managing CRMO:

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is an autoinflammatory disorder, the goal of treatment is to control inflammation, manage pain, and prevent complications like bone deformities. The treatment approach includes:

1. First-Line Treatment-

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) – Ibuprofen, Naproxen, or Indomethacin are used to reduce inflammation and pain.

Side Effects: Gastric irritation, ulcers, kidney issues, cardiovascular risks (long-term use).

2. Second-Line Treatment (If NSAIDs Are Ineffective)- Disease with Anti-Rheumatic Drugs (DMARDs) Methotrexate or Sulfasalazine is considered. Side Effects: Liver toxicity, bone marrow suppression, nausea.
3. Biologic Therapy (For Severe or Resistant Cases)- TNF-alpha Inhibitors (e.g., Adalimumab, Infliximab) which targets inflammation. Side Effects: Risk of infections with getting prone to allergies.

IL-1 or IL-6 Inhibitors (e.g., Anakinra, Tocilizumab) are used in refractory cases.

Side Effects: Risk to infections, injection site reactions.

4. Supportive Therapy- Physiotherapy & Rehabilitation helps maintain mobility and prevent deformities. Vitamin D & Calcium Supplements – To support bone health and prevent fractures. Antibiotics (If Needed) – CRMO is not an infection, antibiotics are used, if patients suffer from bacterial infection.
5. Monitoring & Lifestyle Adjustments-

Regular Imaging (MRI/X-rays) – To monitor bone lesions and progression.Healthy Diet & Exercise reduces bone inflammation.

Chronic Recurrent Multifocal Osteomyelitis (CRMO) Homeopathy Remedies:

Homeopathy aims to manage Chronic Recurrent Multifocal Osteomyelitis (CRMO) by reducing inflammation and strengthening the immune system. Few Homeopathic remedies are:

1. Silicea: Chronic bone infections with delayed healing of bones, pus formation and night sweats. Symptoms: Weakness, sensitivity to cold, slow healing, recurrent abscesses.
2. Hepar Sulphuris Calcareum: Deep-seated infections with pus formation and extreme sensitivity to pain. Symptoms: Irritability, Intense bone pain and swelling with pus discharge which worsens by cold exposure.
3. Calcarea Phosphorica: Remedy Works well with inflammation of bones in children and preferred for the patients with bone weakness with poor healing.Symptoms: Remedy used for bone deformities with delayed bone development.
4. Symphytum Officinalis: This medicine used for chronic osteomyelitis with slow healing, 

bone injuries and fractures.Symptoms:, History of fractures, Bone pain swelling and stiffness.

5. Mercurius Solubilis: Pus-forming infections of bones and joints. Symptoms: Swollen lymph nodes, Profuse sweating, bad breath which increases by night. In Supportive Care calcium and vitamin D-rich foods can be included Hydration helps flush out toxins. Avoid cold exposure to maintain good bone health.

Diet Chart for Chronic Recurrent Multifocal Osteomyelitis (CRMO)

A well-balanced anti-inflammatory and bone-strengthening diet can help manage CRMO by supporting the immune system, reducing inflammation, and improving bone health.

🔹 Dietary Guidelines:

✅ Increase: Anti-inflammatory foods, calcium, vitamin D, omega-3 fatty acids, and probiotics.

❌ Processed foods, refined sugars, excess red meat, and inflammatory oils must be avoided.

• Diet plan :

🍽 Morning (6:30 – 7:00 AM)

Warm Lemon Water or Turmeric Tea which helps in Detoxification. Soaked Almonds & Walnuts (4-5 each) which is Rich in omega-3s and calcium helps for overall well being.

🍳 Breakfast (8:00 – 9:00 AM)

Oats with chia seeds, flaxseeds, honey, and berries or Ragi (finger millet) porridge with dates and nuts can be preferred 

Drink: Herbal tea or green tea.

🍎 Mid-Morning Snack (11:00 AM – 12:00 PM)

Greek yogurt with flaxseeds,  fresh fruits (papaya, apple, banana, or pomegranate) and

Handful of pumpkin or sunflower seeds is suggested.

🍛 Lunch (1:00 – 2:00 PM)

Advised to have brown rice, dal (lentils), steamed vegetables, and paneer/tofu. Choice of  quinoa with chickpeas, sautéed greens or a side of yogurt and whole wheat chapati with spinach curry and grilled fish/chicken 

Drink: Buttermilk or coconut water.

🍵 Evening Snack (4:00 – 5:00 PM)

Turmeric milk (haldi doodh) with a pinch of black pepper. Makhana (fox nuts) roasted in ghee can be preferred.

🥗 Dinner (7:30 – 8:30 PM)

 Advised to take Vegetable soup with grilled salmon or chicken, Stir-fried vegetables with tofu and quinoa or Khichdi (lentil-rice mix) with a side of curd can be chosen.

🌙 Bedtime (9:30 – 10:00 PM)

Warm milk with nutmeg or chamomile tea.

• Nutritional Tips:

✔ Vitamin D – Sunlight exposure (20–30 min daily) + fortified foods (mushrooms, dairy, fish).

✔ Calcium-Rich Foods – Leafy greens, sesame seeds, dairy, ragi.

✔ Omega-3s – Fatty fish, walnuts, chia/flaxseeds for reducing inflammation.

✔ Probiotics – Curd, kefir, kombucha for gut health and immunity.

✔ Hydration – 2.5-3 liters of water daily to flush out toxins.

FAQs on Chronic Recurrent Multifocal Osteomyelitis (CRMO):

1. What causes CRMO?

The exact cause is unknown, but it’s an auto-inflammatory disorder where the immune system attacks bone tissue. Genetic and environmental factors is involved. 

2. How is CRMO diagnosed?

-MRI Scan to detects bone lesions

-Blood Tests like CRP, ESR

-Bone Biopsy to rule out infections or cancer

-Genetic Testing

3. Is CRMO a type of cancer or infection?

No, CRMO is not cancer and not caused by bacteria. Infections are caused and they not respond to antibiotics.

4. What is the treatment for CRMO?

• NSAIDs (Ibuprofen, Naproxen) – First-line treatment to reduce pain and inflammation.
• Corticosteroids – For severe flare-ups.
• DMARDs or Biologics (TNF inhibitors) – If NSAIDs are ineffective.
• Physiotherapy, Vitamin D, and Calcium – To support bone health.

5. Can CRMO be cured?

There is no permanent cure, but with proper treatment and lifestyle changes, long term management is possible. 

Conclusion

It is a challenging disease, but by the intervention in early stages, good management, and combined treatments such as homeopathy, patients can improve their quality of life. Dr. Vaseem Choudhary and his experienced team of professionals at Homeo Care Clinic are homeopathic treatment specialists who treat children afflicted with neurological disorders by providing them with natural but effective individualized medicines.

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