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Chronic non-bacterial osteomyelitis in children.
H J Girschick1, P Raab, S Surbaum
1Section of Paediatric Rheumatology, Children's Hospital, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany. Hermann.Girschick@mail.uni-wuerzburg.de
Annals of the Rheumatic Diseases
|January 14, 2005
Summary
Chronic recurrent multifocal osteomyelitis (CRMO) is a severe form of chronic non-bacterial osteomyelitis (CNO) in children. Most children with CNO experience a favorable outcome, though severe cases may require oral glucocorticoids.
Area of Science:
- Pediatric rheumatology
- Pediatric osteomyelitis
- Inflammatory bone diseases
Background:
- Chronic recurrent multifocal osteomyelitis (CRMO) is a non-suppurative inflammatory condition affecting multiple bone sites in children.
- Chronic non-bacterial osteomyelitis (CNO) encompasses a spectrum of disease, including cases with fewer lesions or non-recurrent patterns.
Purpose of the Study:
- To characterize the long-term outcomes for children diagnosed with the full spectrum of chronic non-bacterial osteomyelitis (CNO).
Main Methods:
- A cohort of 30 children with CNO was followed for a mean of 5.6 years.
- Disease assessment included clinical scoring, advanced imaging, and diagnostic biopsy with microbial analysis.
- Patient disease patterns were categorized into unifocal non-relapsing, unifocal relapsing, multifocal non-relapsing, and multifocal relapsing (CRMO).
Main Results:
- Granulocyte presence was significantly higher in CRMO compared to unifocal/non-recurrent lesions.
- Pustulosis was more frequent in multifocal CNO, irrespective of recurrence.
- Naproxen was effective for single occurrences (mean 9.2 months treatment) and relapsing cases (mean 25 months), though 7/12 relapsing patients required additional oral glucocorticoids for remission.
Conclusions:
- Chronic non-bacterial osteomyelitis (CNO) represents a spectrum of inflammatory conditions, with CRMO being the most severe manifestation.
- The majority of children with CNO exhibit favorable long-term outcomes.
- Oral glucocorticoids may be a necessary therapeutic option for managing severe, recurrent CNO cases.