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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
Insights
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.
Background:
Chronic recurrent multifocal osteomyelitis (CRMO) in children is a chronic non-suppurative inflammation involving multiple sites. Some children affected by chronic non-bacterial osteomyelitis (CNO) do not have multiple lesions or a recurrent course.
Objective:
To characterise the long term outcome of children with the full spectrum of CNO.
Methods:
30 children diagnosed with CNO were followed up for a mean of 5.6 years and their disease assessed using a clinical score, multiple imaging, and a diagnostic biopsy, including extensive microbial analysis.
Results:
9 patients had unifocal non-relapsing disease, 3 unifocal lesions with relapses, 9 multifocal lesions without relapses, and 9 multifocal lesions with relapses (CRMO). Granulocytes were present significantly more often in CRMO than in unifocal and non-recurrent lesions. Pustulosis was more common in multifocal cases regardless of recurrence. Mean duration of treatment in 15 children with a single occurrence was 9.2 months. Naproxen treatment was generally effective. Naproxen treatment in 12 patients with relapses lasted 25 months. However, 7 of these were not effectively treated with naproxen alone. Five were treated with oral glucocorticoids for 27 days in addition to naproxen, which induced remission in four, lasting for at least 1.5 years. Longitudinal growth of affected bones was not altered, except for the development of hyperostosis.
Conclusion:
CNO is a spectrum of inflammatory conditions, with CRMO being the most severe. Most children with CNO have a favourable outcome of the disease. Oral glucocorticoids may be necessary in severe recurrent cases.
