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Published on: February 9, 2011

Pediatric chronic nonbacterial osteomyelitis

Arturo Borzutzky1, Sara Stern, Andreas Reiff

  • 1Program in Rheumatology, Division of Immunology, Children’s Hospital Boston, Boston, Massachusetts 02115, USA.

Pediatrics
|October 17, 2012
PubMed

Insights

Chronic nonbacterial osteomyelitis (CNO) in children often coexists with autoimmune diseases. Immunosuppressive therapies, including disease-modifying antirheumatic drugs and biologics, showed higher efficacy than NSAIDs for CNO treatment.

Area of Science:

  • Pediatric rheumatology
  • Pediatric orthopedics
  • Immunology

Background:

  • Chronic nonbacterial osteomyelitis (CNO) is a rare pediatric condition with limited data on its natural history and optimal management.
  • Understanding CNO's characteristics is crucial for improving patient outcomes.

Purpose of the Study:

  • To retrospectively review a large cohort of pediatric patients diagnosed with CNO.
  • To assess the clinical features, natural history, and treatment responses in children with CNO.

Main Methods:

  • Retrospective chart review of 70 children diagnosed with CNO across three US tertiary care centers (1985-2009).
  • Data extraction included clinical, laboratory, histopathologic, and radiologic findings.
  • Evaluation of treatment responses to various agents: NSAIDs, sulfasalazine, methotrexate, TNFα inhibitors, and corticosteroids.

Main Results:

  • Half of the pediatric CNO patients had comorbid autoimmune diseases, associated with more bone lesions and higher inflammatory markers.
  • Treatment efficacy varied significantly by agent; corticosteroids (95%), TNFα inhibitors (91%), and methotrexate (91%) showed the highest response rates.
  • Disease-modifying antirheumatic drugs (DMARDs) and biologics were more effective than NSAIDs.

Conclusions:

  • Autoimmunity is a significant comorbidity in pediatric CNO, linked to multifocal disease and the need for immunosuppressive therapy.
  • DMARDs and biologics represent more effective treatment options for pediatric CNO compared to NSAIDs.
Abstract

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