Chronic nonbacterial osteomyelitis in children: a retrospective multicenter study

Area of Science:

• Pediatric Rheumatology
• Pediatric Orthopedics
• Pediatric Inflammation

Background:

• Nonbacterial inflammatory bone diseases in children encompass chronic nonbacterial osteomyelitis (CNO) and synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome.
• Understanding their clinical presentation, treatment, and outcomes is vital for effective management.

Purpose of the Study:

• To determine the clinical presentation, current treatment strategies, and outcomes of pediatric patients diagnosed with nonbacterial inflammatory bone diseases.
• To analyze the course and response to therapy in children with CNO and SAPHO syndrome.

Main Methods:

• A retrospective multicenter study was conducted using data from the Swiss Pediatric Rheumatology Working Group registry.
• Patient charts were reviewed for disease presentation, treatment details, disease course, and patient outcomes.

Main Results:

• The study included 41 children with multifocal CNO, unifocal CNO, or SAPHO syndrome, diagnosed between 1995 and 2010.
• Most patients (27/41) had a chronic persistent disease course; 57% achieved disease control with NSAIDs, while others required advanced therapies like corticosteroids, methotrexate, or TNF α inhibitors.
• A significant diagnostic delay was noted in 22% of cases presenting with unifocal lesions.

Conclusions:

• Nonbacterial inflammatory bone diseases in children frequently present as chronic persistent conditions rather than recurrent forms.
• Pelvic osteomyelitis is significantly associated with features of juvenile spondylarthritis.
• Effective management may necessitate a stepwise approach, escalating therapy based on treatment response.