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Comparison of different treatment approaches of pediatric chronic non-bacterial osteomyelitis
Mikhail M Kostik1, Olga L Kopchak2, Irina A Chikova3
1Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint Petersburg, 194100, Russian Federation. kost-mikhail@yandex.ru.
Insights
Chronic non-bacterial osteomyelitis (CNO) treatments vary in efficacy based on disease location. Pamidronate and TNF-α inhibitors show superior results in vertebral CNO, while NSAIDs, methotrexate, and sulfasalazine are effective for non-vertebral forms.
Area of Science:
- Pediatric rheumatology
- Pediatric bone diseases
- Inflammatory bone conditions
Background:
- Chronic non-bacterial osteomyelitis (CNO) is a rare inflammatory bone disease primarily affecting children and adolescents.
- Limited data exists regarding the pathogenesis and optimal treatment strategies for pediatric CNO.
- Understanding treatment efficacy is crucial for managing this debilitating condition in young patients.
Purpose of the Study:
- To compare the efficacy of various treatment approaches in a cohort of pediatric patients diagnosed with CNO.
- To evaluate the effectiveness of non-steroid anti-inflammatory drugs (NSAID), pamidronate (PAM), sulfasalazine (SSZ), methotrexate (MTX), and tumor necrosis factor-α inhibitors (TNFα-inh).
- To determine the influence of disease location (vertebral vs. non-vertebral) on treatment outcomes.
Main Methods:
- A cohort of 52 children diagnosed with CNO was analyzed.
- Treatments included NSAID (non-vertebral) and PAM (vertebral) as first-line, with SSZ, MTX, PAM, and TNFα-inh as second-line options.
- Patient and physician visual-analog scale (VAS) assessments and CNO remission rates were evaluated for each treatment group.
Main Results:
- Pamidronate (PAM) and TNF-α inhibitors (TNFα-inh) demonstrated significant efficacy in achieving CNO remission (88.8% and 73.3%, respectively), particularly in vertebral CNO.
- Non-steroid anti-inflammatory drugs (NSAID), methotrexate (MTX), and sulfasalazine (SSZ) showed effectiveness in non-vertebral CNO cases.
- Patient and physician VAS scores indicated substantial pain reduction with PAM and TNFα-inh treatments.
Conclusions:
- Treatment efficacy for pediatric CNO is significantly influenced by the disease's location.
- Pamidronate and TNF-α inhibitors are highly effective for vertebral CNO, while NSAIDs, MTX, and SSZ are suitable for non-vertebral forms.
- Further randomized controlled trials are essential to confirm the efficacy and safety of these therapeutic strategies.
Abstract:
Chronic non-bacterial osteomyelitis (CNO) is a chronic inflammatory bone disease which usually manifests in children and adolescents. There are a few data about pathogenesis and treatment. The aim of the study to compare the efficacy of different treatment approaches in pediatric CNO cohort patient. Fifty two children (25 boys and 27 girls) with CNO with average age at the onset of the disease 8.4 years (5.4; 11.0), number of foci - 3.0 (2.0; 6.0, incl. multifocal cases in 80.8%). Non-steroid anti-inflammatory drugs (NSAID) was the first-line treatment for non-vertebral cases, as well as pamidronate (PAM) for vertebral involvement. Second-line treatment includes sulfasalazine (SSZ), methotrexate (MTX), PAM and tumor necrosis factor-α inhibitors (TNFα-inh). We evaluated the dynamics of pain, patient's and physician's (MDVAS) assessment with visual-analog scale (VAS) and ability to each medication to achieve remission of CNO activity. According to the NSAID, MTX, SSZ, PAM and TNFα-inh groups the following data were registered: patient's VAS: - 14.2% (p = 0.05), - 50.0% (p = 0.04), - 23.1 (p = 0.89), - 83.3% (p = 0.0001), - 73.6% (p = 0.0007); painVAS: - 21.9% (p = 0.01), - 18.6% (p = 0.13), + 36.4 (p = 0.89), - 79.7% (p = 0.00016), - 74.1%, (p = 0.0015); MDVAS: - 13.8% (p = 0.13); - 56.4% (p = 0.09), + 30.8% (p = 0.89), - 74.7%, (p = 0.0001), - 82.1 (p = 0.0015) respectively. The ability of each treatment strategy to achieve the CNO remission was 52.6%, 44.4%, 57,1%, 88.8% and 73.3%, respectively (log-rank test, p = 0.001). The efficacy of treatment approaches for CNO depended on the severity of the disease. NSAID, methotrexate, and sulfasalazine were effective in forms without spine involvement, but pamidronate and TNF-a inhibitors were useful in vertebral forms of CNO. Pamidronate and TNF-a inhibitors more extensively suppressed CNO activity. The randomized controlled trials for assessment of the efficacy and safety of these medications is mandatory to confirm these results.
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