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Chronic Nonbacterial Osteomyelitis in Children.

Aikaterini Koryllou1, Manel Mejbri1, Katerina Theodoropoulou1,2

  • 1Pediatric Immuno-Rheumatology of Western Switzerland, CHUV, University of Lausanne, 1011 Lausanne, Switzerland.

Children (Basel, Switzerland)
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Summary

Chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis (CRMO), is an inflammatory bone disease diagnosed via MRI. Treatment involves NSAIDs, with other options for severe cases.

Keywords:
DIRAMajeed syndromePAPA syndromeSAPHOauto-inflammatory bone diseasechronic nonbacterial osteitischronic nonbacterial osteomyelitis (CNO)chronic recurrent multifocal osteomyelitis (CRMO)monogenic

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Area of Science:

  • Rheumatology
  • Pediatric Rheumatology
  • Radiology

Background:

  • Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder.
  • It presents with varied clinical manifestations, from single to multiple bone lesions, with multifocal cases termed chronic recurrent multifocal osteomyelitis (CRMO).
  • While CNO/CRMO affects all ages, it is most prevalent in children.

Purpose of the Study:

  • To provide a comprehensive overview of CNO/CRMO.
  • To highlight diagnostic challenges and current management strategies.
  • To emphasize the importance of long-term patient follow-up.

Main Methods:

  • Literature review of CNO/CRMO.
  • Analysis of diagnostic modalities, focusing on MRI as the gold standard.
  • Review of current therapeutic approaches, including first-line and refractory treatments.

Main Results:

  • CNO/CRMO lacks specific laboratory markers and diagnostic criteria, often requiring exclusion of other conditions.
  • Magnetic resonance imaging (MRI) is crucial for diagnosis.
  • Treatment typically starts with NSAIDs, progressing to bisphosphonates or TNF-α inhibitors for refractory cases.

Conclusions:

  • CNO/CRMO diagnosis relies heavily on clinical presentation and advanced imaging like MRI.
  • Management requires a tailored approach, with long-term monitoring essential due to unpredictable disease course and potential complications.
  • Further research is needed for validated diagnostic criteria and optimized treatment protocols.