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Clinical features of children with chronic non-bacterial osteomyelitis: A multicenter retrospective case series from
Ceyhun Açarı1, Elif Çomak2, Şükrü Çekiç3
1Department of Pediatrics, Division of Pediatric Rheumatology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey.
Insights
Turkish children with chronic non-bacterial osteomyelitis often have Mediterranean fever gene mutations. Investigating familial Mediterranean fever (FMF) is crucial for timely diagnosis and treatment in this population.
Area of Science:
- Pediatric Rheumatology
- Genetics
- Osteomyelitis
Background:
- Chronic non-bacterial osteomyelitis (CNBO) is a rare condition in children.
- Accurate diagnosis and understanding of underlying genetic factors are essential for effective management.
Purpose of the Study:
- To evaluate the demographic, clinical, and radiological characteristics of Turkish children diagnosed with CNBO.
- To investigate the prevalence of Mediterranean fever gene (MEFV) mutations and familial Mediterranean fever (FMF) in this cohort.
Main Methods:
- Retrospective analysis of 28 Turkish children diagnosed with CNBO between 2008 and 2018.
- Data collection included demographic, clinical, laboratory, and radiological findings.
- Genetic analysis for MEFV mutations was performed.
Main Results:
- The median age at diagnosis was 10.2 years, with a median diagnostic delay of 6.5 months.
- Arthralgia was the most common symptom (75%), and the femur was the most frequent site (67.9%).
- A high prevalence of MEFV mutations (63.6%) was observed, with five patients meeting FMF criteria. Colchicine was effective in patients with MEFV mutations.
Conclusions:
- Delayed diagnosis of CNBO is common and necessitates careful clinical and radiological evaluation.
- Screening for FMF should be considered in Turkish children with CNBO due to the high comorbidity observed.
Objectives:
This study aims to evaluate demographic, clinical, and radiological characteristics of Turkish children with chronic non-bacterial osteomyelitis.
Patients And Methods:
Between January 2008 and December 2018, a total of 28 patients (10 males, 18 females; median age: 12.5 years; range, 4.5 to 21 years) who were diagnosed with chronic non-bacterial osteomyelitis in three pediatric rheumatology centers were retrospectively analyzed. The demographic, clinical, and laboratory findings of the patients were recorded.
Results:
The median age at the time of diagnosis was 10.2 years. The median time from symptom onset to diagnosis was 6.5 months. The median follow-up was 18.5 months. The most frequent symptom at onset was arthralgia (75.0%). The most frequently involved bone was the femur (67.9%). Eight (63.6%) of 12 patients had at least one Mediterranean fever gene (MEFV) mutation, indicating a significantly higher prevalence than the Turkish population (14.8%). Five of these patients fulfilled the diagnostic criteria for familial Mediterranean fever (FMF). All patients received non-steroidal anti-inflammatory drugs. Other drugs were methotrexate (46.4%), sulfasalazine (39%), corticosteroids (25%), anti-tumor necrosis factor (anti-TNF) agents (32%), pamidronate (25%), and colchicine (21.4%). Six of eight patients with MEFV mutations were administered with colchicine, and all of them responded to treatment.
Conclusion:
Clinical evolution and imaging investigations should be carefully performed to prevent any delay in the diagnosis of patients with chronic non-bacterial osteomyelitis. Based on our study results, FMF coexistence is worth investigating in patients with chronic non-bacterial osteomyelitis, particularly in the Turkish population.
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