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Chronic Non-Bacterial Osteomyelitis in Pediatric Patients: Findings from Multiple Centers in Saudi Arabia
Lujain Alahmadi1,2,3, Jude Almasoud1,2,3, Abdullah Almojali1,2,3
1King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia.
Background:
Chronic non-bacterial osteomyelitis (CNO) is a chronic auto-inflammatory disorder affecting bones in children and adolescents. The study aimed to assess pediatric CNO patients' demographic, clinical, laboratory, imaging, and histopathology characteristics and treatment responses.
Methods:
This is a descriptive and analytical multicenter study that reviewed 58 patients diagnosed with CNO between 2015 and 2021 across six centers in Saudi Arabia.
Results:
The mean age at diagnosis was eight years, and 62% of the patients were females (n = 36). The most common clinical manifestation was bone pain (n = 51, 88%). Elevated erythrocyte sedimentation rate (> 15 mm/hr) was observed in 85% (n = 49) of patients, and positive C-reactive protein (> 8 mg/L) was observed in 41% (n = 24). Bone biopsy was performed in 56.9% (n = 33) of patients. The lower limbs (n = 37, 64%) were the most involved sites. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most commonly used treatment modality, with 88% of patients (n = 51) receiving this treatment. Bisphosphonates and tumor necrosis factor inhibitors (Anti-TNF) were used in 55% (n = 32) of patients, while methotrexate and systemic steroids were used in 36% (n = 21). Clinical remission was achieved in 84% of CNO patients.
Conclusions:
This study provides valuable insights into the phenotype of CNO in the pediatric population and shares the experience of multiple centers in treating this rare condition in Saudi patients.
