Evaluation of 334 Pediatric CNO Cases: A Multicenter Cohort Study Defining Clusters

Area of Science:

• Pediatric Rheumatology
• Osteomyelitis Research
• Clinical Epidemiology

Background:

• Chronic Non-Bacterial Osteomyelitis (CNO) is a rare inflammatory bone disease in children.
• Understanding CNO's clinical and demographic variations is crucial for effective management.
• Previous studies have reported differing epidemiological features across populations.

Purpose of the Study:

• To delineate the clinical and demographic characteristics of pediatric CNO patients in Turkey.
• To identify distinct patient clusters based on patterns of bone involvement.
• To explore factors associated with disease relapse in this cohort.

Main Methods:

• Multicenter cohort study including 334 pediatric CNO patients from 21 centers.
• Comprehensive data collection on clinical presentation, imaging, and biopsy.
• Two-step cluster analysis to categorize patients by bone-site involvement.

Main Results:

• Four distinct bone-site clusters were identified: axial-thoracic, lower-extremity, upper-extremity, and craniofacial.
• The Turkish cohort exhibited a higher proportion of male patients and lower skin involvement compared to prior reports.
• Remission was achieved in 77.3% of patients, with relapse occurring in 22%; mandibular involvement, comorbidities, and localized pain predicted relapse.

Conclusions:

• Pediatric CNO in Turkey presents with male predominance and minimal skin involvement.
• Identified bone-site clusters offer potential for improved prognostic assessment in CNO.
• Further validation of these clusters in diverse populations is warranted.