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Treatment with Vancomycin Loaded Calcium Sulphate and Autogenous Bone in an Improved Rabbit Model of Bone Infection
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Chronic nonbacterial osteomyelitis: current perspectives in pediatric practice.

Özge Başaran1, Adalet Elçin Yıldız2, Yelda Bilginer1

  • 1Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.

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|March 23, 2026
PubMed
Summary

Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disease in children. Advances show innate immune dysregulation drives sterile bone inflammation, requiring multidisciplinary management for better outcomes.

Keywords:
autoinflammatory bone diseasechildchronic nonbacterial osteomyelitispediatric rheumatologyrecurrent osteomyelitis

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Area of Science:

  • Pediatric Rheumatology
  • Autoinflammatory Diseases
  • Skeletal Disorders

Background:

  • Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder affecting children and adolescents, presenting a spectrum from unifocal to multifocal chronic recurrent multifocal osteomyelitis (CRMO).
  • Pathogenesis involves innate immune dysregulation and imbalanced cytokine signaling, leading to sterile bone inflammation, osteoclast activation, pain, and bone lesions.
  • Diagnosis is challenging due to the lack of specific biomarkers, making it a diagnosis of exclusion, though the EULAR/ACR classification framework aids standardization.

Purpose of the Study:

  • To review the current understanding of CNO pathogenesis, diagnosis, and management.
  • To highlight recent advances in classification, imaging, and therapeutic strategies.
  • To emphasize the importance of early recognition and multidisciplinary care for improving long-term outcomes.

Main Methods:

  • Literature review focusing on recent advances in CNO research.
  • Analysis of diagnostic modalities, including whole-body MRI and biopsy indications.
  • Examination of current and emerging therapeutic approaches, from NSAIDs to targeted biologics.

Main Results:

  • Whole-body MRI is the preferred imaging modality for CNO diagnosis and monitoring.
  • Management strategies range from NSAIDs to biologics (e.g., TNF inhibitors) and JAK inhibitors for refractory cases.
  • Despite a history of perceived benignity, CNO carries risks of relapse and structural complications, necessitating long-term follow-up.

Conclusions:

  • CNO pathogenesis is linked to innate immune system dysregulation, particularly cytokine pathways (IL-1, IL-6, IL-17/23).
  • The EULAR/ACR classification framework and advanced imaging like whole-body MRI improve diagnostic consistency.
  • Targeted therapies and multidisciplinary management are crucial for optimizing treatment and outcomes in pediatric CNO patients.