1
|
Ramachandran S, Zhao Y, Ferguson PJ. Update on treatment responses and outcome measure development in chronic nonbacterial osteomyelitis (CNO). Curr Opin Rheumatol 2023:00002281-990000000-00062. [PMID: 37433220 DOI: 10.1097/bor.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
PURPOSE OF REVIEW To review recent trends in treatment and recent progress in developing outcome measures needed for chronic nonbacterial osteomyelitis (CNO) clinical trials. RECENT FINDINGS CNO is an autoinflammatory bone disease. In a minority of patients, the disease is genetically driven, and diagnosis can be made by DNA sequencing. However, for nonsyndromic CNO there is no diagnostic test. The number of children with CNO appears to be increasing and damage is common. Increases in CNO diagnosis is due to raised awareness, increased availability of whole-body magnetic resonance imaging and rising incidence. Treatment remains empiric and it is unclear which second line treatment is superior. Tumor necrosis factor inhibitors (TNFi) and bisphosphonates continue to be used as second line agents for nonsteroidal anti-inflammatory drugs (NSAID) refractory CNO; newer immune modulatory medications are used if this fails. Validated classification criteria, clinical outcome measures and imaging scoring standards are needed for successful clinical trials. SUMMARY Best treatment for NSAID refractory CNO remains unclear. Classification criteria, clinical outcomes measures and standardized imaging scoring have been developed or are near completion. This will facilitate robust clinical trials in CNO with the goal of having approved medications for this painful disease.
Collapse
Affiliation(s)
- Shwetha Ramachandran
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Yongdong Zhao
- Department of Pediatrics, Seattle Children's Hospital. Seattle, Washington, USA
| | - Polly J Ferguson
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| |
Collapse
|
2
|
ULU K, İŞGÜDER R, Gül KARADAĞ Ş, BAĞLAN E, KAVRUL KAYAALP G, OTAR YENER G, ÖZTÜRK K, SÖNMEZ HE, ÖZDEL S, DEMİR F, MAKAY B, ÜNSAL ŞE, SÖZERİ B, AKTAY AYAZ N, ÇAKAN M. Clinical characteristics and predictors for recurrence in chronic nonbacterial osteomyelitis: a retrospective multicenter analysis. Turk J Med Sci 2023; 53:1105-1111. [PMID: 38813038 PMCID: PMC10763774 DOI: 10.55730/1300-0144.5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/26/2023] [Accepted: 02/28/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Chronic nonbacterial osteomyelitis (CNO) is a rare disease of unknown etiology and most commonly occurs during childhood or adolescence. The purpose of this study is to collect data on the clinical features, outcomes, and management of the disease and to identify the factors affecting recurrence. Materials and methods This is a retrospective multicenter cross-sectional study of pediatric patients diagnosed with CNO. A total of 87 patients with a diagnosis of CNO followed for at least 6 months in 8 pediatric rheumatology centers across the country between January 2010 and December 2021 were included in this study. Results The study included 87 patients (38 girls, 49 boys; median age: 12.5 years). The median follow-up time was 20 months (IQR: 8.5-40). The median time of diagnostic delay was 9.9 months (IQR: 3-24). Arthralgia and bone pain were the most common presenting symptoms. Multifocal involvement was detected in 86.2% of the cases and a recurrent course was reported in one-third of those included in the study. The most commonly involved bones were the femur and tibia. Vertebrae and clavicles were affected in 19.5% and 20.6% of cases, respectively. The erythrocyte sedimentation rate (ESR) values of 60.9% of the patients were above 20 mm/h and the C-reactive protein values of 44.8% were above 5 mg/L. The remission rate was 13.3% in patients using nonsteroidal antiinflammatory drugs and 75.0% in those using biological drugs. Vertebral and mandibular involvement and high ESR values at the time of diagnosis were associated with recurrence. Conclusion In this multicenter study, CNO with vertebral and mandibular involvement and high ESR at diagnosis were associated with recurrence.
Collapse
Affiliation(s)
- Kadir ULU
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul,
Turkiye
| | - Rana İŞGÜDER
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Şerife Gül KARADAĞ
- Department of Pediatric Rheumatology, Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Esra BAĞLAN
- Department of Pediatric Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, University of Health Sciences, Ankara,
Turkiye
| | - Gülşah KAVRUL KAYAALP
- Department of Pediatric Rheumatology, Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Gülçin OTAR YENER
- Department of Pediatric Rheumatology, Medical Point Hospital, Gaziantep,
Turkiye
| | - Kübra ÖZTÜRK
- Department of Pediatric Rheumatology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul Medeniyet University, İstanbul,
Turkiye
| | - Hafize Emine SÖNMEZ
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli,
Turkiye
| | - Semanur ÖZDEL
- Department of Pediatric Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, University of Health Sciences, Ankara,
Turkiye
| | - Ferhat DEMİR
- Department of Pediatric Rheumatology, Acıbadem Hospital, İstanbul,
Turkiye
| | - Balahan MAKAY
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Şevket Erbil ÜNSAL
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkiye
| | - Betül SÖZERİ
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul,
Turkiye
| | - Nuray AKTAY AYAZ
- Department of Pediatric Rheumatology, Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Mustafa ÇAKAN
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul,
Turkiye
| |
Collapse
|
3
|
Opala A, Hofman J, Hutny M, Wylazlowska A, Matusik P. A Successful Bisphosphonates Monotherapy in Spinal Form of Paediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO)—Case Report. Metabolites 2023; 13:metabo13030344. [PMID: 36984784 PMCID: PMC10053061 DOI: 10.3390/metabo13030344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 01/18/2023] [Indexed: 03/03/2023] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a non-infectious inflammatory disorder resulting from the multifocal bone and bone marrow lesions with periodic relapses and remissions and with an uncertain prognosis. Treatment options in CRMO are based on expert opinion and relatively small groups of patients. A nine-year-old female patient with no significant past medical history presented with compression fractures and multifocal bone lesions in the thoracic and lumbar spine, as shown in imaging (CT, MRI). Densitometry revealed a diffuse decrease in bone density. Based on the patient’s clinical image and above examinations, the other possible aetiologies—infectious (including tuberculosis), neoplasms, Langerhans cell histiocytosis—were ruled out, which led to eventual final diagnosis—CRMO. The patient was successfully treated with pamidronate infusion initiated in cycles over three consecutive days every 3 months. In addition to clinical improvement, there was a significant remission of inflammation and bone structure healing assessed by MRI after four treatment cycles. Intravenous bisphosphonates usage seems to be a good therapeutic option in CRMO paediatric patients with spinal localization of the lesions complicated by compressive fractures. However, more data, based on larger patient populations, are needed to provide a detailed paediatric CRMO treatment algorithm.
Collapse
Affiliation(s)
- Aleksandra Opala
- Department of Paediatrics, Paediatric Obesity and Metabolic Bone Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Jagoda Hofman
- Scientific Society of Medical Students, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Michał Hutny
- Scientific Society of Medical Students, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Aleksandra Wylazlowska
- Department of Paediatrics, Paediatric Obesity and Metabolic Bone Diseases, Municipal Hospital, 43-100 Tychy, Poland
| | - Paweł Matusik
- Department of Paediatrics, Paediatric Obesity and Metabolic Bone Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
- Correspondence:
| |
Collapse
|
4
|
Shi X, Hou X, Hua H, Dong X, Liu X, Cao F, Li C. Case report: Child chronic nonbacterial osteomyelitis with rapid progressive scoliosis-an association with disease? Front Pediatr 2023; 11:1076443. [PMID: 37025300 PMCID: PMC10070962 DOI: 10.3389/fped.2023.1076443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Background Chronic nonbacterial osteomyelitis (CNO) is an auto-inflammatory bone disease that usually develops in childhood. Spinal involvement is a common manifestation of CNO, but it is rare for CNO to lead to rapid progression of scoliosis deformity. Here we present a 9-year-old girl with acute scoliosis with CNO and scoliosis progressed rapidly in 2 months. Case Presentation A 9-year-old girl presented bilateral shoulder inequality with pain in the left hypochondrium for 2 months. Standing spinal x-rays showed right convex scoliosis with a 25° Cobb angle. Chest magnetic resonance imaging (MRI) showed that the T8 vertebra was flattened and local bone was destroyed with bone marrow edema. The bone biopsy showed evidence of fibrosis and chronic inflammatory changes with no specific diagnosis. One month later, her scoliosis and bone destruction deteriorated obviously. Thoracic vertebra MRI showed that the T8 vertebra had a compression fracture. 99mTc-MDP whole-body bone scintigraphy showed intense uptake at T8/9 and the right sacroiliac joint. She was diagnosed with CNO accompanied by rapidly progressive scoliosis. The scoliosis was successfully treated with adalimumab and zoledronic acid, which showed significant improvement after 6 months of follow-up. Conclusion Zoledronic acid and adalimumab successfully treated CNO with rapidly progressive scoliosis, but could not prevent vertebral compression.
Collapse
Affiliation(s)
- Xiaojun Shi
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Haiqin Hua
- Department of Radiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xia Dong
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoping Liu
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fengjiao Cao
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
- Correspondence: Chen Li
| |
Collapse
|
5
|
Burgaz I, Mahroq T. Nonbacterial osteomyelitis involving the mandible: A case report. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|