Chronic Nonbacterial Osteomyelitis

Abstract

To review the neuroimaging of a series of infants and young children admitted to hospital with subdural haemorrhage (SDH). Methods: Neuroradiological investigations of 74 children under 2 years of age, from South Wales and southwest England, in whom an SDH or subdural effusion had been diagnosed between 1992 and 2001, were reviewed. Two paediatric neuroradiologists blinded to the original radiological report reviewed all the relevant images. Results: Neuroradiological review of images identified radiological features which were highly suggestive of non-accidental head injury (NAHI). Interhemispheric haemorrhages and SDHs in multiple sites or of different densities were almost exclusively seen in NAHI. MRI was more sensitive in identifying SDHs of different signal characteristics, posterior and middle cranial fossa bleeds, and parenchymal changes in the brain. CT scans, if performed with suboptimal protocols, were likely to miss small subdural bleeds. Conclusions: Guidelines for neuroimaging in suspected NAHI are recommended. A radiologist with experience in NAHI should report or review these scans. The initial investigation should be CT, but MRI will also be necessary in most cases. Head CT should be an integral part of the skeletal survey in all infants less than 6 months of age referred for child protection investigation, and in children less than 2 years where child abuse is suspected and there are neurological signs, retinal haemorrhages, or fractures.

Transcriptome analysis based on machine learning reveals a role for autoinflammatory genes of chronic nonbacterial osteomyelitis (CNO)

“…In recent studies, it was found that functional mutations in MPO, a regulator of neutrophil-associated inflammation in the skin, can induce pustular psoriasis 35 . The common presence of Cutibacterium acnes within bone biopsy samples in adult patients diagnosed with synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome, thought to be a subtype of CNO that occurs mostly in adults, suggested that this bacterial species may be associated with the disease 36 . Combined with the ROC curve results of MPO in this study (AUC = 0.60), this observation gives us reason to believe that MPO plays a specific role in the pathogenesis of CNO.…”

Update on treatment responses and outcome measure development in chronic nonbacterial osteomyelitis

“…However, 40-60% of patients do not respond to NSAIDs [24,27,30]. Second-line treatments include csDMARDs, bisphosphonates and TNFi [28,[30][31][32], but it is unclear what is the best second-line medication and among pediatric rheumatologists' practices vary widely [29].…”

Clinical characteristics and predictors for recurrence in chronic nonbacterial osteomyelitis: a retrospective multicenter analysis

“…Although physical examination is usually normal, tenderness, swelling, or warmth may be present over the affected bones. Along with CNO, other inflammatory conditions affecting various organs can be observed, including severe acne, pyoderma gangrenosum, palmoplantar pustulosis, inflammatory bowel disease, and spondylarthritis [ 2 ]. Imaging studies, especially magnetic resonance imaging (MRI), are crucial in diagnosing and monitoring CNO and determining the numbers and sites of affected bones and responses to treatment [ 3 ].…”