Chronic recurrent multifocal osteomyelitis: five-year outcomes in 14 pediatric cases

Job-Deslandre, C; Krebs, Stéphanie; Kahan, André

doi:10.1016/s1297-319x(01)00276-7

Cited by 146 publications

(135 citation statements)

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“…This is consistent with the findings of earlier studies that investigated the distribution of patient characteristics in CNO cases (23,24). There was no evidence that one gender was affected with CNO at an earlier age than the other.…”

Section: Discussionsupporting

confidence: 91%

Characteristics and outcomes of chronic non-bacterial osteitis in children

Wintrich¹,

Horneff²

2015

Eur J Rheumatol

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Objective: To determine patient characteristics, clinical presentation, pattern of involvement, treatment, and outcome of patients with chronic non-bacterial osteitis (CNO).Material and Methods: Consecutive cases of CNO were analyzed at a single center for pediatrics and adolescent medicine from 2006 to 2013 in terms of patient characteristics, clinical presentation, pattern of involvement, treatment, and outcome. Results:We identified 32 children aged 1.5-15 years who were diagnosed with CNO between 2006 and 2013. A maximum of 12 bones per patient were affected in a total of 114 documented locations. The pelvis and clavicle (affecting 34% of patients each) were the most frequently affected bones. The foot skeleton was the most commonly affected region in 60% of patients. Skin manifestations were found in 7 (21%) patient. Increased inflammatory signs at presentation were detected in 18 patients. Pathological findings were found in all 30 children examined using magnetic resonance imaging (MRI), in 10 of 11 children examined using radiography, and in 8 of 10 patients examined using skeletal scintigraphy. Bone biopsy was performed in 9 patients. For initial treatment, non-steroidal anti-inflammatory drugs (NSAIDs) or coxibs were used in 28 (87.5%) patients. Remission or satisfactory follow-up was achieved in all patients.Conclusion: Today, CNO is increasingly diagnosed using MRI and rarely through histological examinations. Therapeutic strategies include NSAIDs, which are often highly effective. All patients in the present study showed good clinical outcomes. Keywords: Chronic recurrent multifocal osteomyelitis, bone diseases, chronic disease IntroductionChronic non-bacterial osteitis (CNO) is a benign noninfectious autoinflammatory disease of the bone tissue with an incomplete etiology (1, 2). The incidence of CNO is 0.4/100.000 children (3). It was first reported by Giedion et al. (4) in 1972. There are several synonyms for CNO, such as chronic recurrent multifocal osteomyelitis (CRMO); non-bacterial osteitis; or synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome, all describing the same disease entity (5, 6). CNO generally occurs in children and adolescents, with a peak age of onset of 7-12 years (7). Localized bone pain is the leading symptom, often with local swelling and warmth (8). Patients are usually in good general condition. CNO can appear as a mono-/oligo-focal disease, as well as in chronic recurrent polyfocal stages with a risk of late effects, such as vertebral fractures and severe hyperostotic bone lesions (9). CNO primarily affects the metaphyses of long bones, although lesions can occur in any part of the skeleton (10). Other organs, including the skin, eyes, gastrointestinal tract, and lungs, can also be affected by inflammation (9,11,12). Skin inflammation manifests as palmoplantar pustulosis, acne, psoriasis, and rarely as pyoderma gangrenosum (1, 2). The most important differential diagnosis is bacterial osteomyelitis, although it is not usually multifocal (13). Even...

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Section: Discussionsupporting

confidence: 91%

Characteristics and outcomes of chronic non-bacterial osteitis in children

Wintrich¹,

Horneff²

2015

Eur J Rheumatol

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“…Nonbacterial bone lesions have been identified in patients at nearly all ages and at any site of the skeleton. The presence of nonbacterial bone lesions is usually recognized as a criterion for inflammatory disorders, including synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome (1-4), chronic recurrent multifocal osteitis (CRMO) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), pustulotic arthro-osteitis (15), chronic sclerosing osteomyelitis, lymphoplasmacellular osteomyelitis, and other disorders.…”

mentioning

confidence: 99%

Clinical score for nonbacterial osteitis in children and adults

Jansson¹,

Müller²,

Gliera³

et al. 2009

Arthritis & Rheumatism

138

111

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Objective. To accurately differentiate nonbacterial osteitis (NBO) from other bone lesions by applying a clinical score through the use of validated diagnostic criteria.Methods. A retrospective study was conducted to assess data on patients from a pediatric clinic and an orthopedic tertiary care clinic, using administrative International Classification of Diseases codes as well as laboratory and department records from 1996 to 2006. Two hundred twenty-four patients older than age 3 years who had either NBO (n ‫؍‬ 102), proven bacterial osteomyelitis (n ‫؍‬ 22), malignant bone tumors (n ‫؍‬ 48), or benign bone tumors (n ‫؍‬ 52) were identified by chart review. Univariate logistic regression was used to determine associations of single risk factors with a diagnosis of NBO, and multivariable logistic regression was used to assess simultaneous risk factor associations with NBO. Conclusion. The proposed scoring system helps to facilitate the diagnostic process in patients with suspected NBO. Use of this system might spare unnecessary invasive diagnostic and therapeutic procedures. Results. NBO was best predicted by a normal blood cell count (odds ratio

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“…The tubular long bones, pelvis, hip, sternum and mandible are the most affected bones [4][5]. The CRMO, in pediatric patients , may be associated with various skin disorders: Pustulosis palmoplantar is syndrome [6][7][8], diffuse pustulosis, psoriasis vulgaris, acne [9][10][11], Sweet's syndrome and pyoderma gangrenosum [9]. Multiple sites of apparent osteomyelitis with negative pathology and cultures and no response to antibiotherapy characterize it [12].…”

Section: Discussionmentioning

confidence: 99%

“…A short course of corticosteroids can be used in refractory cases. Other treatments such as sulfasalazine or methotrexate [6], bisphosphonates [13] and hyperbaric chamber [14] are also indicated in refractory cases. Antibiotics do not seem to be helpful.…”

Section: Discussionmentioning

confidence: 99%

Clavicle chronic recurrent multifocal osteomyelitis: Surgical excision and neo-clavicle

Costa¹,

Marques²,

Pádua³

2015

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review

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Chronic recurrent multifocal osteomyelitis: five-year outcomes in 14 pediatric cases

Cited by 146 publications

References 19 publications

Characteristics and outcomes of chronic non-bacterial osteitis in children

Characteristics and outcomes of chronic non-bacterial osteitis in children

Clinical score for nonbacterial osteitis in children and adults

Clavicle chronic recurrent multifocal osteomyelitis: Surgical excision and neo-clavicle

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