Chronic non-bacterial osteomyelitis: a retrospective international study on clinical manifestations and response to treatment

Chronic non-bacterial osteomyelitis (CNO) is a rare non-infectious bone inflammatory disorder; when multifocal, it is referred to as Chronic Recurrent Multifocal Osteomyelitis (CRMO). This study evaluates the demographic, clinical and radiological characteristics of a multi-centre cohort of patients...

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Published in:Clinical and experimental rheumatology 2020-11, Vol.38 (6), p.1255-1262
Main Authors: Gamalero, Lisa, Belot, Alexandre, Zajc Avramovic, Mojca, Giani, Teresa, Filocamo, Giovanni, Guleria, Sandesh, Ferrara, Giovanna, Minoia, Francesca, Hofer, Michael, Larbre, Jean Paul, Aureal, Melanie, Toplak, Natasa, Avcin, Tadej, Chighizola, Cecilia Beatrice, Cimaz, Rolando
Format: Article
Language:English
Subjects:
Child
Chronic Disease
Europe - epidemiology
Female
France
Humans
India
Italy - epidemiology
Male
Osteomyelitis - diagnostic imaging
Osteomyelitis - drug therapy
Osteomyelitis - epidemiology
Retrospective Studies
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Summary:Chronic non-bacterial osteomyelitis (CNO) is a rare non-infectious bone inflammatory disorder; when multifocal, it is referred to as Chronic Recurrent Multifocal Osteomyelitis (CRMO). This study evaluates the demographic, clinical and radiological characteristics of a multi-centre cohort of patients with CNO/CRMO. Demographic and clinical data of patients with an established diagnosis of CNO/CRMO followed at paediatric rheumatology centres across Europe (Italy, France, Slovenia) and India were retrospectively collected. There were no demographic differences across countries, but time to diagnosis was significantly longer in India (p=0.041). Pain was almost invariably present at disease onset; functional impairment was more frequent among Italian and Slovenian patients (p=0.001). The number of sites of bone involvement was similar between genders and countries, with long bone metaphises being the most common site. Raised acute phase reactants, detected in >50% of patients, were not associated with clinical manifestations or response to treatment. Comorbidities, evinced in 37% of patients, were equally distributed between genders and nationalities. Imaging approach was similar across countries, without any association between radiological findings and clinical manifestations. NSAIDs were almost invariably used as first-line treatment, but response rate was significantly lower in Italy (p=0.02). Methotrexate was used in 28% of case, with an overall rate of response of 82%. Health conditions and rate of permanent deformities were similar across different countries. The differences in clinical presentation, radiological features and response to treatment described in this multinational cohort of CNO/CRMO might provide novel insights into this still elusive disease.
ISSN:0392-856X