Characteristics and outcomes of chronic non-bacterial osteitis in children

Abstract

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.

Figure 1

Absolute numbers of osteomyelitis-affected bones in the examined group of children with CNO during the entire observation period

Figure 2

Relative frequency of CNO-affected bones, reflecting the percentage of patients in whom the bones were affected

Figure 3

a, b. T1 weighted and fat suppressed of the right foot of an 11-year-old male patient with osteomyelitis of the distal tibia at presentation (a) and after 8 months of monotherapy with NSAIDs (b)

Figure 4

Flowchart of the different therapeutic strategies utilized in our patients with CNO, all patients eventually achieved remission