Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017:2017:7694942.
doi: 10.1155/2017/7694942. Epub 2017 Jan 10.

Physicians' Perspectives on the Diagnosis and Treatment of Chronic Nonbacterial Osteomyelitis

Yongdong Zhao  1 , Fatma Dedeoglu  2 , Polly J Ferguson  3 , Sivia K Lapidus  4 , Ronald M Laxer  5 , Miranda C Bradford  6 , Suzanne C Li  7
Affiliations

Physicians' Perspectives on the Diagnosis and Treatment of Chronic Nonbacterial Osteomyelitis

Yongdong Zhao et al. Int J Rheumatol. 2017.

Abstract

Background/Purpose. Understanding the practices of pediatric rheumatologists in diagnosing and treating chronic nonbacterial osteomyelitis (CNO) can provide important information to guide the development of consensus treatment plans. The objectives of this study were to determine physicians' approaches to (1) diagnosing and monitoring CNO, (2) ordering a bone biopsy, and (3) making treatment decisions. Methods. A survey was distributed among members of the Childhood Arthritis and Rheumatology Research Alliance using a web-based questionnaire. Results. 121 of 277 (41%) attending physician members completed the survey. Plain radiographs (89%) were most commonly used followed by regional MRI (78%), bone scintigraphy (43%), and whole-body MRI (36%). The top three reasons for performing a biopsy were constitutional findings (66%), unifocal bone lesions (64%), and nocturnal bone pain (45%). Nearly all responders (95%) prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) as initial therapy. For patients who failed NSAID treatment, methotrexate (67%), tumor necrosis factor inhibitors (65%), and bisphosphonates (46%) were the next most commonly used treatments. The presence of a spinal lesion increased the use of bisphosphonate treatment. Conclusion. The diagnostic approach and disease activity monitoring for CNO varied among surveyed physicians. Our survey findings provided important background for the development of consensus treatment plans for CNO.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
Illustration of responses from CARRA members.
Figure 2
Figure 2
Level of confidence of physicians in treating patients with CNO, (a) by years of practice and (b) by number seen annually.
Figure 3
Figure 3
Imaging choices for suspected CNO.
Figure 4
Figure 4
(a) Frequency of use for non-NSAID as second-line treatment; (b) clinical features indicating non-NSAID as first-line treatment.
Figure 5
Figure 5
Preferred treatment choices for future comparative effectiveness trials in CNO.
See this image and copyright information in PMC

References

    1. Ferguson P. J., Sandu M. Current understanding of the pathogenesis and management of chronic recurrent multifocal osteomyelitis. Current Rheumatology Reports. 2012;14(2):130–141. doi: 10.1007/s11926-012-0239-5. - DOI - PMC - PubMed
    1. Ferguson P. J., Laxer R. M. Autoinflammatory bone disorders. In: Cassidy J., Petyy R., Lindsley C., Laxer R. M., editors. Textbook of Pediatric Rheumatology. 6th. Amsterdam, The Netherlands: Elsevier; 2011. pp. 661–673.
    1. Jansson A., Renner E. D., Ramser J., et al. Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients. Rheumatology (Oxford) 2007;46(1):154–160. doi: 10.1093/rheumatology/kel190. - DOI - PubMed
    1. Girschick H. J., Huppertz H.-I., Harmsen D., Krauspe R., Müller-Hermelink H. K., Papadopoulos T. Chronic recurrent multifocal osteomyelitis in children: diagnostic value of histopathology and microbial testing. Human Pathology. 1999;30(1):59–65. doi: 10.1016/s0046-8177(99)90301-5. - DOI - PubMed
    1. Girschick H. J., Raab P., Surbaum S., et al. Chronic non-bacterial osteomyelitis in children. Annals of the Rheumatic Diseases. 2005;64(2):279–285. doi: 10.1136/ard.2004.023838. - DOI - PMC - PubMed

LinkOut - more resources