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. 2025 May 8.
doi: 10.1002/art.43137. Online ahead of print.

EULAR/American College of Rheumatology Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis

Yongdong Zhao  1 , Melissa S Oliver  2 , Anja Schnabel  3 , Eveline Y Wu  4 , Zhaoyi Wang  1 , Achille Marino  5 , Cassyanne L Aguiar  6 , Jonathan D Akikusa  7 , Ummusen Kaya Akca  8 , Beverley Almeida  9 , Simone Appenzeller  10 , Erin Balay-Dustrude  1 , Ozge Basaran  11 , Matthew L Basiaga  12 , Yelda Bilginer  8 , David A Cabral  13 , Martina Capponi  14 , Nathan Donaldson  15 , Bugra Han Egeli  16 , Emily J Fox  17 , Antonella Insalaco  18 , Ramesh S Iyer  19 , Annette F Jansson  20 , Inna Kostik  21 , Mikhail Kostik  22 , Leonard K Kovalick  4 , Katia Tomie Kozu  23 , Sivia K Lapidus  24 , Tzielan C Lee  25 , Aleksander Lenert  26 , Kamran Mahmood  9 , Edoardo Marrani  27 , Doaa Mosad Mosa  28 , Ian Muse  1 , Alexander Mushkin  29 , Katherine D Nowicki  15 , Farzana Nuruzzaman  30 , Karen Onel  31 , Manuela Pardeo  18 , Trang Sophia Pham  1 , Lauren Potts  32 , Athimalaipet V Ramanan  33 , Angelo Ravelli  34 , Nathan D Rogers  15 , Andrew W Grim  35 , Micol Romano  36 , Natalie Rosenwasser  1 , Takashi Shawn Sato  37 , Gabriele Simonini  27 , Jennifer B Soep  15 , Sara M Stern  38 , Timmy Strauss  3 , Angela Taneja Kohli  39 , Alexander C Theos  40 , Lori B Tucker  13 , Leslie F Vogel  41 , Shima Yasin  42 , Stephen C Wong  1 , Katerina Bouchalova  43 , Alison M Hendry  44 , Kevin C Cain  45 , Hermann J Girschick  46 , Fatma Dedeoglu  16 , Christian M Hedrich  47 , Ronald M Laxer  48 , Polly J Ferguson  42 , Raymond Naden, Seza Ozen  8
Affiliations

EULAR/American College of Rheumatology Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis

Yongdong Zhao et al. Arthritis Rheumatol. .

Abstract

Objective: To develop and validate classification criteria for pediatric chronic nonbacterial osteomyelitis (CNO) jointly supported by EULAR and the American College of Rheumatology (ACR).

Methods: This international initiative had 4 phases: (1) candidate items were proposed in a survey of pediatric rheumatologists, (2) criteria definition and reduction by Delphi and nominal group technique exercises, (3) criteria weighting using multicriteria decision analysis, and (4) refinement of weights and threshold score in a development cohort of 441 patients and validation in another cohort of 514 patients.

Results: The new EULAR/ACR classification criteria for CNO require typical radiographic or magnetic resonance imaging findings and bone pain as an obligatory entry criterion and exclusion criteria of malignancy, infection, vitamin C deficiency, and hypophosphatasia, followed by additive weighted criteria in 5 clinical (site of bone lesions, pattern of bone lesions, age at onset, coexisting conditions, fever) and 4 pathology/laboratory domains (bone biopsy findings if done, anemia, C-reactive protein level, and erythrocyte sedimentation rate). A total score ≥55 is required for classification as CNO. The new criteria had a sensitivity of 82% and specificity of 98% in the validation cohort.

Conclusion: These new classification criteria for pediatric CNO developed with international input reflect current views about CNO, have high specificity and good sensitivity, and provide a key foundation for future CNO research.

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References

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