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Chronic nonbacterial osteomyelitis had high treatment success rate at 1 year, high relapse rate at 5 years
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Chronic nonbacterial osteomyelitis responds well to treatment in the first year, but demonstrates high rates of relapse in long-term follow-up, according to findings.
In the retrospective chart review, researchers identified 56 children (median age, 11.1 years) diagnosed with chronic nonbacterial osteomyelitis (CNO) at the Department of Pediatrics, University Medical Center Carl Gustav Carus, Dresden, Germany between Jan. 1, 2004 and Dec. 31, 2015. Researchers evaluated clinical outcomes up to 24 months after the start of treatment and at the last visit. Patients were monitored for pain and signs of inflammation, as well as blood inflammation markers and number of lesions on imaging.
Of the children, 21 reported multifocal bone pain at onset, most frequently affecting lower extremities (73% of patients). Arthritis distant CNO lesions developed in seven children at a median of 4.9 years after disease onset. The following characteristics were noted in patients who developed arthritis: delayed diagnosis (median 6.5 months); relapsing multifocal courses (mean 13 lesions); persistent disease activity; and prolonged treatment (median 5.9 years).
With the exception of one patient with coexisting Crohn’s disease, all patients were initially treated with NSAIDs. Twenty-three patients were treated with prednisolone; six with disease-modifying antirheumatic drugs; seven with tumor necrosis factor-alpha inhibitors; and eight with bisphosphonates.
Follow-up for these patients continued for a median of 2.4 years, and 21 patients were followed for more than 5 years. During the course of follow-up, 33 patients experienced a median of one relapse. Kaplan-Meier survival analysis revealed the median time from diagnosis to first relapse was 29 months.
Most patients responded well to treatment within the first year, with 62% attaining clinical remission. Independent of treatment used, 85% of the patients had relapse-free survival during the first year.
ients had experienced at least one relapse. The best outcomes were attained in patients treated with pamidronate. After 6 months, two of these patients reached partial remission and six achieved complete remission. Among the six patients for whom 24-month follow-up was available, five attained full remission and one reached partial remission.
“Our findings underscore the importance of a timely diagnosis and treatment initiation,” the researchers wrote. “Prospective studies are warranted to establish evidence-based diagnostic and therapeutic approaches to CNO.” -by Jennifer Byrne
Disclosure: Healio/Rheumatology was unable to determine whether the authors had relevant financial disclosures.
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