Chronic non-bacterial osteomyelitis (CNO) is a chronic inflammatory bone disease which usually manifests in children and adolescents. There are a few data about pathogenesis and treatment. The aim of the study to compare the efficacy of different treatment approaches in pediatric CNO cohort patient. Fifty two children (25 boys and 27 girls) with CNO with average age at the onset of the disease 8.4 years (5.4; 11.0), number of foci - 3.0 (2.0; 6.0, incl. multifocal cases in 80.8%). Non-steroid anti-inflammatory drugs (NSAID) was the first-line treatment for non-vertebral cases, as well as pamidronate (PAM) for vertebral involvement. Second-line treatment includes sulfasalazine (SSZ), methotrexate (MTX), PAM and tumor necrosis factor-α inhibitors (TNFα-inh). We evaluated the dynamics of pain, patient's and physician's (MDVAS) assessment with visual-analog scale (VAS) and ability to each medication to achieve remission of CNO activity. According to the NSAID, MTX, SSZ, PAM and TNFα-inh groups the following data were registered: patient's VAS: - 14.2% (p = 0.05), - 50.0% (p = 0.04), - 23.1 (p = 0.89), - 83.3% (p = 0.0001), - 73.6% (p = 0.0007); painVAS: - 21.9% (p = 0.01), - 18.6% (p = 0.13), + 36.4 (p = 0.89), - 79.7% (p = 0.00016), - 74.1%, (p = 0.0015); MDVAS: - 13.8% (p = 0.13); - 56.4% (p = 0.09), + 30.8% (p = 0.89), - 74.7%, (p = 0.0001), - 82.1 (p = 0.0015) respectively. The ability of each treatment strategy to achieve the CNO remission was 52.6%, 44.4%, 57,1%, 88.8% and 73.3%, respectively (log-rank test, p = 0.001). The efficacy of treatment approaches for CNO depended on the severity of the disease. NSAID, methotrexate, and sulfasalazine were effective in forms without spine involvement, but pamidronate and TNF-a inhibitors were useful in vertebral forms of CNO. Pamidronate and TNF-a inhibitors more extensively suppressed CNO activity. The randomized controlled trials for assessment of the efficacy and safety of these medications is mandatory to confirm these results.
Background. Patients with haematogenous and non-bacterial osteomyelitis have similar clinical symptoms (pain in the nidus area, soft tissue swelling, fever) and laboratory signs (increased erythrocyte sedimentation rate, leukocyte count, C-reactive protein concentration). The criteria for distinguishing these two states are not determined.Objective. Our aim was to determine diagnostic criteria to differentiate haematogenous and non-bacterial osteomyelitis.Methods. The study included data of patients under the age of 18 years with non-bacterial or haematogenous osteomyelitis hospitalised to two clinical centres from 2009 to 2016. The diagnosis was established and re-verified according to archival data (medical history) and after two years of observation (at least once a year). Clinical, anamnestic and laboratory data (haemoglobin, leukocytes, leukocyte formula, platelets, ESR and C-reactive protein, CRP) as well as the results of radiation diagnostics (X-ray, CT scan, MRI or osteosyntigraphy) obtained at the disease onset were taken into account as potential diagnostic criteria.Results. Out of 145 patients with non-bacterial or haematogenous osteomyelitis, the diagnosis was re-verified in 138, of them non-bacterial osteomyelitis — in 91, haematogenous osteomyelitis — in 47. The following criteria had the highest diagnostic value for establishing cases of non-bacterial osteomyelitis: detection of bone destruction foci surrounded by osteosclerosis area [sensitivity (Se) 1.0; specificity (Sp) 0.79]; absence of fever (Se 0.66; Sp 0.92); the number of bone destruction foci > 1 (Se 0.73; Sp 1.0); CRP 55 mg/L (Se 0.94; Sp 0.73); negative results of bacteriological examination of the material from the bone destruction focus (Se 1.0; Sp 0.67).Conclusion. Diagnostic criteria for differentiation of non-bacterial and haematogenous osteomyelitis have been described. Further research on the efficacy of using these criteria to reduce the risk of diagnostic errors, decrease the diagnostic pause, reduce the risk of non-bacterial osteomyelitis complications is needed.
BackgroundNon-bacterial Osteomyelitis (NBO) is a sterile inflammatory bone disorder of unknown etiology. It typically affects children and most commonly presents with bone pain and/or swelling.ObjectivesThe aim of study is to evaluate clinical and laboratory features of non-bacterial osteomyelitis in children.MethodsOur retrospective – prospective study was included 91 patients with NBO. A routine blood test (WBC, platelets, ESR, C-reactive protein (CRP) and hemoglobin levels), a radiological examination and a bone biopsy with evaluation bacteriological and morphological data were performed in all patients.ResultsThe mean age of onset NBO was 7.3 years (2.5; 10.6). We did not reveal any gender peculiarities in our study. Family history of immune-mediated diseases is found in 5/75 (6.7%) in prospective group. Concomitant immune-mediated diseases were noted in 62/89 (68.1%). Diagnostic delay was 6.3 (2.0; 17.8) months. The radiological examination was performed in the following ratio: X-rays - 91 (100.0%), CT - 79 (86.8%), MRI - 66 (72.5), including MRI “whole body” with 15 pts, bone scintigraphy - 54 (59.3%). Monofocal form was registered in 1/3 cases. 2/3 cases was presented as a typical multifocal process with predominant involvement femur - 37 (40.7%), bone of foot - 36 (39.6%), tibia - 33 (36.3%), spine – 29 (31.9%). The number of foci is 3.0 (1.0; 6.0). We did not revealed any significant differences in quantity of WBC, platelets, hemoglobin level, ESR, CRP). Evidence confirming NBO was a negative bone biopsy in 100.0% cases. However, morphological data were as non-specific, as granulomatous inflammation.ConclusionsNBO is determined as a primarily chronic multifocal process without specific clinical and laboratory peculiarities, associated with immune-mediated diseases. Diagnose must be established on morphological and bacteriological data bone biopsy.Disclosure of InterestNone declared
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