Chronic nonbacterial osteomyelitis may be associated with renal disease and bisphosphonates are a good option for the majority of patients

• DOI: 10.1111/apa.13420
• Publication Date: 2016-04-10T12:23:38Z
• Authors: Serena Pastore; Giovanna Ferrara; Lorenzo Monasta; Antonella Meini; Marco Cattalini; Silvana Martino; Maria Alessio; Francesco La Torre; Barbara Teruzzi; Valeria Gerloni; Luciana Breda; Andrea Taddio; Loredana Lepore
• Keywords: 0301 basic medicine; Bisphosphonates; Bone pain; Children; Chronic nonbacterial osteomyelitis; Chronic recurrent multifocal osteomyelitis; Bisphosphonates; Bone pain; Children; Chronic nonbacterial osteomyelitis; Chronic recurrent multifocal osteomyelitis; Pediatrics, Perinatology and Child Health; Adolescent; Diphosphonates; Chronic recurrent multifocal osteomyeliti; Bisphosphonates; Bone pain; Children; Chronic nonbacterial osteomyelitis; Chronic recurrent multifocal osteomyelitis; Adolescent; Child; Child, Preschool; Chronic Disease; Diphosphonates; Humans; Kidney Diseases; Osteomyelitis; Retrospective Studies; Osteomyelitis; Bisphosphonates; Chronic nonbacterial osteomyelitis; 3. Good health; Chronic recurrent multifocal osteomyelitis; Bone pain; 03 medical and health sciences; Child, Preschool; Chronic nonbacterial osteomyeliti; Pediatrics, Perinatology and Child Health; Chronic Disease; Bisphosphonate; Humans; Kidney Diseases; Child; Children; Retrospective Studies

AbstractAimThe aim of this Italian study was to describe the clinical features, treatment options and outcomes of a cohort of patients with chronic nonbacterial osteomyelitis (CNO).MethodsThis was a retrospective cohort study. Laboratory data, diagnostic imaging, histological features and clinical course are reported.ResultsWe enrolled 47 patients diagnosed with CNO. Bone pain was the leading symptom, and multifocal disease was present in 87% of the patients. The majority of the bone lesions were located in the appendicular skeleton (58%). Extraosseous manifestations were present in 34% of the patients, and renal involvement was detected in four patients. Inflammatory indices were increased in 80%, and bone x‐rays were negative in 15% of the patients. Nonsteroidal anti‐inflammatory drugs (NSAIDs) were the first therapy for all patients, achieving clinical remission in 27%. A good response to NSAIDs was significantly associated with a better prognosis. Bisphosphonates were used in 26 patients, with remission in 73%. Only six patients (13%), all with spine involvement, developed sequelae.ConclusionWe found a possible association between CNO and renal disease. Bisphosphonates were more likely to lead to clinical remission when NSAIDs and corticosteroids had failed. Vertebral localisation was the only risk factor for potential sequelae.