Rheumatology (Oxford). 2025 Dec 3:keaf645. doi: 10.1093/rheumatology/keaf645. Online ahead of print.
ABSTRACT
OBJECTIVES: To evaluate the clinical features and diagnostic work-up of patients with Chronic Nonbacterial Osteomyelitis (CNO) followed at a tertiary referral center, and to contribute real-life data to the existing literature. We also aimed to compare our treatment approach to the EULAR recommendations for CNO.
METHODS: This retrospective cohort study included 80 patients diagnosed with CNO between 2020 and 2025, based on EULAR/ACR classification criteria. Demographic, clinical, laboratory, imaging, and treatment data were collected from electronic medical records. Patients were analyzed according to relapse status, treatment response, and MRI findings.
RESULTS: The mean age at symptom onset was 9.4 ± 4.2 years, with a diagnostic delay of 2.2 ± 2.4 years. The most common symptoms were bone pain and fatigue, and 27.5% had skin involvement. Only five patients responded to NSAID monotherapy. DMARDs were used in 68 patients, but only 11 achieved clinical remission. Anti-TNF therapy was the most frequently used treatment modality. In multivariate analysis, the number of bones involved was significantly associated with relapse (OR: 1.20, 95% CI: 1.03-1.39, p= 0.017). Biologics such as secukinumab, anakinra, canakinumab, and tocilizumab were used in refractory cases with favorable responses. Pamidronate was administered to 20 patients; while 3 achieved complete remission, the remaining patients experienced rapid pain relief but ultimately required anti-TNF therapy.
CONCLUSION: Conventional DMARDs are effective in a limited subset of CNO patients, who may represent a milder disease phenotype. The presence of skin involvement and a greater number of affected bones may both suggest a more aggressive disease course. Anti-TNF therapies are the most effective agents, while other biologics offer promising results in resistant cases. Prospective studies are needed to guide individualized treatment strategies.
PMID:41335422 | DOI:10.1093/rheumatology/keaf645
