Scholarly article on topic 'PReS-FINAL-2233: Retrospective analysis of different treatment strategies in chronic non-bacterial osteomyelitis'

PReS-FINAL-2233: Retrospective analysis of different treatment strategies in chronic non-bacterial osteomyelitis Academic research paper on "Clinical medicine"

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Pediatr Rheumatol
OECD Field of science

Academic research paper on topic "PReS-FINAL-2233: Retrospective analysis of different treatment strategies in chronic non-bacterial osteomyelitis"

Kostik et al. Pediatric Rheumatology 2013, 11 (Suppl 2):P223 * % PEDIATRIC



PReS-FINAL-2233: Retrospective analysis of different treatment strategies in chronic non-bacterial osteomyelitis

MM Kostik1*, IA Chikova1, MF Dubko1, LS Snegireva1, VV Masalova1, OV Kalashnikova1, AY Mushkin2, VG Chasnyk1

From 20th Pediatric Rheumatology European Society (PReS) Congress Ljubljana, Slovenia. 25-29 September 2013


Pediatric chronic nonbacterial osteomyelitis (CNO) is a sterile inflammatory bone disorder in which innate and adaptive immunity dysfunction involved. Unifocal and multifocal disease courses are known. The modern treatment modalities include non-steroid anti-inflammatory drugs (NSAIDs), steroids, sulfasalazine (SSZ), meth-otrexate (MTX), bisphosphonates and biologic drugs -TNFa and IL1p-antagonists, with limited data.


The aim of our study was to assess children with CNO and to evaluate efficacy of treatment modalities.


Our cohort of CNO patients included 22 children, 8 boys and 14 girls. Monofocal disease course was in 9/22 children (40.9), multifocal in 13/22 (59.1) with mean 6 foci per patient. Histological confirmation was made in 13/22. Repeated MRI, CT and bone scintigraphy was performed in all patients. 3 patients have family history of autoimmu-nity (1 Crohn's disease, 1 - psoriasis, 1 - ankylosing. 16 patients (72,7%) had comorbid autoimmune diseases (different types of JIA): 5 had monoarthritis, 1 arthritis with uveitis, 1 - psoriatic arthritis, 1 - polyarthritis PF neg, 6 had enthesitis-related arthritis (3 had ankylosing spondy-loarthritis) and 1 had Crohn's disease. Spine involvement was in 5/22 (22.7). Onset age was 8.5 (6.3; 10.5) years, the right diagnosis delay was 3.6 (1.7; 9.5) months.

1Hospital Pediatry, Saint-Petersburg State Pediatric MedicalUniversity, Russian Federation

Full list of author information is available at the end of the article

Ç ^ Bio Med Central


Fever at onset, high painVAS and parental VAS scores highly correlated with risk of relapse disease course. Treatment: effectiveness of NSAID only 3/10 (30%), SSZ - 1/5 (20%), corticosteroids - 0/3 (short-term effect only), MTX - 4/7 (57.1%), pamidronate (PAM) with partial response 2/12 (16.7%) and with complete response -10/12 (83.3%). Biologics - adalimumab and etanercept were effective in 3/4 (75%) patients, who fail to NSAID, MTX, PAM and SSZ. During disease course treatment lead to decreasing sings of disease activity, such as: parental VAS (p = 0.015), pain VAS (p = 0.026), MDVAS (p = 0.026), CRP (p = 0.0008), WBC (p = 0.006), ESR (p = 0.00024), PLT (0.014). The main effectiveness belonged to PAM (p = 0.003) and biologics (p = 0.07) in decreasing of pain VAS (-100% and -80%), parental VAS (-92% and -74%) and MD VAS (-93% and -70%, respectively). We calculated the cumulative probability of survival (event of interest: CNO flare) in the entire patient sample, depending the kind of treatment (PAM, MTX and NSAID) obtained by the Kaplan-Meier method. Significant difference was proved comparing 3 therapeutical branches (p = 0.028). MTX treatment was effective (p = 0.04), as well as PAM (p = 0.01) than NSAID. Only flulike syndrome during PAM treatment was in 10/12 (83.3%). No any others side effects were reported. All patients who had flu-like syndrome on first infusion had complete response to PAM, vice verse patients, who had no such complication had only partial response to this treatment.


CNO is a group of chronic inflammatory conditions associated with different rheumatic diseases. The most effective treatment modalities were PAM, biologics and

©2013 Kostik et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http:// applies to the data made available in this article, unless otherwise stated.

Kostik et al. Pediatric Rheumatology 2013, 11 (Suppl 2):P223 Page 2 of 2

MTX. PAM was safety and can reach the rapid response and maintain long sustained remission.

Disclosure of interest

None declared.

Authors' details

1Hospital Pediatry, Saint-Petersburg State Pediatric Medicallniversity, Russian Federation. 2Non-pulmonary tb department, Scientific and research institute of physiopulmonology, Saint-Petersburg, Russian Federation.

Published: 5 December 2013


Cite this article as: Kostik et al.: PReS-FINAL-2233: Retrospective analysis of different treatment strategies in chronic non-bacterial osteomyelitis.

Pediatric Rheumatology 2013 11 (Suppl 2):P223.

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