Chronic Non-Bacterial Osteomyelitis in Pediatric Patients: Findings from Multiple Centers in Saudi Arabia.

BACKGROUND

Chronic non-bacterial osteomyelitis (CNO) is a chronic auto-inflammatory disorder affecting bones in children and adolescents. The study aimed to assess pediatric CNO patients' demographic, clinical, laboratory, imaging, and histopathology characteristics and treatment responses.

METHODS

This is a descriptive and analytical multicenter study that reviewed 58 patients diagnosed with CNO between 2015 and 2021 across six centers in Saudi Arabia.

RESULTS

The mean age at diagnosis was eight years, and 62% of the patients were females (n = 36). The most common clinical manifestation was bone pain (n = 51, 88%). Elevated erythrocyte sedimentation rate (> 15 mm/hr) was observed in 85% (n = 49) of patients, and positive C-reactive protein (> 8 mg/L) was observed in 41% (n = 24). Bone biopsy was performed in 56.9% (n = 33) of patients. The lower limbs (n = 37, 64%) were the most involved sites. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most commonly used treatment modality, with 88% of patients (n = 51) receiving this treatment. Bisphosphonates and tumor necrosis factor inhibitors (Anti-TNF) were used in 55% (n = 32) of patients, while methotrexate and systemic steroids were used in 36% (n = 21). Clinical remission was achieved in 84% of CNO patients.

CONCLUSIONS

This study provides valuable insights into the phenotype of CNO in the pediatric population and shares the experience of multiple centers in treating this rare condition in Saudi patients.