Evaluating Consensus Treatment Plans for Chronic Nonbacterial Osteomyelitis Using Real-World Data
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction: Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder. To standardize management, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed three consensus treatment plans (CTPs) (1: methotrexate or sulfasalazine [conventional disease-modifying antirheumatic drugs; DMARDs], 2: tumor necrosis factor (TNF)-alpha inhibitors (TNFi), and 3: bisphosphonates). The Clinical Disease Activity Score (CNO CDAS) was introduced to assess disease activity without relying solely on imaging. Objective: The objectives were to evaluate clinicians’ tendencies in applying CNO-CTPs and to assess treatment responses using CNO CDAS in real-world practice, including therapeutic strategies and outcomes at final follow-up. Methods: A retrospective cohort study of 171 pediatric patients with CNO from 18 centers was conducted. Disease activity was assessed using CDAS at diagnosis, at treatment modification, and at the last visit. This score incorporates clinically active lesions, patient pain, and global assessment. Treatments included NSAIDs, DMARDs, TNFi, and pamidronate. Results: Median age was 10 years at onset and 14 years at last follow-up, with a median follow-up of 36 months. The most frequent symptoms were bone pain (95.3%), activity limitation (67.8%), and fatigue (35.1%). All patients received NSAIDs; methotrexate (85.4%) and TNFi (54.4%) were commonly used. TNF inhibitors were the most used CTP, especially in patients with spinal involvement or higher MRI lesion counts, and they achieved the highest remission rate (40.4%). Of the 89 (52.0%) patients who changed treatment, 93.2% switched from DMARDs to TNFi. At the final follow-up, 62% were in medicated remission, 29.2% were in unmedicated remission, and 8.8% had active disease. CDAS scores significantly improved over time (p < 0.05). Conclusions: CARRA CTPs are effective in clinical practice, with anti-TNF therapy yielding the highest remission rates and marked improvement in CDAS.
Source: Children
Authors: Nebahat Zeynep Özaslan, Eray Tunce, Şerife Tuncez, Bengisu Menentoğlu, Betül Sözeri, Semanur Özdel, Nuray Aktay Ayaz, Serkan Türkuçar, Selçuk Yüksel, Mukaddes Kalyoncu, Sıla Atamyıldız Uçar, Semra Ayduran, Şeyma Türkmen, Fırat Gündoğmuş, Merve Özen Balcı, Kübra Öztürk, Nihal Karacayır, Sevcan Bakkaloğlu, Gökçe Sumer, Sara Şebnem Kılıç, Mustafa Çakan, Kadir Ulu, Hatice Adıgüzel Dündar, Ferhat Demir, Burcu Bozkaya, Hande Ilgaz Tüzen, Belde Kasap Demir, Figen Çakmak, Özge Altuğ Gücenmez, Fatma Gül Demirkan, Nihal Şahin, Hafize Emine Sönmez
Institutions: Kocaeli Üniversitesi, Ümraniye Eğitim ve Araştırma Hastanesi, Sağlık Bilimleri Üniversitesi, Turkish Armed Forces, Memorial Ankara Hospital, Istanbul University, Pamukkale University, Çanakkale Onsekiz Mart Üniversitesi, Karadeniz Technical University, Istanbul Medeniyet University, Gazi University, Bursa Uludağ Üni̇versi̇tesi̇, Zeynep Kamil Hospital, University of Health Sciences Antigua, Dr. Behçet Uz Çocuk Hastalıkları Hastanesi, Samsun University, Izmir Kâtip Çelebi University, İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,896
OpenAlex ID: W7222165507