| Autor: |
Liu HM; Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Shi YY; Department of Radiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Ruan XM; Department of Nuclear Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Gong YR; Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Zhang T; Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Li YF; Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Zeng QQ; Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Lyu QY; Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Li GM; Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Qiao ZW; Department of Radiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Wu H; Department of Nuclear Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Wang DH; Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Chen L; Department of Pathology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Yu H; Department of Infectious Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Xu H; Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China., Sun L; Department of Rheumatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102,China. |
| Abstrakt: |
Objective: To investigate the clinical features of children with chronic nonbacterial osteomyelitis (CNO), and raise awareness among clinicians. Methods: In this retrospective study, 18 patients with CNO who were diagnosed in Children's Hospital of Fudan University from January 2015 to December 2021 were included. Results: Eighteen children with CNO (12 males, 6 females) were identified. Their age at onset was 9 (5, 11) years, the delay in diagnosis was 2 (1, 6) months, and follow-up-was 17 (8, 34) months. The most common symptoms were fever in 14 children, as well as bone pain and (or) arthralgia in 14 children. In terms of laboratory results, normal white blood cell counts were observed at onset in 17 patients; increased erythrocyte sedimentation rate (ESR) in all patients; increased C reactive protein (CRP) over the normal value in 14 patients. Of the 18 patients, 2 had positive antinuclear antibodies, while none had positive human leukocyte antigen-B27 or rheumatoid factor. Imaging examination revealed that all the patients had symmetrical and multifocal skeletal lesions. The number of structural lesions detected by imaging investigation was 8 (6, 11). The most frequently affected bones were tibia in 18 patients and femur in 17 patients. Bone biopsy was conducted in 14 patients and acute or chronic osteomyelitis manifested with inflammatory cells infiltration were detected. Magnetic resonance imaging (MRI) found bone lesions in all the patients and bone scintigraphy were positive in 13 patients. All the patients were treated with nonsteroidal anti-inflammatory drugs, among whom 10 cases also treated with oral glucocorticoids, 9 cases with traditional disease modifying anti-rheumatic drugs, 8 cases with bisphosphonates and 6 cases with tumor necrosis factor inhibitors. The pediatric chronic nonbacterial osteomyelitis disease activity score, increased by 70% or more in 13 patients within the initial 6-month follow-up. Conclusions: The clinical manifestations of CNO are lack of specificity. The first symptom of CNO is fever, with or without bone pain and (or) arthralgia, with normal peripheral blood leukocytes, elevated CRP and (or) ESR. Whole body bone scanning combined with MRI can early detect osteomyelitis at subclinical sites, and improve the diagnostic rate of CNO. |
