Figure 3

Treatment of CNO/CRMO. NSAIDs, preferentially naproxen, should be applied as first-line therapy for most patients. When disease activity is high or complications, such as vertebral involvement or fractures, are present at the time of diagnosis, corticosteroids or biological treatment may be considered. Treatment effects should be monitored after three months, using MRI. If patients fail to respond within three months, treatment can be escalated. The authors apply 2 mg/kg oral prednisone per day over two weeks, followed by clinical assessment and MRI imaging after three months. Our treatment goal is clinical, and, in the case of vertebral involvement, complete radiological remission. In the case of a relapse after initial improvement, we repeat high-dose steroids (2 mg/kg/day) for seven days or apply low-dose corticosteroids (0.1-0.2 mg/kg/day) over a longer period. In individuals who relapse again or fail to reach clinical and (if vertebrae are involved) radiological remission, TNF-α inhibitors or bisphosphonates should be considered. Though, reports on the use of sulfasalazine and particularly methotrexate are limited, we made favorable experience using sulfasalazine in the treatment of concomitant inflammatory bowel disease, skin involvement, or HLA-B27 positivity.