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Comparison of different treatment approaches in chronic non-bacterial osteomyelitis.

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Pediatric Rheumatology201513 (Suppl 1) :P203

https://doi.org/10.1186/1546-0096-13-S1-P203

  • Published:

Keywords

  • Methotrexate
  • Treatment Approach
  • Osteomyelitis
  • Rheumatic Disease
  • Bone Disease

Chronic non-bacterial osteomyelitis (CNO) is a heterogenous group of immune-mediated inflammatory bone diseases, which often co-exist with other rheumatic diseases. There are no approved treatments for CNO, except non-steroid anti-inflammatory drugs (NSAID). The efficacy of methotrexate (MTX), sulfasalazine, pamidronate (PAM), anti-IL1 and TNFα-inhibitors was shown in different reports, but there are some concerns about safety of pamidronate due to long-term accumulation and persistation in bone.

The aim of our study was to compare the efficacy of non-randomized different treatment approaches in pediatric patient cohort with CNO.

Materials

37 children (16 M and 21 F) with CNO from medical centers in Saint Petersburg. The average age at the onset of disease was 8.5 years (5.9÷10.5), the number of foci - 3.0 (2.0÷6.5, incl. multifocal cases in 78.4%), fever at the onset -37.8%, spine involvement - 32.4%, positive family autoimmune diseases (AID) history - 8.1%, concomitant AID - 64.9%. NSAID was the first-line treatment for non-vertebral cases, as well as PAM for vertebral involvement. Second-line treatment includes MTX, PAM and TNFα-inh. Dynamics of pain, patient's (PVAS) and physician's (MDVAS) assessment of CNO activity we evaluated.

Results

According to the NSAID, MTX, PAM and TNFα-inh groups next data were registered:

PVAS: -26.2% (p=0.05), -14.6% (p=0.06), -84.7% (p=0.0002),-75.6% (p=0.012);

pain: -36.4% (p=0.028), -15.6% (p=0.31), -84.8% (p=0.0002), -82.6%, p=0.012);

MDVAS: -33.8% (p=0.08); +2.4% (p=0.24),-81.4% (p=0.0002), -75.8%, (p=0.012), respectively.

The therapy was effective in 38.9%, 57.1%, 83.3% and 88.8% respectively (log-rank test, p=0.012). TNFα-inh usually used as second-third line treatment in cases where other options, especially PAM were fall.

Conclusions

The most effective treatment approaches for CNO were PAM and TNFα-inh. The randomized controlled trials for assessment efficacy and safety of these medications is mandatory to confirm these results.

Authors’ Affiliations

(1)
Saint-Petersburg State Pediatric Medical University, Hospital Pediatry, Saint Petersburg, Russian Federation
(2)
Saint-Petersburg State Pediatric Medical University, Pediatric Surgery, Saint Petersburg, Russian Federation
(3)
Federal State Budget Institue “Science research Institute of Phthisiopulmonology Ministry of Health RF”, Pediatric Surgery, Saint Petersburg, Russian Federation

Copyright

© Kostik et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), 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://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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