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Arthritis Care Res (Hoboken). 2018 Aug;70(8):1228-1237. doi: 10.1002/acr.23462. Epub 2018 Jul 12.

Consensus Treatment Plans for Chronic Nonbacterial Osteomyelitis Refractory to Nonsteroidal Antiinflammatory Drugs and/or With Active Spinal Lesions.

Author information

1
Seattle Children's Hospital, University of Washington, Seattle.
2
University of North Carolina, Chapel Hill.
3
Stanford Children's Health, Stanford University, Palo Alto, California.
4
Children's Mercy, Kansas City, Missouri.
5
Levine Children's Hospital, Charlotte, North Carolina.
6
Schneider Children's Medical Center of Israel, Petach Tikva Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
7
University of Utah, Salt Lake City.
8
Duke Children's Hospital, Durham, North Carolina.
9
Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey.
10
Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.
11
Hospital for Special Surgery, New York, New York.
12
Stony Brook Children's Hospital, Stony Brook, New York.
13
Boston Children's Hospital and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
14
University of Calgary, Calgary, Alberta, Canada.
15
McMaster Children's Hospital, Hamilton, Ontario, Canada.
16
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
17
University of Vermont Medical Center, Burlington.
18
Goryeb Children's Hospital, Morristown, New Jersey.
19
Hacettepe University, Ankara, Turkey.
20
Vivantes Children's Hospital in Friedrichshain, Berlin, Germany.
21
The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
22
Boston Children's Hospital, Boston, Massachusetts.
23
Children's Hospital Dresden, University Medical Center Carl Gustav Carus, TU Dresden, Dresden, Germany, and Institute of Translational Medicine, University of Liverpool, and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
24
University of Iowa Carver College of Medicine, Iowa City.

Abstract

OBJECTIVE:

To develop standardized treatment regimens for chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis (CRMO), to enable comparative effectiveness treatment studies.

METHODS:

Virtual and face-to-face discussions and meetings were held within the CNO/CRMO subgroup of the Childhood Arthritis and Rheumatology Research Alliance (CARRA). A literature search was conducted, and CARRA membership was surveyed to evaluate available treatment data and identify current treatment practices. Nominal group technique was used to achieve consensus on treatment plans for CNO refractory to nonsteroidal antiinflammatory drug (NSAID) monotherapy and/or with active spinal lesions.

RESULTS:

Three consensus treatment plans (CTPs) were developed for the first 12 months of therapy for CNO patients refractory to NSAID monotherapy and/or with active spinal lesions. The 3 CTPs are methotrexate or sulfasalazine, tumor necrosis factor inhibitors with optional methotrexate, and bisphosphonates. Short courses of glucocorticoids and continuation of NSAIDs are permitted for all regimens. Consensus was achieved on these CTPs among CARRA members. Consensus was also reached on subject eligibility criteria, initial evaluations that should be conducted prior to the initiation of CTPs, and data items to collect to assess treatment response.

CONCLUSION:

Three consensus treatment plans were developed for pediatric patients with CNO refractory to NSAIDs and/or with active spinal lesions. Use of these CTPs will provide additional information on efficacy and will generate meaningful data for comparative effectiveness research in CNO.

PMID:
29112802
PMCID:
PMC5938153
[Available on 2019-08-01]
DOI:
10.1002/acr.23462

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