title: Aggressive Therapy Reduces Disease Activity without Skeletal Damage Progression in Chronic Nonbacterial Osteomyelitis.
abstract: OBJECTIVE
  To retrospectively assess changes in disease activity and skeletal damage in children with chronic nonbacterial osteomyelitis (CNO) after infliximab and methotrexate, with or without zoledronic acid or nonsteroidal antiinflammatory drug (NSAID) monotherapy, using a standardized magnetic resonance imaging (MRI) approach.
  
  
  METHODS
  Treatment-related changes in clinical and MRI measures from aggressive therapy and NSAID monotherapy groups (n = 9 per group) were evaluated using nonparametric methods.
  
  
  RESULTS
  Pain, physical function, physician global assessment, inflammatory markers, nonvertebral inflammatory lesion number, and maximum bone edema score all improved significantly with aggressive therapy (p < 0.03), whereas only the maximum soft tissue inflammation severity decreased (p = 0.02) with NSAID monotherapy. Vertebral deformities and physeal damage did not worsen in the aggressive therapy group but 1 in the NSAID group had worsening of growth plate damage.
  
  
  CONCLUSIONS
  An aggressive treatment regimen in CNO improved clinical and imaging measures of disease activity without progression of skeletal damage.
authors.affiliation: From the Pediatric Rheumatology Department, Seattle Children's Hospital, Seattle, Washington; Department of Radiology, and the Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.Y. Zhao, MD, PhD, acting assistant professor, Pediatric Rheumatology Department, Seattle Children's Hospital; N.A. Chauvin, MD, Assistant Professor; D. Jaramillo, MD, MPH, Professor, Department of Radiology, The Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia.
authors.forename: Yongdong
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: From the Pediatric Rheumatology Department, Seattle Children's Hospital, Seattle, Washington; Department of Radiology, and the Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.Y. Zhao, MD, PhD, acting assistant professor, Pediatric Rheumatology Department, Seattle Children's Hospital; N.A. Chauvin, MD, Assistant Professor; D. Jaramillo, MD, MPH, Professor, Department of Radiology, The Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Chauvin
authors.affiliation: From the Pediatric Rheumatology Department, Seattle Children's Hospital, Seattle, Washington; Department of Radiology, and the Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.Y. Zhao, MD, PhD, acting assistant professor, Pediatric Rheumatology Department, Seattle Children's Hospital; N.A. Chauvin, MD, Assistant Professor; D. Jaramillo, MD, MPH, Professor, Department of Radiology, The Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia.
authors.forename: Diego
authors.initials: D
authors.lastname: Jaramillo
authors.affiliation: From the Pediatric Rheumatology Department, Seattle Children's Hospital, Seattle, Washington; Department of Radiology, and the Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.Y. Zhao, MD, PhD, acting assistant professor, Pediatric Rheumatology Department, Seattle Children's Hospital; N.A. Chauvin, MD, Assistant Professor; D. Jaramillo, MD, MPH, Professor, Department of Radiology, The Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia. burnhams@email.chop.edu.
authors.forename: Jon M
authors.initials: JM
authors.lastname: Burnham
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001842:Bone and Bones / Q000187:drug effects* / Q000473:pathology; D002648:Child; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D000069285:Infliximab / Q000494:pharmacology / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000494:pharmacology / Q000627:therapeutic use*; D010019:Osteomyelitis / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000069285:Infliximab; D008727:Methotrexate
keywords: CHRONIC NONBACTERIAL OSTEOMYELITIS; INFLIXIMAB; MAGNETIC RESONANCE IMAGING; METHOTREXATE; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; ZOLEDRONIC ACID