title: Chronic nonbacterial osteomyelitis may be associated with renal disease and bisphosphonates are a good option for the majority of patients.
abstract: OBJECTIVE
  The aim of this Italian study was to describe the clinical features, treatment options and outcomes of a cohort of patients with chronic nonbacterial osteomyelitis (CNO).
  
  
  METHODS
  This was a retrospective cohort study. Laboratory data, diagnostic imaging, histological features and clinical course are reported.
  
  
  RESULTS
  We enrolled 47 patients diagnosed with CNO. Bone pain was the leading symptom, and multifocal disease was present in 87% of the patients. The majority of the bone lesions were located in the appendicular skeleton (58%). Extraosseous manifestations were present in 34% of the patients, and renal involvement was detected in four patients. Inflammatory indices were increased in 80%, and bone x-rays were negative in 15% of the patients. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the first therapy for all patients, achieving clinical remission in 27%. A good response to NSAIDs was significantly associated with a better prognosis. Bisphosphonates were used in 26 patients, with remission in 73%. Only six patients (13%), all with spine involvement, developed sequelae.
  
  
  CONCLUSIONS
  We found a possible association between CNO and renal disease. Bisphosphonates were more likely to lead to clinical remission when NSAIDs and corticosteroids had failed. Vertebral localisation was the only risk factor for potential sequelae.
authors.affiliation: Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Pastore
authors.affiliation: University of Trieste, Trieste, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Ferrara
authors.affiliation: Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Monasta
authors.affiliation: Pediatric Clinic, Spedali Civili and University of Brescia, Brescia, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Meini
authors.affiliation: Pediatric Clinic, Spedali Civili and University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cattalini
authors.affiliation: Department of Paediatrics, University di Torino, 10126, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Martino
authors.affiliation: University Federico II, Napoli, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Alessio
authors.affiliation: Department of Paediatrics, Antonio Perrino Hospital, Brindisi, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: La Torre
authors.affiliation: UOC di Rheumatology, A. O. L. Sacco, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Teruzzi
authors.affiliation: Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Gerloni
authors.affiliation: Department of Paediatrics, Rheumatology Unit, University of Chieti, Chieti, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Breda
authors.affiliation: Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.|University of Trieste, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Taddio
authors.affiliation: University of Trieste, Trieste, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Lepore
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004164:Diphosphonates / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D010019:Osteomyelitis / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D004164:Diphosphonates
keywords: Bisphosphonates; Bone pain; Children; Chronic nonbacterial osteomyelitis; Chronic recurrent multifocal osteomyelitis