Rheumatology International

, Volume 39, Issue 1, pp 89–96 | Cite as

Comparison of different treatment approaches of pediatric chronic non-bacterial osteomyelitis

  • Mikhail M. KostikEmail author
  • Olga L. Kopchak
  • Irina A. Chikova
  • Eugenia A. Isupova
  • Alexander Y. Mushkin
Observational Research


Chronic non-bacterial osteomyelitis (CNO) is a chronic inflammatory bone disease which usually manifests in children and adolescents. There are a few data about pathogenesis and treatment. The aim of the study to compare the efficacy of different treatment approaches in pediatric CNO cohort patient. Fifty two children (25 boys and 27 girls) with CNO with average age at the onset of the disease 8.4 years (5.4; 11.0), number of foci − 3.0 (2.0; 6.0, incl. multifocal cases in 80.8%). Non-steroid anti-inflammatory drugs (NSAID) was the first-line treatment for non-vertebral cases, as well as pamidronate (PAM) for vertebral involvement. Second-line treatment includes sulfasalazine (SSZ), methotrexate (MTX), PAM and tumor necrosis factor-α inhibitors (TNFα-inh). We evaluated the dynamics of pain, patient’s and physician’s (MDVAS) assessment with visual-analog scale (VAS) and ability to each medication to achieve remission of CNO activity. According to the NSAID, MTX, SSZ, PAM and TNFα-inh groups the following data were registered: patient’s VAS: − 14.2% (p = 0.05), − 50.0% (p = 0.04), − 23.1 (p = 0.89), − 83.3% (p = 0.0001), − 73.6% (p = 0.0007); painVAS: − 21.9% (p = 0.01), − 18.6% (p = 0.13), + 36.4 (p = 0.89), − 79.7% (p = 0.00016), − 74.1%, (p = 0.0015); MDVAS: − 13.8% (p = 0.13); − 56.4% (p = 0.09), + 30.8% (p = 0.89), − 74.7%, (p = 0.0001), − 82.1 (p = 0.0015) respectively. The ability of each treatment strategy to achieve the CNO remission was 52.6%, 44.4%, 57,1%, 88.8% and 73.3%, respectively (log-rank test, p = 0.001). The efficacy of treatment approaches for CNO depended on the severity of the disease. NSAID, methotrexate, and sulfasalazine were effective in forms without spine involvement, but pamidronate and TNF-a inhibitors were useful in vertebral forms of CNO. Pamidronate and TNF-a inhibitors more extensively suppressed CNO activity. The randomized controlled trials for assessment of the efficacy and safety of these medications is mandatory to confirm these results.


Chronic non-bacterial osteomyelitis Pamidronate TNFα-inhibitors 


Author contributions

All authors were involved in drafting the article or revising it critically. All authors approved the final version to be submitted for publication. Dr. Kostik, Dr. Kopchak, and Dr. Mushkin had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design: Kostik, Kopchak, Mushkin. Acquisition of data: Kostik, Kopchak, Chikova, Isupova. Analysis and interpretation of data: Kostik, Kopchak, Mushkin.


This work supported by the Russian Foundation for Basic Research (Grant No. 18-515-57001).

Compliance with ethical standards

Informed consent

Informed consent obtained from all parents/guardians of minors participating in the study according to the declaration of Helsinki.

Ethical approval

The study was approved by the local Ethics Committee of St.-Petersburg State Pediatric University (protocol number 10/8 from 23.10.2017).

Conflict of interest

The authors declare that they have no conflict of interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Saint-Petersburg State Pediatric Medical UniversitySaint PetersburgRussian Federation
  2. 2.Kirov’s Regional Children’s HospitalKirovRussian Federation
  3. 3.Science Research Institute of PhthisiopulmonologySaint PetersburgRussian Federation

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