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Consensus Treatment Plans for Chronic Nonbacterial Osteomyelitis Refractory to Nonsteroidal Antiinflammatory Drugs and/or With Active Spinal Lesions
Author(s) -
Zhao Yongdong,
Wu Eveline Y.,
Oliver Melissa S.,
Cooper Ashley M.,
Basiaga Matthew L.,
Vora Sheetal S.,
Lee Tzielan C.,
Fox Emily,
Amarilyo Gil,
Stern Sara M.,
Dvergsten Jeffrey A.,
Haines Kathleen A.,
RousterStevens Kelly A.,
Onel Karen B.,
Cherian Julie,
Hausmann Jonathan S.,
Miettunen Paivi,
Cellucci Tania,
Nuruzzaman Farzana,
Taneja Angela,
Barron Karyl S.,
Hollander Matthew C.,
Lapidus Sivia K.,
Li Suzanne C.,
Ozen Seza,
Girschick Hermann,
Laxer Ronald M.,
Dedeoglu Fatma,
Hedrich Christian M.,
Ferguson Polly J.
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23462
Subject(s) - chronic recurrent multifocal osteomyelitis , medicine , refractory (planetary science) , sulfasalazine , nonsteroidal , methotrexate , certolizumab pegol , osteomyelitis , intensive care medicine , infliximab , surgery , physical therapy , tumor necrosis factor alpha , osteitis , physics , disease , astrobiology , ulcerative colitis
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.