Document Type

Article

Publication Date

9-2025

Identifier

DOI: 10.1016/j.ard.2024.11.006

Abstract

OBJECTIVES: To develop and validate classification criteria for paediatric chronic nonbacterial osteomyelitis (CNO) jointly supported by the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR).

METHODS: This international initiative had 4 phases: (1) candidate items were proposed in a survey of paediatric rheumatologists, (2) criteria definition and reduction by Delphi and nominal group technique exercises, (3) criteria weighting using multicriteria decision analysis, and (4) refinement of weights and threshold score in a development cohort of 441 patients and validation in another cohort of 514 patients.

RESULTS: The new EULAR/ACR classification criteria for CNO require typical radiographic or magnetic resonance imaging findings and bone pain as an obligatory entry criterion and exclusion criteria of malignancy, infection, vitamin C deficiency, and hypophosphatasia, followed by additive weighted criteria in 5 clinical (site of bone lesions, pattern of bone lesions, age at onset, coexisting conditions, fever) and 4 pathology/laboratory domains (bone biopsy findings if done, anaemia, C-reactive protein level, and erythrocyte sedimentation rate). A total score ≥55 is required for classification as CNO. The new criteria had a sensitivity of 82% and specificity of 98% in the validation cohort.

CONCLUSIONS: These new classification criteria for paediatric CNO developed with international input reflect current views about CNO, have high specificity and good sensitivity, and provide a key foundation for future CNO research.

Journal Title

Annals of the rheumatic diseases

Volume

84

Issue

9

First Page

1458

Last Page

1468

MeSH Keywords

Humans; Osteomyelitis; Child; Magnetic Resonance Imaging; Male; Chronic Disease; Female; Adolescent; Delphi Technique; Child, Preschool; Blood Sedimentation; Rheumatology

PubMed ID

39966038

Keywords

Osteomyelitis; Magnetic Resonance Imaging; Chronic Disease; Delphi Technique; Blood Sedimentation; Rheumatology

Comments

This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.

Publisher's Link: https://ard.eular.org/article/S0003-4967(25)00077-9/fulltext

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