EULAR/American College of Rheumatology Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis.
Document Type
Article
Publication Date
3-2026
Identifier
DOI: 10.1002/art.43137
Abstract
OBJECTIVE: To develop and validate classification criteria for pediatric chronic nonbacterial osteomyelitis (CNO) jointly supported by EULAR and the American College of Rheumatology (ACR).
METHODS: This international initiative had 4 phases: (1) candidate items were proposed in a survey of pediatric 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, anemia, 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.
CONCLUSION: These new classification criteria for pediatric 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
Arthritis Rheumatol
Volume
78
Issue
3
First Page
537
Last Page
547
MeSH Keywords
Humans; Osteomyelitis; Child; Magnetic Resonance Imaging; Rheumatology; Chronic Disease; Male; Blood Sedimentation; Female; Delphi Technique; Adolescent; Sensitivity and Specificity; C-Reactive Protein; Child, Preschool
PubMed ID
40342207
Keywords
Osteomyelitis; Magnetic Resonance Imaging; Rheumatology; Chronic Disease; Blood Sedimentation; Delphi Technique; Sensitivity and Specificity; C-Reactive Protein
Recommended Citation
Zhao Y, Oliver MS, Schnabel A, et al. EULAR/American College of Rheumatology Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis. Arthritis Rheumatol. 2026;78(3):537-547. doi:10.1002/art.43137
COinS
Comments
Grants and funding