Rheumatology Advance Access originally published online on June 17, 2006
Rheumatology 2007 46(1):154-160; doi:10.1093/rheumatology/kel190
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Classification of Non-Bacterial Osteitis
Retrospective study of clinical, immunological and genetic aspects in 89 patients
1Dr v. Haunersches Kinderspital, Ludwig–Maximilians University, Munich, Germany, 2Department of Pediatrics, University of Washington, Seattle, WA, USA, 3Institute of Human Genetics, 4Institute of Pathology, 5Department of Orthopaedics, Grosshadern, Ludwig–Maximilians–University and 6Department of Gynaecology and Obstetrics at the Technical University, Munich, Germany.
Correspondence to: A. Jansson, MD, Dr v. Haunersches Kinderspital, Ludwig–Maximilians University, Lindwurmstr. 4, D-80337 Munich, Germany. E-mail: Annette.Jansson{at}med.uni-muenchen.de
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Abstract |
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Objective. To define non-bacterial osteitis (NBO) as a clinical entity possibly associated with autoimmune manifestations. Patients with sterile osteitis were analysed to develop diagnostic criteria.
Methods. A total of 89 patients with non-bacterial inflammatory bone lesions were observed for a median of 49 months. History, diagnostic imaging, laboratory and histological data were obtained. Mutation analysis in the genes PSTPIP1 and PSTPIP2 was performed.
Results. Patients had an onset of disease at a median age of 10 yrs [interquartile range (IQR) 7.5–12] and suffered a median period of 21 (IQR 9–52) months with a median of three foci per patient. Twenty percent of all the patients demonstrated associated autoimmune disorders, particularly of the skin and bowel. The majority of bone lesions were located in the vertebrae and metaphyses. Slight-to-moderate elevation of inflammation values were found in all the patients and antinuclear antibodies were elevated in 30%. Non-steroidal anti-inflammatory drugs (NSAIDs) were effective in 85% of the patients. HLA-B27 and Human Leukocyte Antigen-DR (HLA-DR)-classification did not differ from the general population. Autoimmune diseases in 40% of all the families, multiply affected family members, linkage to 18q21 and mouse models strongly indicate a genetic basis for NBO. We observed three different courses of disease regarding the duration of complaints, rate of complications and associated autoimmune manifestations leading to a new classification of NBO.
Conclusions. Clinical analysis of our cohort leads us to define NBO as a distinct disease entity with three clinical presentations: acute NBO, chronic recurrent multifocal osteomyclitis or persistent chronic NBO. Diagnostic criteria were proposed to differentiate NBO from diseases with similar clinical presentation.
KEY WORDS: Non-bacterial osteitis (NBO), Chronic recurrent multifocal osteomyelitis (CRMO), SAPHO syndrome, Complications, Therapy, Classification, Diagnostic criteria, Genetic results
* Annette Jansson and Ellen D. Renner contributed equally to this work.
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