Efficacy of conservative treatment of chronic multiple nonbacterial osteomyelitis in adults based on one-year follow-up results

Abstract

BACKGROUND: Chronic multiple nonbacterial osteomyelitis is an orthopaedic autoinflammatory disease of bones and joints of unclear aetiology, characterised by the formation of multiple foci of osteitis refractory to antibiotic therapy and surgical treatment, occurring predominantly before the age of 18 years. Data on the treatment of adult chronic multiple nonbacterial osteomyelitis are limited due to the orphan character of the disease and the rarity of its onset in adults.

AIM: To present data on the efficacy of conservative treatment of adult chronic multiple nonbacterial osteomyelitis after one-year follow-up.

MATERIALS AND METHODS: 12 patients aged 18 years and older with a histologically confirmed diagnosis of chronic multiple nonbacterial osteomyelitis were followed up. Clinical, demographic and laboratory data of the patients were recorded.

RESULTS: The sex and age structure of the studied group of the patients: 7 women (58.33%), 5 men (41.67%); the average age of the patients was 37.35 ± 15.5 years. Monofocal forms of chronic multiple nonbacterial osteomyelitis were observed in 8 cases (66.67%), multifocal – in 4 cases (33.33%). Drug therapy in the study group: all the patients (100%) received non-steroidal anti-inflammatory drugs, 3 patients (25.0%) received glucocorticosteroids per os; cytostatics – by 7 patients (58.33%), bisphosphonates – by 3 patients (25.0%), genetically engineered biological therapy – by 5 patients (41.67%). Therapeutic treatment of chronic multiple nonbacterial osteomyelitis was started after surgical treatment in 6 patients (50.0%); in 6 patients (50.0%) conservative treatment was prescribed immediately after diagnosis. The conservative treatment was effective: after the beginning of adequate drug therapy; no surgical reatment was performed; stable clinical and laboratory remission of the disease without relapses of osteitis was observed.

CONCLUSIONS: In a typical group of adult patients with chronic multiple nonbacterial osteomyelitis, conservative treatment with the use of immunosuppressive treatment allows to achieve control over the disease activity with the absence of osteitis recurrences during a year of observation.

Keywords

multifocal non-bacterial osteomyelitis / chronic recurrent multifocal non-bacterial osteomyelitis / chronic non-bacterial osteomyelitis / SAPHO syndrome / chronic recurrent sterile osteomyelitis

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