Chronic Nonbacterial Osteomyelitis (CNO) at a Single Center Large Academic Children’s Hospital Public
Rodriguez, Mara (Spring 2024)
Published
Abstract
Objective
One of the conditions patients are seen in pediatric rheumatology for is Chronic Nonbacterial Osteomyelitis (CNO), also referred to as Chronic Recurrent Multifocal Osteomyelitis (CRMO). Within the United States, there is a lack of literature published regarding extra osseous features present within patients that have CNO/CRMO, along with any differences in patterns of disease amongst genders, age, and having a familial history of autoimmunity. The objective of this study was to assess the patients clinical features and outcomes at their last clinical visit at this single center large academic children’s hospital that have CNO/CRMO.
Methods
The study population is 111 pediatric patients that have been diagnosed with CNO/CRMO and are seen by pediatric rheumatologists at this institution from August 1st, 2013- August 1st, 2023. The inclusion criteria for this study consisted of patients with a physician designated diagnosis of CNO/CRMO on their EPIC Chart, have at least one whole body MRI, and age <21 years old at time of enrollment. The pediatric patients that do not fit all three of these inclusion criteria points were not included, along those who were diagnosed with osteomyelitis as a result of infection. The procedures that were fulfilled for data compilation began with obtaining list of pediatric subjects with rheumatology encounters who also have ICD-9 or ICD-10 codes consistent with CNO/CRMO.
Results
Within the study population, 44.1% of the study participants were male, 54.1% of the study participants were female and 1.8% of the study population chose not to disclose their gender. This study found the average age of onset of disease for both males and females was 9 years old. The average age of diagnosis for females was 10 years old and 9 years old for males. The most significant extra osseous features that were associated with CNO/CRMO were arthritis with 7.2%, psoriasis with 6.3%, and IBD with 4.5%. Additionally, we found a consistent familial history of autoimmunity present on both the maternal side with 40.5% and paternal side with 20.7% .
Conclusion
As this study was conducted at a single center large academic children’s hospital in the Rheumatology Department, many patients who come in have extra osseous features such as arthritis, psoriasis, and IBD. As well, there should be an emphasis on diagnosis and standardized clinical questionnaires for physicians within pediatrics as this can aid in bridging the gap with the ramifications of delayed treatment. This study points an emphasis on the continuation of publishing literature on the various clinical features and outcomes that are present amongst those diagnosed with CNO/CRMO. This is important as a wide array of features and outcomes can present themselves amongst pediatric patients.
Table of Contents
Introduction 1
Literature Review 6
Data and Methods 23
Results 33
Discussion 40
References 48
Tables 51
Appendices 55
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