Clinical features of children with chronic non-bacterial osteomyelitis: A multicenter retrospective case series from Turkey
Ceyhun Açarı1, Elif Çomak2, Şükrü Çekiç3, Serkan Türkuçar1, Hatice Adıgüzel Dündar1, Sara Şebnem Kılıç3, Sema Akman2, Balahan Makay1, Şevket Erbil Ünsal1
1Department of Pediatrics, Division of Pediatric Rheumatology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
2Department of Pediatrics, Division of Pediatric Nephrology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
3Department of Pediatrics, Division of Pediatric Allergy-Immunology, Uludağ University, Faculty of Medicine, Bursa, Turkey
Keywords: Children, familial Mediterranean fever, MEFV mutation, non-bacterial osteomyelitis
Objectives: This study aims to evaluate demographic, clinical, and radiological characteristics of Turkish children with chronic non-bacterial osteomyelitis.
Patients and methods: Between January 2008 and December 2018, a total of 28 patients (10 males, 18 females; median age: 12.5 years; range, 4.5 to 21 years) who were diagnosed with chronic non-bacterial osteomyelitis in three pediatric rheumatology centers were retrospectively analyzed. The demographic, clinical, and laboratory findings of the patients were recorded.
Results: The median age at the time of diagnosis was 10.2 years. The median time from symptom onset to diagnosis was 6.5 months. The median follow-up was 18.5 months. The most frequent symptom at onset was arthralgia (75.0%). The most frequently involved bone was the femur (67.9%). Eight (63.6%) of 12 patients had at least one Mediterranean fever gene (MEFV) mutation, indicating a significantly higher prevalence than the Turkish population (14.8%). Five of these patients fulfilled the diagnostic criteria for familial Mediterranean fever (FMF). All patients received non-steroidal anti-inflammatory drugs. Other drugs were methotrexate (46.4%), sulfasalazine (39%), corticosteroids (25%), anti-tumor necrosis factor (anti-TNF) agents (32%), pamidronate (25%), and colchicine (21.4%). Six of eight patients with MEFV mutations were administered with colchicine, and all of them responded to treatment.
Conclusion: Clinical evolution and imaging investigations should be carefully performed to prevent any delay in the diagnosis of patients with chronic non-bacterial osteomyelitis. Based on our study results, FMF coexistence is worth investigating in patients with chronic non-bacterial osteomyelitis, particularly in the Turkish population.