EULAR/ACR classification criteria for paediatric chronic nonbacterial osteomyelitis (CNO).
| Title: | EULAR/ACR classification criteria for paediatric chronic nonbacterial osteomyelitis (CNO). |
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| Authors: | Zhao Y; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: yongdong.zhao@seattlechildrens.org.; Oliver MS; Division of Pediatric Rheumatology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.; Schnabel A; Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; Wu EY; Division of Pediatric Rheumatology, Department of Pediatrics, The University of North Carolina at Chapel Hill, NC, USA.; Wang Z; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.; Marino A; Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy.; Aguiar CL; Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, VA, USA.; Akikusa JD; Rheumatology service, Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.; Akca UK; Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey.; Almeida B; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, UK.; Appenzeller S; Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Brazil.; Balay-Dustrude E; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.; Basaran O; Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey; Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA.; Basiaga ML; Division of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.; Bilginer Y; Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey.; Cabral DA; BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada.; Capponi M; Department of Maternal Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy.; Donaldson N; University of Colorado School of Medicine, Aurora, CO, USA.; Egeli BH; Division of Immunology, Rheumatology Program, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.; Fox EJ; Division of Pediatric Rheumatology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA.; Insalaco A; Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy.; Iyer RS; Pediatric Radiology, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.; Jansson AF; Division of Pediatric Rheumatology and Immunology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.; Kostik I; Sanatorium for children 'Detskie Duny', Saint-Petersburg, Russia.; Kostik M; Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia.; Kovalick LK; Division of Pediatric Rheumatology, Department of Pediatrics, The University of North Carolina at Chapel Hill, NC, USA.; Kozu KT; Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Lapidus SK; Pediatric Rheumatology Division, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, NJ, USA.; Lee TC; Division of Pediatric Rheumatology, Stanford University School of Medicine, Stanford, CA, USA.; Lenert A; Division of Immunology, Department of Internal Medicine, Carver College of Medicine, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.; Mahmood K; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, UK.; Marrani E; Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Firenze, Italy.; Mosad Mosa D; Rheumatology Department, Mansoura University Hospitals, Mansoura University Faculty of Medicine, Mansoura, Egypt.; Muse I; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.; Mushkin A; Science-Research Institute of Phthisiopulmonology, Saint-Petersburg, Russia.; Nowicki KD; University of Colorado School of Medicine, Aurora, CO, USA.; Nuruzzaman F; Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.; Onel K; Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA.; Pardeo M; Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy.; Pham TS; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.; Potts L; Patient Research Partner, CA, USA.; Ramanan AV; Bristol Royal Hospital for Children & Translational Health Sciences, University of Bristol, Bristol, UK.; Ravelli A; IRCCS Istituto Giannina Gaslini and Università degli Studi di Genova, Genoa, Italy.; Rogers ND; University of Colorado School of Medicine, Aurora, CO, USA.; Grim AW; Division of Pediatric Rheumatology, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA.; Romano M; Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy; Department of Pediatrics, Division of Pediatric Rheumatology, Behcet and Autoinflammatory Disease Center, Western University, London, ON, Canada.; Rosenwasser N; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.; Sato TS; Stead Family Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.; Simonini G; Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Firenze, Italy.; Soep JB; University of Colorado School of Medicine, Aurora, CO, USA.; Stern SM; University of Utah, Salt Lake City, UT, USA.; Strauss T; Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; Kohli AT; Emory University School of Medicine/Children's Healthcare of Atlanta, GA, USA.; Theos AC; Patient/parent partner, Georgetown University, Washington, DC, USA.; Tucker LB; BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada.; Vogel LF; Department of Rehabilitation Seattle Children's Hospital, Seattle, WA, USA.; Yasin S; Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.; Wong SC; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.; Bouchalova K; Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic.; Hendry AM; General Medicine and Rheumatology Service, Division of Medicine, Middlemore Hospital Counties Manukau District Health, Auckland, New Zealand.; Cain KC; Department of Biostatistics, University of Washington, Seattle, WA, USA.; Girschick HJ; Department of Pediatrics, Vivantes Clinic Friedrichshain, Berlin, Germany.; Dedeoglu F; Division of Immunology, Rheumatology Program, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.; Hedrich CM; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, UK; Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.; Laxer RM; The Hospital for Sick Children, St. Michael's Hospital and the University of Toronto, ON, Canada.; Ferguson PJ; Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.; Naden R; Auckland City Hospital, Auckland, New Zealand.; Ozen S; Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey. |
| Source: | Annals of the rheumatic diseases [Ann Rheum Dis] 2025 Sep; Vol. 84 (9), pp. 1458-1468. Date of Electronic Publication: 2025 Jan 30. |
| Publication Type: | Journal Article; Validation Study |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: United States NLM ID: 0372355 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-2060 (Electronic) Linking ISSN: 00034967 NLM ISO Abbreviation: Ann Rheum Dis Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2025- : [New York] : Elsevier; Original Publication: London : H.K. Lewis |
| MeSH Terms: | Osteomyelitis*/classification ; Osteomyelitis*/diagnosis; Rheumatology/standards ; Humans ; Child ; Magnetic Resonance Imaging ; Male ; Chronic Disease ; Female ; Adolescent ; Delphi Technique ; Child, Preschool ; Blood Sedimentation |
| Abstract: | Objectives: To develop and validate classification criteria for paediatric chronic nonbacterial osteomyelitis (CNO) jointly supported by the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR).; Methods: This international initiative had 4 phases: (1) candidate items were proposed in a survey of paediatric 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, anaemia, 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.; Conclusions: These new classification criteria for paediatric 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.; (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.) |
| Competing Interests: | Competing interests YZ: ACR, EULAR, CARRA (Grants to Institution, Finance Committee), Bristol-Myer Squibbs (Grants to Institution), Rheumatology Research Foundation (Grants to Institution), CTIP (Grants to Institution), UpToDate CRMO/CNO (Royalties/Licence), Novartis (Consulting Fees to Self), U.S. Provisional Application No. 63/356977 (Patent Issued), Seattle Children's CRMO Warriors Guild (Leadership/Fiduciary Role), American Board of Pediatrics, Pediatric Rheumatology Subboard (Leadership/Fiduciary Role). Melissa SO: CARRA (AF-Small Grants from 2022 to 2024, Total: $48,399.00). AS: EULAR (Fellow with Funding of €15,000.00, Grants or Contracts). JDA: Novartis (Participation on Advisory Board 2023). MLB: Sjogren Foundation (Grants to Institution), Childhood Arthritis and Rheumatology Research Alliance (Grants to Institution). SKL: Time Hearst Foundation Physician Scientist Award (Grants), ACR (Support for Attending Meetings), Hackensack Meridian Health (Support for Attending Meetings), CARRA PFAPA/Autoinflammatory (Work Group Leader), APMC (Pediatrics Committee). TCL: Crohns & Colitis Congress Talk 2024 (Honoraria for Self, Support for Travel), Packard Children's Health Alliance Board of Directors (Board Member, Unpaid), Lupus Foundation of Northern California (Board Member, Unpaid). AL: National Institution of Health Award Number K23AR082966 (Grants to Institution). TSS: Invicro (Consulting Fees to Institution), Hippo Education (Payment to Self). GS: Sobi (Consulting Fees), Novartis (Consulting Fees), AbbVie (Consulting Fees, Payment/Honoraria). LBT: Cassie & Friends Society (Board Member, Unpaid). LFV: Trinds 2022-2025 (Contract for Trials, Payment to Self), Wolters Kluwer 2021 (Payment for Authorship to Self), Scholar Rock 2024 (Support for Travel). SC-YW: Arthritis Foundation Great West Region (Medical Advisory Board, Unpaid), Aicardi Goutieres Syndrome Advocacy Association (ECHO Faculty, Unpaid). KB: Czech Ministry of Health (DRO FNOl, 00098892, Support for the Manuscript). AMH: Seattle Children's Research Institute (Support for the Manuscript, Consulting Fees). FD: UpToDate (Royalties or Licences), ISSAID (Support for Attending Meetings in 2023, Education Committee Chair). CMH: Merck (Unrestricted Research Grant), Novartis (Unrestricted Research Grant Ended in 2022, Advisory Board on the Use of IL-1 blockers in CNO). RML: UpToDate (Royalties or Licences), Elsevier (Royalties or Licences), Sanofi (Consulting Fees to Institution, Participation on Board), Eli Lilly Canada (Consulting Fees to Self, Participation on Board), Sobi (Consulting Fees to Self), Novartis (Consulting Fees to Self, Participation on Board), Akros Pharma (Consulting Fees to Self), Children's Hospital of Philadelphia (Participation on Board). PJF: American Board of Pediatrics (Chair, Payment or Honoraria to Self), Pediatric Rheumatology Subcommittee (Chair, Payment or Honoraria to Self), Current Opinion in Rheumatology Section Editor (Payment or Honoraria to Self), CARRA (Support for Travel), CNO Meeting in Liverpool 2022 (Support for Travel), PRES Invited Speaker 2022 (Support for Travel). RN: ACR/EULAR Development for Classification for Anti-Phospholipid Syndrome and IgG4-Related Diseases (Consulting Fees), Genentech Development of Pediatric Glucocorticoid Toxicity Index (Consulting Fees, Support for Travel). SO: Novartis (Consulting Fees), Sobi (Consulting Fees). Eveline Yawei Wu, ZW, AM, CLA, UKA, BA, SA, EEB-D, OB, YB, DAC, MC, ND, BHE, EF, AI, RSI, AFJ, IK, MK, LKK, KTK, KM, EM, DMM, IM, AM, KDN, FN, KO, MP, TSP, LP, AVR, AR, NDR, AWG, MR, NR, JBS, SMS, TS, ATK, ACT, SY, KCC, and HJG have no conflicts of interest to disclose. |
| Entry Date(s): | Date Created: 20250218 Date Completed: 20250906 Latest Revision: 20250906 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.ard.2024.11.006 |
| PMID: | 39966038 |
| Database: | MEDLINE |
Journal Article; Validation Study