EULAR/American College of Rheumatology Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis.
| Title: | EULAR/American College of Rheumatology Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis. |
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| Authors: | Zhao Y; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle.; Oliver MS; Division of Pediatric Rheumatology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis.; 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, Chapel Hill.; Wang Z; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle.; 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.; Akikusa JD; Rheumatology service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, 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.; Basaran O; Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey, and Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York.; Basiaga ML; Division of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.; 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, British Columbia, 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.; Egeli BH; Division of Immunology, Rheumatology Program, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.; Fox EJ; Division of Pediatric Rheumatology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.; Insalaco A; Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.; Iyer RS; Pediatric Radiology, Department of Radiology, University of Washington School of Medicine, Seattle.; 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, Chapel Hill.; Kozu KT; Pediatric Rheumatology Unit, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.; Lapidus SK; Pediatric Rheumatology Division, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey.; Lee TC; Division of Pediatric Rheumatology, Stanford University School of Medicine, Stanford, California.; Lenert A; Division of Immunology, Department of Internal Medicine, Carver College of Medicine, University of Iowa Hospitals & Clinics, Iowa City.; 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, Florence, Italy.; Mosa DM; 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.; Mushkin A; Science-Research Institute of Phthisiopulmonology, Saint-Petersburg, Russia.; Nowicki KD; University of Colorado School of Medicine, Aurora.; Nuruzzaman F; Renaissance School of Medicine at Stony Brook University, Stony Brook, New York.; Onel K; Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York.; Pardeo M; Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.; Pham TS; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle.; Potts L; Patient Research Partner, California.; 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.; Grim AW; Division of Pediatric Rheumatology, Department of Pediatrics, Michigan Medicine, Ann Arbor.; Romano M; Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy, and Department of Pediatrics, Division of Pediatric Rheumatology, Behcet and Autoinflammatory Disease Center, Western University, London, Ontario, Canada.; Rosenwasser N; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle.; Sato TS; Stead Family Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City.; Simonini G; Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, Florence, Italy.; Soep JB; University of Colorado School of Medicine, Aurora.; Stern SM; University of Utah, Salt Lake City.; 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, Georgia.; Theos AC; Patient/Parent Partner, Georgetown University, Washington, DC.; Tucker LB; BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.; Vogel LF; Department of Rehabilitation Seattle Children's Hospital, Seattle, Washington.; Yasin S; Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City.; Wong SC; Pediatric Rheumatology, Department of Pediatrics, University of Washington School of Medicine, Seattle.; 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.; 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, Massachusetts.; Hedrich CM; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Eaton Road, and 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, Ontario, Canada.; Ferguson PJ; Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City.; Naden R; Ozen S; Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey. |
| Source: | Arthritis & rheumatology (Hoboken, N.J.) [Arthritis Rheumatol] 2026 Mar; Vol. 78 (3), pp. 537-547. Date of Electronic Publication: 2025 May 08. |
| Publication Type: | Journal Article; Validation Study |
| Language: | English |
| Journal Info: | Publisher: Wiley Country of Publication: United States NLM ID: 101623795 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2326-5205 (Electronic) Linking ISSN: 23265191 NLM ISO Abbreviation: Arthritis Rheumatol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Malden, MA : Wiley, [2014]- |
| MeSH Terms: | Osteomyelitis*/classification ; Osteomyelitis*/diagnosis ; Osteomyelitis*/diagnostic imaging; C-Reactive Protein/metabolism ; Humans ; Child ; Magnetic Resonance Imaging ; Rheumatology ; Chronic Disease ; Male ; Blood Sedimentation ; Female ; Delphi Technique ; Adolescent ; Sensitivity and Specificity ; Child, Preschool |
| Abstract: | Objective: To develop and validate classification criteria for pediatric chronic nonbacterial osteomyelitis (CNO) jointly supported by EULAR and the American College of Rheumatology (ACR).; Methods: This international initiative had 4 phases: (1) candidate items were proposed in a survey of pediatric 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, anemia, 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.; Conclusion: These new classification criteria for pediatric 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.; (© 2025 American College of Rheumatology.) |
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| Grant Information: | EULAR/ACR Classification Criteria Award |
| Substance Nomenclature: | 9007-41-4 (C-Reactive Protein) |
| Entry Date(s): | Date Created: 20250509 Date Completed: 20260316 Latest Revision: 20260316 |
| Update Code: | 20260317 |
| DOI: | 10.1002/art.43137 |
| PMID: | 40342207 |
| Database: | MEDLINE |
Journal Article; Validation Study