"Updates in chronic nonbacterial osteomyelitis: emerging insights across the age spectrum".

Abstract

Purpose of review: To review and highlight key research findings in children and adults with chronic nonbacterial osteomyelitis (CNO).

Recent findings: Recent studies highlight substantial progress in CNO. Emerging data supports the existence of distinct phenotypic clusters in children and adults, along with recognition of extraosseous manifestations associated with greater disease severity and biologic use. New EULAR/ACR classification criteria and expert consensus recommendations represent important progress toward improving patient care. Administrative data is promising for cohort building and epidemiologic research in CNO. Recent work has identified key health domains impacting patients, highlighting the multidimensional nature, and reduced quality of life in CNO. Genetic and biomarker studies provide insight into inflammatory pathways. Advances in imaging and disease activity assessment emphasize the limitations of clinical measures alone, with composite measures providing improved performance. Reports of sarcopenia, and bone microarchitecture abnormalities suggest additional information may be gleaned from imaging. Finally, expanded therapeutic options are being used in recalcitrant cases suggesting that targeting interleukin (IL)-17/IL-23/Janus kinase pathways need to be tested in controlled studies to determine their place in treatment of CNO.

Summary: There is encouraging progress in CNO, with research efforts expanding our understanding of this disease across the age spectrum, with the ultimate goal of improving patient care.