Consensus Treatment Plans for Chronic Nonbacterial Osteomyelitis Refractory to Nonsteroidal Antiinflammatory Drugs and/or With Active Spinal Lesions

Objective To develop standardized treatment regimens for chronic nonbacterial osteomyelitis(CNO), also known as chronic recurrent multifocal osteomyelitis(CRMO) to enable comparative effectiveness treatment studies. Methods Virtual and face-to-face discussions and meetings were held within the CNO subgroup of the Childhood Arthritisand Rheumatology Research Alliance (CARRA). A literature search was conducted, and CARRA membership was surveyed to evaluate available treatment data and identify current treatment practices. Nominal group techniquewas used to achieve consensuson treatment plans for CNO refractory to non-steroidal anti-inflammatory drug (NSAID) monotherapy and/or with active spinal lesions. Results Three consensustreatment plans (CTPs) were developed for the first 12 months of therapy for CNO patients refractory to NSAID monotherapy and/or with active spinal lesions. The three CTPs are: (1) methotrexate or sulfasalazine, (2) tumor necrosis factor (TNF)-alpha inhibitors with optional use of methotrexate, and (3) bisphosphonates. Short coursesof glucocorticoids and continuation of NSAIDs are permitted for all regimens. Consensuswas achieved on these CTPs among CARRA members. Consensuswas also reached on subject eligibility criteria, initial evaluations that should be conducted prior to the initiation of CTPs, and data items to collect to assess treatment response. Conclusion Three consensustreatment plans were developed for pediatric patients with CNO refractory to NSAIDs and/or with active spinal lesions. Use of these CTPs will provide additional information on efficacy and will generate meaningful data for comparative effectiveness researchin CNO. This article is protected by copyright. All rights reserved.