Pediatric Chronic Nonbacterial Osteomyelitis and SAPHO May Represent Single Syndrome

The study compared pediatric and adult patients with CRMO/CNO and SAPHO syndrome, respectively.

Chronic recurrent multifocal osteomyelitis (CRMO)/chronic nonbacterial osteomyelitis (CNO) in children, and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome in adults, may represent a single clinical syndrome, according to study results published in Pediatric Rheumatology.

The results indicated that diagnostic and therapeutic guidelines for these disorders need to be validated.

The study included pediatric patients diagnosed with CRMO/CNO (n=24) and adult patients diagnosed with SAPHO syndrome (n=10).

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Median age at diagnosis was 12.3 years (range, 7.9-18.9 years) among pediatric patients and 32.5 years (range, 22-56 years) among adult patients. Compared with the adult group, the pediatric group had a shorter median time to diagnosis (1.0 vs 0.3 years).

Both pediatric and adult patients had similar initial clinical presentations, laboratory and histopathologic findings. Mean number of bone lesions in pediatric patients was 3.1 compared with 3.0 in adults. Pediatric patients also had a similar rate of skin involvement compared with that of adult patients (33% vs 30%).

The results indicated that compared with the pediatric patients, adult patients were more likely to have sternal involvement (10.0 % vs 41.7%); however, pediatric patients were more likely to have clavicle and long bone involvement.

The researchers found that computerized tomography was used more often in the adult group than in the group with children. Whole-body magnetic resonance imaging was only used in the pediatric group.

Compared with the adults, the children had a higher rate of bisphosphonate application (30.0% vs 62.5%).

“Clinical appearance and imaging-study, histopathologic, and biomarker findings are similar in pediatric and adult patients diagnosed with CRMO/CNO or SAPHO syndrome in our study indicating that CRMO/CNO and SAPHO syndrome might be variant phenotypes of the same entity,” the researchers wrote.


Skrabl-Baumgartner A, Singer P, Greimel T, Gorkiewicz G, Hermann J. Chronic non-bacterial osteomyelitis: a comparative study between children and adults Pediatric Rheumatol. 2019;17:49.