Table 1.

Patient characteristics for pediatric CNO refractory to NSAID monotherapy and/or with active spinal lesion

Enrolled patients should have:

Age at enrollment equal to or younger than 21 years

Presence of bone edema on STIR or T2 fat saturation sequence on MRI within 12 weeks of enrollment

Whole body imaging evaluation (either WB MRI$ or bone scintigraphy)

Active disease* after failing at least 4 weeks of NSAIDs and/or presence of active spinal lesions& regardless of NSAID trial

Bone biopsy to exclude infection or malignancy unless bone lesions follow typical distribution# or there is IBD, psoriasis, or palmar plantar pustulosis

Enrolled patients should not have:

History of or current malignancy

Current infectious osteomyelitis

Contraindication to the selected treatment agent

CNO: chronic nonbacterial osteomyelitis; NSAID: non-steroidal anti-inflammatory drug; STIR: short tau inversion recovery sequence; MRI: magnetic resonance imaging; WB: whole body; IBD: inflammatory bowel disease.

^$Suggested protocol includes STIR or fat saturation sequences of coronal views of whole body and sagittal view of total spine. Some patients may require dedicated views of hands or feet when lesions in these areas are present. Gadolinium is not required.

^*Active disease is defined as persistent pain with focal tenderness and/or warmth and/or persistence of bone edema on MRI in at least one lesion site

^&Active spinal lesions are defined as bone edema within at least one vertebral body of the cervical, thoracic, or lumbar spine

^#Typical distribution of lesions include the clavicle or symmetrical lesions in long bones at metaphysis/epiphysis