Journal article
EULAR/ACR classification criteria for paediatric chronic nonbacterial osteomyelitis (CNO)
Annals of the rheumatic diseases, Vol.84(9), pp.1458-1468
09/2025
DOI: 10.1016/j.ard.2024.11.006
PMID: 39966038
Abstract
To develop and validate classification criteria for paediatric chronic nonbacterial osteomyelitis (CNO) jointly supported by the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR).
This international initiative had 4 phases: (1) candidate items were proposed in a survey of paediatric 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.
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, anaemia, 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.
These new classification criteria for paediatric 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.
Details
- Title: Subtitle
- EULAR/ACR classification criteria for paediatric chronic nonbacterial osteomyelitis (CNO)
- Creators
- Yongdong Zhao - University of Washington School of MedicineMelissa S. Oliver - Indiana University School of MedicineAnja Schnabel - University Hospital Carl Gustav CarusEveline Y. Wu - University of North Carolina at Chapel HillZhaoyi Wang - University of Washington School of MedicineAchille Marino - Mylan (Switzerland)Cassyanne L. Aguiar - Children's Hospital of The King's DaughtersJonathan D. Akikusa - Royal Children's HospitalUmmusen Kaya Akca - Hacettepe UniversityBeverley Almeida - Alder Hey Children's NHS Foundation TrustSimone Appenzeller - Universidade Estadual de Campinas (UNICAMP)Erin Balay-Dustrude - University of Washington School of MedicineOzge Basaran - Hacettepe UniversityMatthew L. Basiaga - Mayo ClinicYelda Bilginer - Hacettepe UniversityDavid A. Cabral - University of British ColumbiaMartina Capponi - Sapienza University of RomeNathan Donaldson - University of Colorado Anschutz Medical CampusBugra Han Egeli - Boston Children's HospitalEmily J. Fox - Children's Mercy HospitalAntonella Insalaco - Bambino Gesù Children's HospitalRamesh S. Iyer - University of Washington School of MedicineAnnette F. Jansson - Ludwig-Maximilians-Universität MünchenInna Kostik - Sanatorium for children ‘Detskie Duny’, Saint-Petersburg, RussiaMikhail Kostik - Saint Petersburg State Pediatric Medical UniversityLeonard K. Kovalick - University of North Carolina at Chapel HillKatia Tomie Kozu - Universidade de São PauloSivia K. Lapidus - Hackensack University Medical CenterTzielan C. Lee - Stanford University School of MedicineAleksander Lenert - University of IowaKamran Mahmood - Alder Hey Children's NHS Foundation TrustEdoardo Marrani - Meyer Children's HospitalDoaa Mosad Mosa - Mansoura UniversityIan Muse - University of Washington School of MedicineAlexander Mushkin - Saint-Petersburg Research Institute of PhthisiopulmonologyKatherine D. Nowicki - University of Colorado Anschutz Medical CampusFarzana Nuruzzaman - Stony Brook UniversityKaren Onel - Hospital for Special SurgeryManuela Pardeo - Bambino Gesù Children's HospitalTrang Sophia Pham - University of Washington School of MedicineLauren Potts - Patient Research Partner, CA, USAAthimalaipet V. Ramanan - University of BristolAngelo Ravelli - Istituto Giannina GasliniNathan D. Rogers - University of Colorado Anschutz Medical CampusAndrew W. Grim - Michigan MedicineMicol Romano - Mylan (Switzerland)Natalie Rosenwasser - University of Washington School of MedicineTakashi Shawn Sato - University of IowaGabriele Simonini - Meyer Children's HospitalJennifer B. Soep - University of Colorado Anschutz Medical CampusSara M. Stern - University of UtahTimmy Strauss - University Hospital Carl Gustav CarusAngela Taneja Kohli - Emory UniversityAlexander C. Theos - Georgetown UniversityLori B. Tucker - University of British ColumbiaLeslie F. Vogel - Seattle Children's HospitalShima Yasin - University of IowaStephen C. Wong - University of Washington School of MedicineKaterina Bouchalova - Palacký University OlomoucAlison M. Hendry - Middlemore HospitalKevin C. Cain - University of WashingtonHermann J. Girschick - Klinikum im FriedrichshainFatma Dedeoglu - Boston Children's HospitalChristian M. Hedrich - Alder Hey Children's NHS Foundation TrustRonald M. Laxer - University of TorontoPolly J. Ferguson - University of IowaRaymond Naden - Auckland City HospitalSeza Ozen - Hacettepe University
- Resource Type
- Journal article
- Publication Details
- Annals of the rheumatic diseases, Vol.84(9), pp.1458-1468
- DOI
- 10.1016/j.ard.2024.11.006
- PMID
- 39966038
- NLM abbreviation
- Ann Rheum Dis
- ISSN
- 0003-4967
- Publisher
- Elsevier B.V
- Language
- English
- Electronic publication date
- 01/2025
- Date published
- 09/2025
- Academic Unit
- Radiology; Stead Family Department of Pediatrics; Rheumatology, Allergy, and Immunology; Immunology; Internal Medicine
- Record Identifier
- 9984786446902771
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