Journal article
EULAR/American College of Rheumatology Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis
Arthritis & rheumatology (Hoboken, N.J.), Vol.78(3), pp.537-547
03/2026
DOI: 10.1002/art.43137
PMID: 40342207
Abstract
To develop and validate classification criteria for pediatric chronic nonbacterial osteomyelitis (CNO) jointly supported by EULAR and the American College of Rheumatology (ACR).
This international initiative had 4 phases: (1) candidate items were proposed in a survey of pediatric 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, anemia, 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 pediatric 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/American College of Rheumatology Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis
- 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 MarinoCassyanne L Aguiar - Children's Hospital of The King's DaughtersJonathan D Akikusa - The Royal Children's Hospital FoundationUmmusen 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 - Harvard Medical SchoolAntonella Insalaco - Bambino Gesù Children's HospitalEmily J Fox - Children's Mercy 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 - Science-Research Institute of Phthisiopulmonology, Saint-Petersburg, RussiaKatherine 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, CaliforniaAthimalaipet V Ramanan - University of BristolAngelo Ravelli - Istituto Giannina GasliniNathan D Rogers - University of Colorado Anschutz Medical CampusAndrew W Grim - Michigan MedicineMicol Romano - University of LondonNatalie 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 - Vivantes KlinikumFatma Dedeoglu - Boston Children's HospitalChristian M Hedrich - University of LiverpoolRonald M Laxer - University of TorontoPolly J Ferguson - University of IowaRaymond NadenSeza Ozen - Hacettepe University
- Resource Type
- Journal article
- Publication Details
- Arthritis & rheumatology (Hoboken, N.J.), Vol.78(3), pp.537-547
- DOI
- 10.1002/art.43137
- PMID
- 40342207
- NLM abbreviation
- Arthritis Rheumatol
- ISSN
- 2326-5205
- eISSN
- 2326-5205
- Publisher
- Wiley
- Grant note
- EULAR/ACR Classification Criteria Award
- Language
- English
- Electronic publication date
- 05/08/2025
- Date published
- 03/2026
- Academic Unit
- Radiology; Stead Family Department of Pediatrics; Rheumatology, Allergy, and Immunology; Immunology; Internal Medicine
- Record Identifier
- 9984821349502771
Metrics
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