Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Curr Opin Rheumatol. 2011 Sep;23(5):424-31. doi: 10.1097/BOR.0b013e328349c363.
To review the current literature of sterile bone inflammation in childhood and to evaluate the evidence for clinical care including diagnostic methods and treatment.
Chronic noninfectious osteomyelitis includes several different entities marked by sterile bone inflammation associated with histologic evidence of a predominant neutrophil infiltration in the absence of autoantibodies and autoreactive T cells, some of which are associated with a genetic mutation. Whole body MRI is helpful in detecting asymptomatic lesions. Initial treatment with NSAIDs is usually sufficient to control symptoms as the bone heals. However, if the lesions persist and do not respond to first-line treatment, or involve the spine or hip, treatment with bisphosphonate will usually lead to a resolution of symptoms. Rarely, treatment with anti-TNF agents is required.
This review summarizes recent information on diagnosis, treatment and prognosis of disorders involving sterile bone inflammation in childhood. It also addresses the evolving differential diagnosis for autoinflammatory disorders that include sterile bone inflammation and presents a treatment algorithm for management.
回顾儿童无菌性骨炎症的现有文献，并评估其临床护理的证据，包括诊断方法和治疗。
慢性非传染性骨髓炎包括几种不同的实体，其特征是无菌性骨炎症伴有组织学证据表明在没有自身抗体和自身反应性 T 细胞的情况下存在主要的中性粒细胞浸润，其中一些与基因突变有关。全身 MRI 有助于检测无症状病变。在骨骼愈合过程中，最初使用 NSAIDs 治疗通常足以控制症状。然而，如果病变持续存在且对一线治疗无反应，或涉及脊柱或臀部，则通常使用双膦酸盐治疗可导致症状缓解。在极少数情况下，需要使用抗 TNF 药物治疗。
本综述总结了儿童无菌性骨炎症相关疾病的诊断、治疗和预后的最新信息。它还讨论了包括无菌性骨炎症的自身炎症性疾病的不断发展的鉴别诊断，并提出了管理的治疗算法。
