积极治疗可降低慢性非细菌性骨髓炎的疾病活动度，且不会导致骨骼损伤进展。
Aggressive Therapy Reduces Disease Activity without Skeletal Damage Progression in Chronic Nonbacterial Osteomyelitis.
作者信息
Zhao Yongdong, Chauvin Nancy A, Jaramillo Diego, Burnham Jon M
机构信息
From the Pediatric Rheumatology Department, Seattle Children's Hospital, Seattle, Washington; Department of Radiology, and the Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.Y. Zhao, MD, PhD, acting assistant professor, Pediatric Rheumatology Department, Seattle Children's Hospital; N.A. Chauvin, MD, Assistant Professor; D. Jaramillo, MD, MPH, Professor, Department of Radiology, The Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia.
出版信息
J Rheumatol. 2015 Jul;42(7):1245-51. doi: 10.3899/jrheum.141138. Epub 2015 May 15.
OBJECTIVE
To retrospectively assess changes in disease activity and skeletal damage in children with chronic nonbacterial osteomyelitis (CNO) after infliximab and methotrexate, with or without zoledronic acid or nonsteroidal antiinflammatory drug (NSAID) monotherapy, using a standardized magnetic resonance imaging (MRI) approach.
METHODS
Treatment-related changes in clinical and MRI measures from aggressive therapy and NSAID monotherapy groups (n = 9 per group) were evaluated using nonparametric methods.
RESULTS
Pain, physical function, physician global assessment, inflammatory markers, nonvertebral inflammatory lesion number, and maximum bone edema score all improved significantly with aggressive therapy (p < 0.03), whereas only the maximum soft tissue inflammation severity decreased (p = 0.02) with NSAID monotherapy. Vertebral deformities and physeal damage did not worsen in the aggressive therapy group but 1 in the NSAID group had worsening of growth plate damage.
CONCLUSION
An aggressive treatment regimen in CNO improved clinical and imaging measures of disease activity without progression of skeletal damage.
目的
采用标准化磁共振成像（MRI）方法，回顾性评估英夫利昔单抗和甲氨蝶呤联合或不联合唑来膦酸或非甾体抗炎药（NSAID）单药治疗的慢性非细菌性骨髓炎（CNO）患儿的疾病活动度和骨骼损伤变化。
方法
使用非参数方法评估积极治疗组和NSAID单药治疗组（每组n = 9）临床和MRI测量指标的治疗相关变化。
结果
积极治疗后，疼痛、身体功能、医生整体评估、炎症标志物、非椎体炎症病变数量和最大骨水肿评分均显著改善（p < 0.03），而NSAID单药治疗仅最大软组织炎症严重程度降低（p = 0.02）。积极治疗组椎体畸形和骨骺损伤未加重，但NSAID组有1例生长板损伤加重。
结论
CNO的积极治疗方案改善了疾病活动度的临床和影像学指标，且骨骼损伤无进展。
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