Clinical care of children with sterile bone inflammation

Curr Opin Rheumatol. 2011 Sep;23(5):424-31. doi: 10.1097/BOR.0b013e328349c363.


Purpose of review: To review the current literature of sterile bone inflammation in childhood and to evaluate the evidence for clinical care including diagnostic methods and treatment.

Recent findings: 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.

Summary: 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.

Publication types

  • Review

MeSH terms

  • Acquired Hyperostosis Syndrome / diagnosis
  • Acquired Hyperostosis Syndrome / etiology
  • Acquired Hyperostosis Syndrome / therapy
  • Anemia, Dyserythropoietic, Congenital / diagnosis
  • Anemia, Dyserythropoietic, Congenital / etiology
  • Anemia, Dyserythropoietic, Congenital / therapy
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Cherubism / diagnosis
  • Cherubism / etiology
  • Cherubism / therapy
  • Child
  • Female
  • Hereditary Autoinflammatory Diseases / diagnosis
  • Hereditary Autoinflammatory Diseases / etiology
  • Hereditary Autoinflammatory Diseases / therapy
  • Humans
  • Immunologic Deficiency Syndromes
  • Interleukin 1 Receptor Antagonist Protein
  • Magnetic Resonance Imaging
  • Male
  • Osteitis / diagnosis
  • Osteitis / etiology
  • Osteitis / therapy*
  • Osteomyelitis / diagnosis
  • Osteomyelitis / etiology
  • Osteomyelitis / therapy


  • Anti-Inflammatory Agents, Non-Steroidal
  • Interleukin 1 Receptor Antagonist Protein

Supplementary concepts

  • Chronic recurrent multifocal osteomyelitis
  • Deficiency of interleukin-1 receptor antagonist
  • Majeed syndrome