Chronic Nonbacterial Osteomyelitis and Chronic Recurrent Multifocal Osteomyelitis in Children

Pediatr Clin North Am. 2018 Aug;65(4):783-800. doi: 10.1016/j.pcl.2018.04.003.


Chronic nonbacterial osteomyelitis (CNO) is an innate immune system disorder that predominantly affects children. It can present as part of a syndrome or in isolation. It presents as bone pain with or without fever or objective swelling at the site. It is difficult to diagnose. Laboratory studies can be normal, whereas a biopsy reveals sterile osteomyelitis. Osteolytic or sclerotic bone changes may be seen on radiographs. However, MRI is more sensitive for detecting CNO and is considered the gold standard for monitoring the disease. Treatment depends on disease severity and includes nonsteroidal antiinflammatory drugs, bisphosphonates, and cytokine inhibitors.

Keywords: Chronic nonbacterial osteomyelitis; Chronic recurrent multifocal osteomyelitis; DIRA; Majeed syndrome; NSAID; Whole-body MRI.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Age of Onset
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Child
  • Child, Preschool
  • Chronic Disease
  • Diagnosis, Differential
  • Drug Therapy, Combination
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Magnetic Resonance Imaging
  • Male
  • Osteomyelitis / complications
  • Osteomyelitis / diagnosis*
  • Osteomyelitis / drug therapy
  • Radiography
  • Radionuclide Imaging


  • Anti-Inflammatory Agents, Non-Steroidal
  • Immunosuppressive Agents

Supplementary concepts

  • Chronic recurrent multifocal osteomyelitis