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Diagnostik und Therapie der nichtbakteriellen Osteitis

Konsensus-Statement des 16. Wörlitzer Expertengesprächs 2013 für die Deutsche Gesellschaft für Kinder- und Jugendrheumatologie

Diagnostics and therapy of non-bacterial osteitis

Consensus statement of the 16th Worlitz expert meeting 2013 for the Deutsche Gesellschaft für Kinder- und Jugendrheumatologie

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Zusammenfassung

Bei der nichtbakteriellen Osteitis (NBO) handelt es sich um eine aseptische Form der Osteomyelitis. Die Diagnose stellt mangels genetischer oder anderer spezifischer Kriterien derzeit eine Ausschlussdiagnose dar. Unter klinischen Aspekten können akute und chronische Verlaufsformen beschrieben werden. Die vorliegende Konsensusfindung bezieht sich auf chronische Verlaufsformen, die länger als 6 Monate bestehen. Der Konsensus ist im Rahmen des 16. Wörlitzer Expertengesprächs 2013 für die Deutsche Gesellschaft für Kinder- und Jugendrheumatologie entstanden. Er fasst den momentanen Stand des diagnostischen und therapeutischen Vorgehens als Expertenmeinung zusammen.

Abstract

Non-bacterial osteitis (NBO) is an aseptic form of osteomyelitis. The diagnosis is currently a diagnosis by exclusion due to the lack of genetic or other specific criteria. Under clinical aspects acute and chronic forms can be differentiated. The present consensus statement is concerned with chronic forms which last for longer than 6 months. The consensus was agreed within the framework of the 16th Worlitz expert meeting 2013 for the German Society for Paediatric and Adolescent Rheumatology and summarizes the current state of the diagnostic and therapeutic approach as an expert opinion.

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Abbreviations

AP:

alkalische Phosphatase

BKS:

Blutkörperchensenkungsgeschwindigkeit

CED:

chronisch-entzündliche Darmerkrankungen

CK:

Kreatinkinase

CNO:

chronische, nichtbakterielle Osteitis

CRMO:

chronisch-rekurrierende, multifokale Osteomyelitis

CRP:

C-reaktives Protein

ED:

Einzeldosis

IL1RN:

„interleukin 1 receptor antagonist“

KM:

Kontrastmittel

LDH:

Laktatdehydrogenase

LPIN2:

„lipin 2“

MTX:

Methotrexat

NBO:

nichtbakterielle Osteitis

NOD2:

„nucleotide-binding oligomerization domain-containing protein 2“

NSAID:

nichtsteroidale Antiphlogistika

PPP:

palmoplantare Pustolosis

Ps:

Psoriasis

Pstpip2:

„proline-serine-threonine phosphatase-interacting protein 2“

SAPHO:

Synovitis, Akne, Pustulosis, Hyperostose und Osteitis

STIR:

„short-tau inversion recovery“

TIRM:

„turbo-inversion recovery-magnitude“

TNFRSF1A:

„tumor necrosis factor receptor superfamily member 1A“

VAS:

visuelle Analogskala

Literatur

  1. Aksentijevich I, Masters SL, Ferguson PJ et al (2009) An autoinflammatory disease with deficiency of the interleukin-1-receptor antagonist. N Engl J Med 360:2426–2437

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Assmann G, Kueck O, Kirchhoff T et al (2009) Efficacy of antibiotic therapy for SAPHO syndrome is lost after its discontinuation: an interventional study. Arthritis Res Ther 11:R140

    Article  PubMed Central  PubMed  Google Scholar 

  3. Beck C, Girschick HJ, Morbach H et al (2011) Mutation screening of the IL-1 receptor antagonist gene in chronic non-bacterial osteomyelitis of childhood and adolescence. Clin Exp Rheumatol 29:1040–1043

    PubMed  Google Scholar 

  4. Beck C, Morbach H, Beer M et al (2010) Chronic nonbacterial osteomyelitis in childhood: prospective follow-up during the first year of anti-inflammatory treatment. Arthritis Res Ther 12:R74

    Article  PubMed Central  PubMed  Google Scholar 

  5. Borzutzky A, Stern S, Reiff A et al (2012) Pediatric chronic nonbacterial osteomyelitis. Pediatrics 130:e1190–e1197

    Article  PubMed  Google Scholar 

  6. Bousvaros A, Marcon M, Treem W et al (1999) Chronic recurrent multifocal osteomyelitis associated with chronic inflammatory bowel disease in children. Dig Dis Sci 44:2500–2507

    Article  CAS  PubMed  Google Scholar 

  7. Eleftheriou D, Gerschman T, Sebire N et al (2010) Biologic therapy in refractory chronic non-bacterial osteomyelitis of childhood. Rheumatology (Oxford) 49:1505–1512

  8. Ferguson PJ, El-Shanti HI (2007) Autoinflammatory bone disorders. Curr Opin Rheumatol 19:492–498

    Article  CAS  PubMed  Google Scholar 

  9. Fritz J, Tzaribatchev N, Claussen CD et al (2009) Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data. Radiology 252:842–851

    Article  PubMed  Google Scholar 

  10. Girschick HJ, Huppertz HI, Harmsen D et al (1999) Chronic recurrent multifocal osteomyelitis in children: diagnostic value of histopathology and microbial testing. Hum Pathol 30:59–65

    Article  CAS  PubMed  Google Scholar 

  11. Girschick HJ, Mornet E, Beer M et al (2007) Chronic multifocal non-bacterial osteomyelitis in hypophosphatasia mimicking malignancy. BMC Pediatr 7:3

    Article  PubMed Central  PubMed  Google Scholar 

  12. Girschick HJ, Raab P, Surbaum S et al (2005) Chronic non-bacterial osteomyelitis in children. Ann Rheum Dis 64:279–285

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Girschick HJ, Zimmer C, Klaus G et al (2007) Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated? Nat Clin Pract Rheumatol 3:733–738

    Article  PubMed  Google Scholar 

  14. Golla A, Jansson A, Ramser J et al (2002) Chronic recurrent multifocal osteomyelitis (CRMO): evidence for a susceptibility gene located on chromosome 18q21.3–18q22. Eur J Hum Genet 10:217–221

    Article  PubMed  Google Scholar 

  15. Hedrich CM, Hofmann SR, Pablik J et al (2013) Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J 11:47

    Article  PubMed Central  PubMed  Google Scholar 

  16. Hofmann C, Wurm M, Schwarz T et al (2015) A standardized clinical and radiological follow-up of patients with chronic non-bacterial osteomyelitis treated with pamidronate. Clin Exp Rheumatol (im Druck)

  17. Hofmann SR, Morbach H, Schwarz T et al (2012) Attenuated TLR4/MAPK signaling in monocytes from patients with CRMO results in impaired IL-10 expression. Clin Immunol 145:69–76

    Article  CAS  PubMed  Google Scholar 

  18. Hospach T, Langendoerfer M, Von Kalle T et al (2010) Spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate. Eur J Pediatr 169:1105–1111

    Article  CAS  PubMed  Google Scholar 

  19. Huber AM, Lam PY, Duffy CM et al (2002) Chronic recurrent multifocal osteomyelitis: clinical outcomes after more than five years of follow-up. J Pediatr 141:198–203

    Article  PubMed  Google Scholar 

  20. Jansson A, Borte M, Boschow G et al (2006) Non-bacterial osteitis in children and adults. Consensus statement of the 8th Worlitz Expert Meeting 2005, for the German Society for Paediatric and Adolescent Rheumatology. Monatsschr Kinderheilkd 154:831–833

    Article  Google Scholar 

  21. Jansson A, Reinhardt D (2009) Bone pain. Monatsschr Kinderheilkd 157:645–646

    Article  Google Scholar 

  22. Jansson A, Renner ED, Ramser J et al (2007) Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients. Rheumatology (Oxford) 46:154–160

  23. Jansson AF, Grote V (2011) Nonbacterial osteitis in children: data of a German Incidence Surveillance Study. Acta Paediatr 100:1150–1157

    Article  PubMed  Google Scholar 

  24. Jansson AF, Muller TH, Gliera L et al (2009) Clinical score for nonbacterial osteitis in children and adults. Arthritis Rheum 60:1152–1159

    Article  PubMed  Google Scholar 

  25. Lukens JR, Gross JM, Calabrese C et al (2014) Critical role for inflammasome-independent IL-1beta production in osteomyelitis. Proc Natl Acad Sci U S A 111:1066–1071

    Article  CAS  PubMed  Google Scholar 

  26. Miettunen PM, Wei X, Kaura D et al (2009) Dramatic pain relief and resolution of bone inflammation following pamidronate in 9 pediatric patients with persistent chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J 7:2

    Article  PubMed Central  PubMed  Google Scholar 

  27. Morbach H, Dick A, Beck C et al (2010) Association of chronic non-bacterial osteomyelitis with Crohn’s disease but not with CARD15 gene variants. Rheumatol Int 30:617–621

    Article  CAS  PubMed  Google Scholar 

  28. Morbach H, Hedrich CM, Beer M et al (2013) Autoinflammatory bone disorders. Clin Immunol 147:185–196

    Article  CAS  PubMed  Google Scholar 

  29. Morbach H, Schneider P, Schwarz T et al (2012) Comparison of magnetic resonance imaging and 99mtechnetium-labelled methylene diphosphonate bone scintigraphy in the initial assessment of chronic non-bacterial osteomyelitis of childhood and adolescents. Clin Exp Rheumatol 30:578–582

    PubMed  Google Scholar 

  30. Neubauer H, Evangelista L, Morbach H et al (2012) Diffusion-weighted MRI of bone marrow oedema, soft tissue oedema and synovitis in paediatric patients: feasibility and initial experience. Pediatr Rheumatol Online J 10:20

    Article  PubMed Central  PubMed  Google Scholar 

  31. Schilling F, Kessler S (2000) SAPHO syndrome: clinico-rheumatologic and radiologic differentiation and classification of a patient sample of 86 cases. Z Rheumatol 59:1–28

    Article  CAS  PubMed  Google Scholar 

  32. Sharma M, Ferguson PJ (2013) Autoinflammatory bone disorders: update on immunologic abnormalities and clues about possible triggers. Curr Opin Rheumatol 25:658–664

    Article  CAS  PubMed  Google Scholar 

  33. Tlougan BE, Podjasek JO, O’Haver J et al (2009) Chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with associated neutrophilic dermatoses: a report of seven cases and review of the literature. Pediatr Dermatol 26:497–505

    Article  PubMed  Google Scholar 

  34. Twilt M, Laxer RM (2011) Clinical care of children with sterile bone inflammation. Curr Opin Rheumatol 23:424–431

    Article  CAS  PubMed  Google Scholar 

  35. Von Chamier G, Holl-Wieden A, Stenzel M et al (2010) Pitfalls in diagnostics of hip pain: osteoid osteoma and osteoblastoma. Rheumatol Int 30:395–400

    Article  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A.F. Jansson, M. Borte, A. Hospach, T. Kallinich, P.T. Oommen, R. Trauzeddel, E. Weißbarth-Riedel, D. Windschall, H.J. Girschick und V. Grote geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Rheumatologie & Immunologie, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität, Lindwurmstr. 4, 80337, München, Deutschland

    A.F. Jansson & V. Grote

  2. Fachbereich Pädiatrische Rheumatologie, Immunologie und Infektiologie, Klinikum St. Georg gGmbH, Leipzig, Deutschland

    M. Borte

  3. Pädiatrische Rheumatologie, Olgahospital, Stuttgart, Deutschland

    A. Hospach

  4. Zentrum für Seltene Erkrankungen (ZSE), Charité Universitätsmedizin Berlin, Berlin, Deutschland

    T. Kallinich

  5. Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    P.T. Oommen

  6. Helios Klinikum Berlin-Buch, Berlin, Deutschland

    R. Trauzeddel

  7. Pädiatrische Rheumatologie, Klinik und Poliklinik für Kinder- und Jugendmedizin, UKE, Hamburg, Deutschland

    E. Weißbarth-Riedel

  8. Kinder-Rheumatologie, Asklepios-Klinik Weißenfels, Weißenfels, Deutschland

    D. Windschall

  9. Kinder-Rheumatologie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland

    H.J. Girschick

Authors
  1. A.F. Jansson
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  2. M. Borte
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  3. A. Hospach
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  4. T. Kallinich
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  5. P.T. Oommen
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  6. R. Trauzeddel
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  7. E. Weißbarth-Riedel
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  8. D. Windschall
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  9. H.J. Girschick
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  10. V. Grote
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Corresponding author

Correspondence to A.F. Jansson.

Additional information

M. Borte, A. Hospach, T. Kallinich, P.T. Oommen, R. Trauzeddel, E. Weißbarth-Riedel, D. Windschall, H.J. Girschick, V. Grote haben zu gleichen Anteilen zu der Arbeit beigetragen.

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Jansson, A., Borte, M., Hospach, A. et al. Diagnostik und Therapie der nichtbakteriellen Osteitis. Monatsschr Kinderheilkd 162, 539–545 (2014). https://doi.org/10.1007/s00112-014-3148-z

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