Abstract：
Chronic nonbacterial osteomyelitis (CNO) can cause significant morbidity, including bone pain and damage. In the absence of clinical trials, treatments include non-steroidal anti-inflammatory drugs, corticosteroids, TNF-inhibitors (TNFi) and/or bisphosphonates. In a retrospective chart review in the United Kingdom and Germany, we investigated response to TNFi and/or pamidronate. Ninety-one patients were included, receiving pamidronate (n = 47), TNFi (n = 22) or both sequentially (n = 22). Patients with fatigue [p = 0.003] and/or arthritis [p = 0.002] were more frequently treated with TNFi than pamidronate. Both therapies were associated with clinical remission at 6 months, and reduction of bone lesions on MRI at 12 months. While not reaching statistical significance, pamidronate resulted in faster resolution of MRI lesions. Fewer flares were observed with TNFi. Failure to respond to pamidronate was associated with female sex [p = 0.027], more lesions on MRI [p = 0.01] and higher CRP levels [p = 0.03]. Randomized clinical trials are needed to confirm observations and generate evidence.
摘要：
慢性非细菌性骨髓炎（CNO）可引起显著的发病率，包括骨痛和损伤.在没有临床试验的情况下,治疗包括非甾体抗炎药，皮质类固醇,TNF-抑制剂(TNFi)和/或双膦酸盐。在英国和德国的回顾性图表审查中，我们调查了对TNFi和/或帕米膦酸盐的反应。包括91名患者，接受帕米膦酸盐（n=47），TNFi(n=22)或两者依次(n=22)。患有疲劳[p=0.003]和/或关节炎[p=0.002]的患者用TNFi治疗的频率高于帕米膦酸盐。两种疗法均与6个月时的临床缓解有关。12个月时MRI显示骨病变减少。虽然没有达到统计意义，帕米膦酸盐导致MRI病变更快的分辨率。用TNFi观察到更少的耀斑。帕米膦酸盐反应失败与女性性别有关[p=0.027]，更多的MRI病变[p=0.01]和更高的CRP水平[p=0.03]。需要随机临床试验来确认观察结果并产生证据。
