Diagnosis, treatment and monitoring of chronic nonbacterial osteomyelitis (CNO) and chronic recurrent…

GuidelineAutoimmunity reviews· Jul 2026

Diagnosis, treatment and monitoring of chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO) - Evidence, practice and consensus-based recommendations from the German pediatric rheumatology society (GKJR).

A Schnabel, C Reiser, M Beer … C M Hedrich

RheumatologyGuidelineClinical practiceQ1IF 9.5

New recommendations provide structured guidance for chronic nonbacterial osteomyelitis.

Diagnosis, treatment and monitoring of chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO) - Evidence, practice and consensus-based recommendations from the German pediatric rheumatology society (GKJR).

A Schnabel … C M Hedrich

Autoimmunity reviews · Jul 2026

Background

Chronic nonbacterial osteomyelitis (chronic nonbacterial osteomyelitis), sometimes also referred to as chronic recurrent multifocal osteomyelitis (chronic recurrent multifocal osteomyelitis), is a rare autoinflammatory bone disease primarily affecting children and adolescents.

Purpose

This initiative of the German Society of Pediatric and Adolescent Rheumatology (GKJR) aimed to develop evidence-, practice-, and consensus-based recommendations for the diagnosis and management of chronic nonbacterial osteomyelitis, incorporating current knowledge on pathophysiology, therapeutic strategies and disease monitoring.

Methods

Based on a systematic literature review and a subsequent Delphi survey, preliminary statements were developed.

More results

Where available, diagnostic workup should include whole-body skeletal imaging (usually MRI).

Treatment options include first-line (NSAIDs, short-term corticosteroids) and second-line (conventional and/or biologic DMARDs, bisphosphonates) agents.

In patients with vertebral involvement, rapid treatment with bisphosphonates and/or TNF inhibitors is recommended.

More results

As chronic nonbacterial osteomyelitis is a chronic disease, long-term monitoring is recommended, including follow-up after treatment discontinuation.

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Conclusion · 1 of 2

Although evidence levels are low to moderate, consensus statements and recommendations provide structured guidance for clinicians diagnosing and treating chronic nonbacterial osteomyelitis.

Conclusion · 2 of 2

They provide a framework for harmonized care aiming at improved long-term outcomes.

Diagnosis, treatment and monitoring of chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO) - Evidence, practice and consensus-based recommendations from the German pediatric rheumatology society (GKJR).

Diagnosis, treatment and monitoring of chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO) - Evidence, practice and consensus-based recommendations from the German pediatric rheumatology society (GKJR).

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