Childhood Nonbacterial Osteomyelitis

Childhood nonbacterial osteomyelitis (CNO) is an autoimmune condition in which there is chronic inflammation in the bone. Childhood nonbacterial osteomyelitis is more commonly known as chronic recurrent multifocal osteomyelitis (CRMO) in the Western Hemisphere. In traditional (bacterial) osteomyelitis, bacteria cause infection in the bone. With childhood nonbacterial osteomyelitis, there are no bacteria or infections in the bone—it is inflammation in the bone that may at first appear to be infection.

Symptoms of childhood nonbacterial osteomyelitis include:

Arthritis
Significant bone-related pain; particularly in the knee, ankle, wrist, back, pelvis or collarbone
Areas of pain which may be red, warm to the touch and difficult to move
Unexplained fevers

Diagnosis of Childhood Nonbacterial Osteomyelitis

Because the condition mimics a bone infection, children often see various specialists before getting an accurate diagnosis. Your child’s rheumatologist will run one or more of the following tests to diagnose childhood nonbacterial osteomyelitis:

Imaging tests. Your child's doctor may recommend the following imaging tests to evaluate the bones for inflammation:

Magnetic resonance imaging (MRI)
Nuclear medicine bone scan

Biopsy. A sample of the affected bone may be removed from your child’s body for closer analysis in the laboratory.
Blood test. A sample of your child’s blood may be drawn to check for markers of chronic inflammation as well as rule out other conditions that can mimic this condition.
X-ray. Your child’s doctor may order an X-ray, which can help reveal any abnormalities in his or her bones.

If your child’s doctor diagnoses him or her with childhood nonbacterial osteomyelitis, it is important that you seek the expert treatment of a pediatric rheumatologist as soon as possible to avoid long-term damage.

Treatments

Childhood nonbacterial osteomyelitis flare-ups can last a couple of weeks to several months. Correct treatment can help reduce how long the flare-ups last. The goals of treatment for this condition are to:

Reduce your child’s pain
Improve your child’s ability to move
Allow your child to live a normal life

Your child’s pediatric rheumatologist may also prescribe one or more of the following medicines to help manage the symptoms of CNO:

Nonsteroidal anti-inflammatory drugs (NSAIDs). Your child may take these oral medicines to reduce swelling and pain.
Corticosteroids. Your child’s doctor may prescribe corticosteroids—such as prednisone—to reduce severe inflammation.
Immunosuppressants. Your child’s doctor may prescribe this type of medicine to reduce his or her overactive immune system.
Biologics. These medicines can also help reduce your child’s overactive immune system, which may decrease inflammation.

Your child’s rheumatologist may also recommend that he or she see a physical therapist or occupational therapist to make sure he or she stays engaged in the activities of everyday life.

Key Points to Remember

Childhood nonbacterial osteomyelitis causes inflammation in the bone and is often mistaken for bone infection.
Childhood nonbacterial osteomyelitis episodes can vary in length from a couple of weeks to several months.
The goals of treatment for this condition are to reduce pain, improve your child’s ability to move and allow your child to live a normal life.

Support Services & Resources

Visit the trusted websites below to learn more about childhood nonbacterial osteomyelitis.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

American Academy of Orthopaedic Surgeons

The American Academy of Orthopaedic Surgeons provides more information about bone, joint and muscle infections in children.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

Sort through 3 facilities offering Childhood Nonbacterial Osteomyelitis care by entering your city or zip below.

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Departments Treating This Condition

Rheumatology