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Arthritis und Rheuma 2023; 43(05): 336-344
DOI: 10.1055/a-2129-2943
Kinderrheumatologie
Übersichtsartikel

Die Chronisch Nichtbakterielle Osteomyelitis (CNO) im Kindes- und Jugendalter

Anja Schnabel
1   Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Pädiatrische Rheumatologie, Dresden, Deutschland
,
Hermann Girschick
2   Vivantes Klinikum im Friedrichshain, Pädiatrische Rheumatologie, Berlin, Deutschland
,
Gabriele Hahn
3   Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Pädiatrische Radiologie, Dresden, Deutschland
,
Christiane Reiser
4   Landeskrankenhaus Bregenz, Abteilung für Kinder- und Jugendheilkunde, Bregenz, Österreich
5   Universitätsklinikum Tübingen, Pädiatrische Rheumatologie und Autoinflammation Reference Center Tübingen (arcT), Tübingen, Deutschland
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ZUSAMMENFASSUNG

Die CNO zählt zu den autoinflammatorischen Knochenerkrankungen mit dem Leitsymptom muskuloskelettaler Schmerz. Das breite klinische Spektrum, das Fehlen validierter Diagnosekriterien und die unvollständig verstandene Pathophysiologie machen die Diagnose CNO zu einer Herausforderung. Die Patienten können systemische Entzündungszeichen aufweisen, pathognomonische Laborbefunde existieren jedoch nicht. Die Ganzkörper-Magnetresonanztomografie stellt mittlerweile den Goldstandard (bei Verfügbarkeit) in der CNO-Diagnostik dar. Der histologische Befund einer Knochenbiopsie zeigt kein CNO-spezifisches Entzündungsmuster, kann aber bei unifokaler/atypischer Manifestation für die Differenzierung zu Malignität oder bakteriellen Infektionen notwendig sein. In erster Linie kommen therapeutisch nichtsteroidale Antirheumatika (NSAR) zum Einsatz. In refraktären Fällen oder bei Wirbelsäulenbeteiligung sollte auf Zweitlinien-Medikamente wie Bisphosphonate oder TNF-Inhibitoren zurückgegriffen werden. Der Krankheitsverlauf ist schwer vorhersehbar. Da eine unkontrollierte Krankheitsaktivität zu Komplikationen wie Wirbelkörperfrakturen führen kann, ist eine zeitnahe Diagnosestellung und Therapie wichtig für den Krankheitsverlauf.

Schlüsselwörter

Chronisch Nichtbakterielle Osteomyelitis (CNO) - Chronisch Rekurrierende Multifokale Osteomyelitis (CRMO) - autoinflammatorische Knochenerkrankung


Publication History

Article published online:
18 October 2023

© 2023. Thieme. All rights reserved.

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