Nichtbakterielle Osteitiden

Zusammenfassung

Der Begriff „Nichtbakterielle Osteitis (NBO)“ steht für autoinflammatorische Knochenentzündungen. Diese verlaufen in aller Regel chronisch, können sich jedoch mitunter auch als kurze, vorübergehende Episode manifestieren. Nichtbakterielle Osteitiden stellen eine wichtige Differenzialdiagnose zur bakteriellen Osteomyelitis (BO) dar. Sie können in allen Altersklassen auftreten und als „Knochenrheuma“ betrachtet werden. Neuere Untersuchungen zeigen, dass die bakterielle Osteomyelitis bei sonst gesunden Patienten deutlich seltener vorkommt als die NBO. Bei der Diagnose NBO handelt es sich derzeit noch um eine Ausschlussdiagnose, da genetische oder andere spezifische diagnostische Parameter fehlen. Hier können Diagnosekriterien und ein Diagnostikplan hilfreich sein. Die Therapie ist vorwiegend symptomatisch. Es besteht Konsens, primär NSAR einzusetzen. Bisphosphonate und Biologika stellen bei Wirbelkörperbefall oder Therapieresistenz weitere Optionen dar.

Summary

The term „Nonbacterial Osteits“ (NBO) describes autoinflammatory bone lesions. In a few patients those osteitic lesions occur as an acute flare and vanish spontaneously. But in the majority of cases the disease takes a chronic course. Bacterial osteomyelitis (BO) is an important differential diagnosis. NBO can affect children and adults and may be described as „bone rheumatism“. A recent report shows that in otherwise healthy patients NBO seems to occur more frequently than BO. As genetic or other specific diagnostic parameters are lacking NBO is a diagnosis of exclusion and a diagnostic challenge. Diagnostic criteria and schedules can be helpful. Therapy is symptomatic. Nonsteroidals are the medication of choice. In patients with vertebral involvement or resistant courses bisphosphonates or anti-TNF agents are additional treatment options.

Schlüsselwörter

NBO - CRMO - CNO - SAPHO-Syndrom

Keywords

NBO - CRMO - CNO - SAPHO-Syndrom

• Literatur

• 1 Jansson A, Renner ED, Ramser J. et al. Classification of nonbacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients. Rheumatology (Oxford) 2007; 46 (01) 154-160.
• 2 Fiehn C, Plathow C. SAPHO-Syndrom. arthritis + rheuma 2013; 33 (04) 213-222.
• 3 Beretta-Piccoli BC, Sauvain MJ, Gal I. et al. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in childhood: a report of ten cases and review of the literature. Eur J Pediatr 2000; 159 (08) 594-601.
• 4 Huber AM, Lam PY, Duffy CM. et al. Chronic recurrent multifocal osteomyelitis: clinical out comes after more than five years of follow-up. J Pediatr 2002; 141 (02) 198-203.
• 5 Jansson A, Golla A, Plewig G. et al. Chronisch rezidivierende multifokale Osteomyelitis und andere nichtbakterielle Osteitiden. Dtsch Ärztebl 2004; 101 (09) A584-A589.
• 6 Girschick HJ, Zimmer C, Klaus G. et al. Chronic recurrent multifocal osteomyelitis: what is it and how should it be treated?. Nat Clin Prac Rheumatol 2007; 3 (12) 733-738.
• 7 Girschick HJ, Raab P, Surbaum S. et al. Chronic non-bacterial osteomyelitis in children. Ann Rheum Dis 2005; 64 (02) 279-285.
• 8 Jansson AF, Grote V. Nonbacterial osteitis in children: data of a German Incidence Surveillance Study. Acta Paediatr 2011; 100 (08) 1150-1157.
• 9 Assmann G, Kueck O, Kirchhoff T. et al. Efficacy of antibiotic therapy for SAPHO syndrome is lost after its discontinuation: an interventional study. Arthritis Res Ther 2009; 11 (05) R140.
• 10 Girschick HJ, Huppertz HI, Harmsen D. et al. Chronic recurrent multifocal osteomyelitis in children: diagnostic value of histopathology and microbial testing. Hum Pathol 1999; 30 (01) 59-65.
• 11 Ferguson PJ, Bing X, Vasef MA. et al. A missense mutation in pstpip2 is associated with the murine autoinflammatory disorder chronic multifocal osteomyelitis. Bone 2006; 38 (01) 41-47.
• 12 Hofmann SR, Morbach H, Schwarz T. et al. Attenuated TLR4/MAPK signaling in monocytes from patients with CRMO results in impaired IL-10 expression. Clin Immunol 2012; 145 (01) 69-76.
• 13 Majeed HA, El-Shanti H, Al-Rimawi H, Al-Masri N. On mice and men: An autosomal recessive syndrome of chronic recurrent multifocal osteomyelitis and congenital dyserythropoietic anemia. J Pediatr 2000; 137 (03) 441-442.
• 14 Aksentijevich I, Masters SL, Ferguson PJ. et al. An autoinflammatory disease with deficiency of the interleukin-1-receptor antagonist. N Engl J Med 2009; 360 (23) 2426-2437.
• 15 Nestle FO. Psoriasis. Curr Dir Autoimmun 2008; 10: 65-75.
• 16 Golla A, Jansson A, Ramser J. et al. Chronic recurrent multifocal osteomyelitis (CRMO): evidence for a susceptibility gene located on chromosome 18q21.3–18q22. Eur J Hum Genet 2002; 10 (03) 217-221.
• 17 Morbach H, Dick A, Beck C. et al. Association of chronic non-bacterial osteomyelitis with Crohn’s disease but not with CARD15 gene variants. Rheumatol Int. 2010 30. (5) 617-621 doi: [Epub 2009 Jul 5]
• 18 Jansson A, Borte M, Böschow G. et al. Nicht-Bakterielle Osteitis des Kindes- und Erwachsenenalters, Konsensus-Statement des 8. Wörlitzer Expertengespräches 2005 für die Deutsche Gesell schaft für Kinder- und Jugendrheumatologie. Monatsschr Kinderheilkd 2006; 154: 831-834.
• 19 von Kalle T, Heim N, Hospach T. et al. Typical patterns of bone involvement in whole-body MRI of patients with chronic recurrent multifocal osteomyelitis (CRMO). Rofo 2013; 185 (07) 655-661.
• 20 Morbach H, Schneider P, Schwarz T. et al. 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. Rheumatol Int 2011; 31 (10) 1315-1320.
• 21 Jansson AF, Mueller T, Gliera L. et al. Clinical score for nonbacterial osteitis. Arthritis Rheum 2009; 60 (04) 1152-1159.
• 22 Darville T, Jacobs RF. Management of acute hematogenous osteomyelitis in children. Pediatr Infect Dis J 2004; 23 (03) 255-257.
• 23 Beck C, Morbach H, Wirth C. et al. Whole-body MRI in the childhood form of hypophosphatasia. Rheumatol Int 2011; 31 (10) 1315-1320.
• 24 Simm PJ, Allen RC, Zacharin MR. Bisphosphonate treatment in chronic recurrent multifocal osteomyelitis. J Pediatr 2008; 152 (04) 571-575.
• 25 Miettunen PM, Wei X, Kaura D. et al. 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 2009; 7: 2.
• 26 Hospach T, Langendoerfer M, von Kalle T. et al. Spinal volvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate. Eur J Pediatr 2010; 169 (09) 1105-1011.
• 27 Moll C, Hernández MV, Cañete JD. et al. Ilium osteitis as the main manifestation of the SAPHO syndrome: response to infliximab therapy and review of the literature. Semin Arthritis Rheum 2008; 37 (05) 299-306.
• 28 Eleftheriou D, Gerschman T, Sebire N. et al. Biologic therapy in refractory chronic non-bacterial osteomyelitis of childhood. Rheumatology (Oxford) 2010; 49 (08) 1505-1512.
• 29 Rech J, Manger B, Lang B. et al. Adult-onset Still’s disease and chronic recurrent multifocal osteomyelitis: a hitherto undescribed manifestation of autoinflammation. Rheumatol Int 2012; 32 (06) 1827-1829.
• 30 Kalb RE, Bagel J, Korman NJ. et al. Treatment of intertriginous psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2009; 60 (01) 120-124.