Chronic Nonbacterial Osteomyelitis

  • Liza McCann
  • Michael W. Beresford
  • Gabriele Hahn
  • Christian M. HedrichEmail author


Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder that most commonly affects children and adolescents. While initially considered a benign disorder, we now know that CNO is a chronic and sometimes debilitating disease. The pathophysiology of CNO is incompletely understood. Imbalanced expression of pro- and anti-inflammatory cytokines contributes to osteoclast activation and bone inflammation. Animal models support these observations and suggest the involvement of alterations to the gut microbiome in disease pathology. Currently available treatment options inhibit inflammation and/or osteoclast activity and are efficacious in a large proportion of patients. However, prospective studies are missing, and some patients develop complications before “matching” treatment has been established. Here, we discuss disease presentation and outcomes, the current understanding of disease pathology, diagnostic approaches to CNO, available treatment options, and potential future directions.


Chronic nonbacterial osteomyelitis CNO Chronic recurrent multifocal osteomyelitis CRMO Bone inflammation Inflammasome 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Liza McCann
    • 1
    • 2
  • Michael W. Beresford
    • 1
    • 2
  • Gabriele Hahn
    • 3
  • Christian M. Hedrich
    • 1
    • 2
    Email author
  1. 1.Department of Women’s & Children’s HealthInstitute of Translational Medicine, University of LiverpoolLiverpoolUK
  2. 2.Department of Paediatric RheumatologyAlder Hey Children’s NHS Foundation Trust HospitalLiverpoolUK
  3. 3.Institute of Radiology, Faculty of Medicine Carl Gustav CarusUniversity of Technology DresdenDresdenGermany

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