Dr. Lacassagne, who notes the U.K. does not yet have a clinical trial of a CNO treatment, praises the criteria’s high sensitivity and specificity. “These classifications tend to try to identify the more typical cases” for the purposes of research so investigators can better compare patient responses to treatment, she explains. “This is an important international effort with strong methodology for a rare disease to support future research and improve care.”
With the recently published classification criteria, “we can capture main features of CNO and recognize that patients with CNO do not present in a single pattern,” adds Dr. Zhao.
The criteria, while intended for research, can serve as a reminder to clinicians that “a combination of different features may still classify a patient as [having] CNO,” he adds. “Keep mimicker conditions in mind and make sure that adequate laboratory and imaging data are collected during the diagnostic process. Prioritize non-invasive tests before an invasive test unless a clear indication is present.”
Deborah Levenson is a writer and editor based in College Park, Md.
Disclosures
Dr. Zhao made the following disclosures: ACR, EULAR, CARRA (grants to institution, finance committee), Bristol Myers Squibb (grants to institution), Rheumatology Research Foundation (grants to institution), CTIP (grants to institution), UpToDate CRMO/CNO (royalties/license), Novartis (consulting fees to self), U.S. Provisional Application No. 63/356977 (patent issued), Seattle Children’s CRMO Warriors Guild (leadership/fiduciary role), American Board of Pediatrics, Pediatric Rheumatology Subboard (leadership/fiduciary role).
Dr. Ozen reports consulting fees from Novartis and Sobi.
Dr. Lacassagne reports no conflicts of interest.
Reference
- Zhao Y, Oliver MS, Schnabel A, et al. EULAR/American College of Rheumatology Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis. Arthritis Rheumatol. 2025 May 8.
