Nationwide Swedish Study on Childhood-onset IBD and Chronic Non-bacterial Osteomyelitis
Overview
This nationwide Swedish cohort study found a six-fold increased risk of chronic non-bacterial osteomyelitis (CNO) in children with inflammatory bowel disease (IBD) compared to matched non-IBD controls. Patients with both IBD and CNO were younger at IBD diagnosis, had more frequent extraintestinal manifestations, and were more often treated with biologics.
Background
Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, often presents with extraintestinal manifestations affecting organs such as the skin and musculoskeletal system. Chronic non-bacterial osteomyelitis (CNO) is a rare, aseptic inflammatory bone disorder primarily affecting children and young adults, sometimes occurring alongside immune-mediated diseases like IBD. Prior to this study, data on the association between childhood-onset IBD and CNO were limited to case reports and small series. This study aimed to clarify the incidence, prevalence, and clinical characteristics of CNO in a large, nationwide pediatric IBD cohort.
Data Highlights
Parameter
IBD Cohort
Non-IBD Comparators
Number of children
8,244
82,400
CNO diagnosed at IBD diagnosis
0.13% (11/8,244)
0.03% (26/82,400)
Incident CNO cases during follow-up
13
22
Adjusted hazard ratio for CNO
5.87 (95% CI 2.95-11.66)
Prevalence of CNO at study end (Dec 31, 2022)
0.48% (9/1,885)
0.02% (4/18,567)
Median age at IBD diagnosis (IBD + CNO vs IBD only)
11 years vs 14 years
Extraintestinal manifestations frequency
62% (IBD + CNO)
21% (IBD only)
Biologic treatment usage
78% (IBD + CNO)
44% (IBD only)
Key Findings
Children with IBD have a nearly six-fold increased risk of developing CNO compared to matched non-IBD peers.
CNO prevalence among children with IBD was 0.48%, significantly higher than 0.02% in non-IBD comparators.
IBD patients with CNO were diagnosed with IBD at a younger median age (11 years) than those without CNO (14 years).
Extraintestinal manifestations other than CNO were more common in the IBD + CNO group (62% vs 21%).
Use of biologic therapies was significantly higher in IBD patients with CNO (78%) compared to those without (44%).
Clinical Implications
Clinicians should be aware of the increased risk of CNO in children diagnosed with IBD, especially in younger patients and those presenting with multiple extraintestinal manifestations. Early recognition of CNO may prompt timely initiation of biologic therapies, which are more commonly used in this subgroup. Monitoring for musculoskeletal symptoms in pediatric IBD patients is warranted to improve diagnosis and management.
Conclusion
This large, nationwide study confirms a strong association between childhood-onset IBD and chronic non-bacterial osteomyelitis, highlighting distinct clinical features in affected patients. These findings underscore the importance of vigilance for CNO in pediatric IBD populations to optimize care.
References
Nationwide Swedish Study 2002-2022 -- Childhood-onset IBD and CNO Association
