Addressing the urgent need for clinical trials in chronic non-bacterial osteomyelitis.

Firsekibart for gouty arthritis: a review of clinical efficacy, safety, and therapeutic positioning

Gout is the most prevalent inflammatory arthritis worldwide, yet conventional treatments—non-steroidal anti-inflammatory drugs, colchicine, and glucocorticoids—are limited by efficacy ceilings, safety concerns, and contraindications in patients with renal impairment or cardiovascular disease. Firsekibart, a novel fully human anti-interleukin-1β monoclonal antibody, was approved in China in 2025 for acute gouty arthritis in patients unsuitable for standard therapies. This narrative review synthesizes the clinical evidence for firsekibart in gouty arthritis, examining its pharmacological properties, efficacy, safety profile, and therapeutic positioning in gout management. Published literature was identified through structured searches of PubMed, Embase, China National Knowledge Infrastructure (CNKI), and ClinicalTrials.gov through June 2026. Included studies encompassed Phase 1 through Phase 3 clinical trials, open-label extension studies, conference abstracts, and peer-reviewed publications. Firsekibart provides a single-dose therapeutic paradigm combining rapid analgesia with sustained flare prevention (87–94% risk reduction over 12–24 weeks across active-controlled trials) and generally favourable short- to medium-term safety, with no treatment-related serious adverse events reported in the gout trials. It represents a meaningful addition to the gout therapeutic armamentarium; longer-term, international, and real-world evidence remains needed. Firsekibart is the first Chinese-developed anti-IL-1β antibody approved for gout. Single-dose administration provides rapid analgesia and sustained flare prevention.

[Advances in the diagnosis and treatment of diffuse sclerosing osteomyelitis of the jaw].

Chronic Nonbacterial Osteomyelitis/Chronic Recurrent Multifocal Osteomyelitis - A Case Report and Literature Review.

Chronic non-bacterial osteomyelitis/chronic recurrent multifocal osteomyelitis (CNO/CRMO) is an autoinflammatory, sterile bone disorder that predominantly affects children but can also occur in adults. The nonspecific nature of its presentation, as well as relative lack of awareness of the condition, often results in significant diagnostic delay. In this article, we present the case of a female patient who began experiencing sternal pain at the age of 14, initially thought to be due to costochondritis but ultimately discovered to be secondary to CNO/CRMO. We demonstrate her long and tortuous diagnostic journey including key imaging and bone biopsy findings. We also report good clinical and radiographic response to tumour necrosis factor-α (TNF-α) inhibitors, despite having to switch from adalimumab (ADA) to etanercept (ETN) and then to methotrexate (MTX) due to side effects and anti-drug antibody production.

Long-term outcome of bisphosphonate therapy in paediatric CNO: a single-centre cohort study

Chronic non-bacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder affecting mainly children. While non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line therapy, bisphosphonates (BPs) are frequently used in refractory cases despite limited evidence. This study evaluated the clinical, laboratory, and radiological outcomes of BPs therapy in children affected by CNO. We conducted a single-centre retrospective study of 30 children with CNO treated with intravenous BPs between 2010 and 2023. Data were collected at diagnosis, 12 months after BPs initiation (T2), and at last follow-up (T3). Multivariate analyses were performed to identify factors associated with treatment outcomes. At baseline, 80% of patients reported inflammatory pain and 30% had vertebral fractures. Clinical remission was achieved in 46.7% of patients at T2 and in 66.7% at final follow-up. Pain severity and inflammatory markers improved significantly over time. No new vertebral fractures or worsening of vertebral lesions were observed during follow-up, and vertebral bone marrow oedema resolved in all patients with vertebral involvement. MRI abnormalities frequently persisted despite clinical remission. A higher number of BP courses was associated with improved clinical and laboratory outcomes, whereas no clear additional radiological benefit was observed beyond four courses. BPs were generally well tolerated. BPs are effective for symptom control in children affected by CNO and may be particularly beneficial in vertebral disease. Persistent MRI abnormalities despite clinical remission highlight the complexity of treatment targets in CNO. Prospective studies are needed to optimize treatment duration and clarify the long-term impact of BP therapy.

Chronic Non-Bacterial Osteomyelitis in Children: A Retrospective Cohort Study From a Single Center

Objective: Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder characterized by sterile osteitis. This study aimed to evaluate the clinical, radiological, and therapeutic characteristics of pediatric patients with CNO and to analyze the evolving diagnostic and management strategies in a tertiary referral center. Materials and Methods: This retrospective single-center cohort study included 33 children diagnosed with CNO between 2018 and 2024. Demographic characteristics, clinical presentation, laboratory markers, magnetic resonance imaging (MRI) findings, treatment modalities, and outcomes were analyzed. Results: The cohort showed a slight male predominance (54.5%). The median age at symptom onset was 9 years (IQR 5.5–11.5), with a median diagnostic delay of 24 months. Multifocal involvement was observed in 81.3% of patients, with the femur (51.6%) and vertebrae (29.0%) being the most frequently affected sites. Whole-body MRI was used in 69.6% of cases, facilitating a relatively low bone biopsy rate (21.2%). Regarding treatment, although nonsteroidal anti-inflammatory drugs were used as initial therapy, 93.5% of patients required conventional disease-modifying antirheumatic drugs. Notably, 48.5% required escalation to anti-tumor necrosis factor agents due to disease recalcitrance or relapse. The relapse rate was 36.3% during a median follow-up of 37 months. Conclusion: Pediatric CNO presents with a heterogeneous phenotype. Our findings highlight a regional male predominance and a paradigm shift toward MRI-based diagnosis, reducing the need for invasive biopsies. The high utilization of biologic therapies underscores the refractory nature of the disease in tertiary care settings and supports a proactive, stepwise therapeutic approach to achieve sustained remission.

Confirming the Validity of the New EULAR/ACR Classification Criteria for Pediatric Chronic Nonbacterial Osteomyelitis

We aimed to investigate the performance characteristics of the new European Alliance of Associations for Rheumatology (EULAR) /American College of Rheumatology (ACR) classification criteria for pediatric CNO, in a distinct real-world clinical setting and compare it to the performance characteristics of the existing Jansson and Bristol diagnostic criteria. Single-center cross-sectional study including children ≤18 years, diagnosed with CNO, acute infectious osteomyelitis (AOM) and bone malignancy from June 1, 2018, to May 31, 2024. Patients with other mimicking conditions, immunodeficiency, sickle cell disease, or those previously included in the original development cohort were excluded. Patients were divided into 2 groups: a CNO group and a non-CNO group (AOM and bone malignancy), from the latter a representative, random, sample was selected ( www.random.org ). Demographic, clinical, laboratory, imaging and pathology data were collected at disease onset. EULAR/ACR criteria were retrospectively applied to the entire cohort, independently from the initial diagnosis. Patients with an aggregate score ≥ 55 points were classified as having CNO. A secondary analysis was conducted excluding patients with missing data. Classification results using the new criteria were compared with the final clinical diagnosis based on physician assessment (criterion standard). The same analysis was applied to Jansson and Bristol criteria. Sensitivity and specificity, positive likelihood ratio (LR+) and post-test probability (PTP) (pre-test probability: 20%, based on CNO prevalence in our center) were calculated. Of 164 children included, 82 had CNO, 41 were randomly selected from 274 cases of AOM, and 41 from 849 cases of bone malignancy. The median age was 10 years (IQR 3-16), with 62% girls and 37% boys, 33% had a bone biopsy. Overall, 40% scored ≥ 55 and 60% did not, with 19 false positive and 3 false negative. The EULAR/ACR criteria demonstrated 77% sensitivity and 96% specificity, with a LR+ of 19.25 and PTP of 83%. In our secondary analysis excluding patients with incomplete data, results remained consistent (sensitivity 79%, specificity 96%, LR+ 19.75, PTP 83.2%). In comparison, the Jansson criteria showed 78% sensitivity, 67% specificity, LR+ of 2.36, and PTP of 37%. The Bristol criteria yielded 89% sensitivity, 70% specificity, LR+ of 2.97, and PTP of 43%. Based on its favorable sensitivity and specificity, especially in comparison to existing criteria, the new EULAR/ACR criteria appeared to be more effective in distinguishing CNO from AOM and bone malignancy at disease onset, results consistent with findings from the original validation cohort. Best Abstract by a Rheumatology Post- Graduate Research Trainee Award