ABSTRACT
INTRODUCTION: Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease usually managed by pediatric rheumatologists (PRs). There is a need for a consensus treatment plan to minimize the diversity in clinical practice in the diagnosis and management of CNO. In this study, we explored the practice of PRs in Saudi Arabia on the diagnosis and treatment of patients with CNO. METHODS: This is a cross-sectional study that was conducted among PRs in Saudi Arabia (May to September 2020). A survey was performed among PRs registered in the Saudi Commission for Health Specialties using an electronic-based questionnaire. The survey consisted of 35 closed-ended questions about the diagnosis and management of CNO patients. We explored the approaches adopted by PRs in diagnosing and monitoring the disease activity, their awareness of clinical possibilities that necessitate ordering bone biopsy, and the treatment choices they considered for CNO patients. RESULTS: We scrutinized data from a total of 77% (n=41/53) PRs who responded to our survey. Magnetic resonance imaging (MRI) was reported as the most frequently used modality in suspected CNO (82%, n=27/33), followed by plain X-ray (61%) and bone scintigraphy (58%). Magnetic resonance imaging of a symptomatic site is the imaging modality of choice for the diagnosis of CNO (82%), Followed by X-ray (61%) and bone scintigraphy (58%). The reasons for performing bone biopsy were unifocal lesions (82%), unusual sites of presentation (79%), and multifocal lesions (30%). The preferred treatment regimens were bisphosphonates (53%), non-steroidal anti-inflammatory drugs alone (43%), or biologics with bisphosphonates (28%). The reasons to upgrade the treatment in CNO included the development of vertebral lesions (91%), the development of new lesions in MRI (73%), and the elevation of inflammatory markers (55%). The disease activity was assessed by history and physical examination (91%), inflammatory markers (84%), MRI of targeted symptomatic site (66%), and a whole-body MRI (41%). CONCLUSIONS: The approach to diagnosis and treatment of CNO varies among PRs in Saudi Arabia. Our findings provide a background for the development of a consensus treatment plan for challenging CNO patients.
ABSTRACT
Background The prevalence of total edentulism differs significantly between countries and between cities/regions within the same country. It can be affected by various factors, such as age, sex, and socioeconomic factors along with lifestyle and health behavior. Positive findings on panoramic radiographs are frequently observed in totally edentulous patients (TEP) during routine screening. Objectives This study aimed to retrospectively determine the prevalence of total edentulism and to evaluate the distribution and location of positive findings on panoramic radiographs of TEP at a dental school in Jeddah, Saudi Arabia. Methods A total of 12,428 digital panoramic radiographs of patients aged ≥35 years seeking treatment at a dental school from January 2018 to December 2021 were evaluated to determine the prevalence of total edentulism. Retained root stumps, impacted teeth, radiolucent, and radiopaque lesions were detected on the panoramic radiographs of the TEP. Data were analyzed using descriptive statistics. Results Among the 12,428 patients, 521 (4.2%) showed total edentulism on their panoramic radiographs. The prevalence of edentulism was the highest among patients aged >65 years (n=305, 4.5%), men (n=246, 4.2%), and non-Saudi citizens (n=300, 4.4%). A total of 198 radiographic findings were identified in 150 patients. The frequency rates of retained root stumps and impacted teeth were 19.2% (n=100) and 4.6% (n=24), respectively. Radiolucent and radiopaque lesions each accounted for 2.5% (n=13) of the lesions. Conclusions The prevalence of edentulism was higher in patients aged >65 years, male patients, and non-Saudi citizens. Retained root stumps were most often encountered among the four positive findings on panoramic radiographs. Considering the high frequency of positive radiographic findings in TEP, panoramic radiographs must be routinely obtained for TEP, but caution must be exercised to reduce the effects of radiation.
