Childhood-onset inflammatory bowel disease and chronic non-bacterial osteomyelitis: A Swedish nationwide cohort study 2002–2022

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Abstract Background and Aims Nationwide, population-based studies of chronic non-bacterial osteomyelitis (CNO) in patients with childhood-onset inflammatory bowel disease (IBD) are lacking. Methods We used nationwide registers to identify all children in Sweden diagnosed with IBD during 2002–2022 and the occurrence of CNO in this IBD cohort and general population non-IBD comparators. To estimate the temporal associations between IBD and CNO we used Cox regression. We compared clinical data for IBD patients with CNO (IBD+CNO) and the IBD patients without CNO. Results We identified 8,244 children with IBD and 82,400 non-IBD comparators. At IBD diagnosis, CNO had been diagnosed in 0.13% (11/8,244) of the IBD cohort and 0.03% (26/82,400) of the non-IBD comparators. During follow-up, 13 additional CNO cases occurred in the IBD cohort and 22 in the non-IBD comparators (adjusted Hazard Ratio=5.87 [95% CI 2.95-11.66]). The prevalence of CNO among all prevalent children with IBD and prevalent matched non-IBD comparators 31 December 2022 was 0.48% (9/1,885) and 0.02% (4/18,567) respectively. Median age at IBD diagnosis was lower in IBD+CNO compared to IBD without CNO (11 vs 14 years [-3 years, 95% CI -5 to -1]). Extraintestinal manifestations (except CNO) were more frequent in IBD+CNO (62% vs 21%, p<.0001). Treatment with biologics was more common in the IBD+CNO group (78% vs 44%, p=.004), prescribed for IBD and/or CNO. Conclusions We found a six-fold increased risk of CNO in childhood-onset IBD compared to non-IBD comparators. Patients with IBD+CNO are characterized by younger age at IBD onset, more frequent extraintestinal manifestations, and higher usage of biologics.