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Ito H, Hirano Y. Long-term clinical course of two rare cases of synovitis-acne-pustulosis-hyperostosis-osteomyelitis syndrome involving only unilateral femur. Mod Rheumatol Case Rep 2024; 8:373-377. [PMID: 38748401 DOI: 10.1093/mrcr/rxae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/07/2024] [Accepted: 04/21/2024] [Indexed: 07/09/2024]
Abstract
Synovitis-acne-pustulosis-hyperostosis-osteomyelitis (SAPHO) syndrome is characterised by aseptic osteitis and is often complicated by pustular dermatitis, such as palmoplantar pustulosis or acne. Although bone lesions are most found in the anterior thoracic region or spine, femoral lesions are not well documented in the literature. There is no established treatment for this condition, and few reports have described its long-term course. Here, we describe two cases of SAPHO syndrome involving the femur and discuss their long-term follow-up. A 40-year-old man (Case 1) presented with right thigh pain. Fifteen years after the initial diagnosis, the pain could be controlled with minomycin, salazosulfapyridine, and methotrexate. X-rays of the femur showed gradual cortical thickening. Although there were waves of pain, it gradually improved with the adjustment of drugs 25 years following the initial diagnosis. A 35-year-old man (Case 2) with right thigh pain was prescribed salazosulfapyridine and methotrexate; however, these were ineffective. Alendronate and guselkumab also proved ineffective. Ultimately, infliximab was started 9 years following disease onset, and pain became manageable. X-rays of the femur showed cortical thickening. SAPHO syndrome can be managed with drug therapies, such as nonsteroidal anti-inflammatory drugs, methotrexate, and conventional synthetic disease-modifying antirheumatic drugs; however, there are occasional treatment-resistant cases.
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Affiliation(s)
- Hiroki Ito
- Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yuji Hirano
- Department of Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Japan
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2
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El Harras Y, Imrani K, Setti SES, Moatassim Billah N, Nassar I. The challenging diagnosis of synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome: A rare case report. SAGE Open Med Case Rep 2024; 12:2050313X241259395. [PMID: 38828378 PMCID: PMC11143798 DOI: 10.1177/2050313x241259395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
Considered rare, the synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is a distinct clinical entity, associating skin manifestations and osteoarticular symptoms. Anterior chest wall pain centered at sternoclavicular and sternocostal joints is an important and characteristic clinical finding that can lead to its diagnosis. Radiologists and clinicians must be aware of synovitis-acne-pustulosis-hyperostosis-osteitis syndrome as it can mimic some of the more common disease entities such as Paget's disease. We report the case of a 63-year-old male patient, with no significant medical history, who presented to the dermatology department, with severe palmar and plantar pustulosis associated with polyarthralgia. Computerized tomography scan showed sternoclavicular hyperostosis, in favor of SAPHO syndrome, with regression of clinical symptoms after non-steroidal anti-inflammatory drug treatment.
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Affiliation(s)
- Yahya El Harras
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Kaoutar Imrani
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Sara ES Setti
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Nabil Moatassim Billah
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Ittimade Nassar
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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3
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Saffarzadeh M, Haydar S, Chan D, Andrews G, Ouellette H, Mallinson P, Munk PL, Sheikh A. A clinico-radiological review of chronic non-bacterial osteomyelitis in paediatrics, adolescents, and adults: demystifying a forgotten differential. Clin Radiol 2024; 79:170-178. [PMID: 38160105 DOI: 10.1016/j.crad.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
Chronic non-bacterial osteomyelitis (CNO), also known as non-bacterial osteitis, is a chronic autoinflammatory disease of unknown aetiology that primarily occurs in the paediatric population, although rare cases of adult-onset disease also exist. CNO has non-specific clinical and radiological presentations, and the affected population often present with bone pain of insidious onset secondary to sterile bony inflammation that can be associated with swelling, focal tenderness, and warmth at the affected sites. The pattern of bony involvement appears to be dependent on the age of onset, with adults frequently having axial skeletal lesions and children and adolescents often being affected in the appendicular skeletal sites. CNO is a diagnosis of exclusion, and imaging is heavily relied on to identify and characterise the bony lesions in addition to exclude diseases that can mimic CNO. Magnetic resonance imaging is often the reference standard with biochemical and histopathological findings being complementary. Although combining imaging methods can be used to facilitate the diagnosis, a single technique could be adequate depending on the clinical picture. Given the relatively rare incidence of CNO, limited awareness of the disease among care providers, and its similarity in clinical and radiological presentation to various bony diseases, there are often long delays in diagnosis, with adults being unfavourably affected compared to paediatrics and adolescents. This review of CNO will describe the condition, overview its clinical presentation, highlight the radiological features, and emphasise clinical pearls that can aid in diagnosis and ruling out the mimics.
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Affiliation(s)
- M Saffarzadeh
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
| | - S Haydar
- Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - D Chan
- Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - G Andrews
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - H Ouellette
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - P Mallinson
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - P L Munk
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - A Sheikh
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Radiology, Vancouver General Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
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Ishikawa Y, Kobayashi T, Shoji R, Miyakoshi N. Dysphagia Secondary to Myotonic Dystrophy Unveiled in a Case of Destructive Spondylitis With Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) Syndrome Presenting As Torticollis. Cureus 2024; 16:e54271. [PMID: 38496079 PMCID: PMC10944548 DOI: 10.7759/cureus.54271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
To report an instructive case involving destructive spondylitis and synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome, presenting with torticollis and postoperative dysphagia without hoarseness, attributed to hidden myotonic dystrophy (DM). A 51-year-old male patient with a cervical deformity, who was previously managed conservatively for a metastatic tumor, underwent reconstruction surgery and subsequently experienced postoperative dysphagia. The presence of destructive spondylitis with torticollis, warranting prompt assessment to prevent paralysis, adds complexity to the delayed identification of DM. Given the rarity of DM, peculiar neurological symptoms and other systemic comorbidities did not lead to a preoperative diagnosis without prior knowledge. The patient's dysphagia induced respiratory arrest and required reintubation. Challenges in extubation and ventilator weaning arose due to hypercapnia. Superimposed COVID-19 infection elongated the duration of intubation. Extubation failed due to aspiration pneumonia and required a tracheotomy. Despite laryngeal elevation and preservation of the relaxation of the oesophageal entrance, the sensation and movement of the tracheopharynx were disturbed. The patient exhibited an oropharyngeal propulsive disorder, predominantly indicative of motor neuron disease. The patient's mother stated that his brother had been hospitalized for a long time after abdominal surgery. Finally, the patient was diagnosed with DM, which is known to cause post-anesthetic dysphagia. Recognizing the existence of severe destructive cervical spondylitis associated with SAPHO is crucial. Although DM is not very common, it is not classified as extremely rare. Therefore, surgeons should be mindful of the potential risks associated with general anesthesia in patients with DM. The complexity of preoperative conditions may hinder an accurate diagnosis. Recognizing and establishing preoperative expectations can assist surgeons in preventing complications, even if complex spinal surgery is required for patients with DM.
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Affiliation(s)
| | | | - Ryo Shoji
- Orthopedic Surgery, Akita Kousei Medical Center, Akita, JPN
| | - Naohisa Miyakoshi
- Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, JPN
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Duan H, Gao S, Zhang L, Song L, Zhai J, Deng X. The clinical characteristics and prognosis of patients with SAPHO syndrome--a real-world cohort study. Clin Rheumatol 2024; 43:561-568. [PMID: 37755548 DOI: 10.1007/s10067-023-06782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/22/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES We aimed to analyze the clinical characteristics and outcomes of patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. METHODS The clinical records of 64 patients with SAPHO syndrome were collected, and the treatment and outcomes of 27 patients were followed up. The patients were divided into three groups according to the site of bone lesions: only anterior chest wall (ACW) involvement, only spinal involvement, and bone lesion involvement at both sites. The clinical characteristics and outcomes were compared. The clinical characteristics of the patients with and without peripheral joint involvement were compared. RESULTS Among all patients, 31.25% (20/64) had only ACW involvement, 15.63% (10/64) had only spinal involvement, and 53.12% (34/64) had both ACW and spinal involvement. Peripheral joint involvement was observed in 25.00% (16/64) of the patients. Patients with only spinal involvement were older than those with only ACW involvement (p = 0.006). Patients with both ACW and spinal involvement were older than those with only ACW involvement (p = 0.002) and had a longer diagnosis delay (p = 0.015). Patients with peripheral joint involvement were younger than those without peripheral joint involvement (p = 0.028). During follow-up, 88.89% (24/27) of patients had good outcomes. Twenty-two patients were treated with non-steroidal anti-inflammatory drugs + Iguratimod (IGU), and the outcomes of 90.91% (20/22) improved. CONCLUSIONS A relationship may exist between the sites of bone lesions and clinical characteristics of patients with SAPHO syndrome. The clinical outcomes of these patients may be good, and IGU may be effective in treating SAPHO syndrome. Key Points • This study is the first long-term follow-up on the effectiveness of iguratimod in treating patients with SAPHO. • This study revealed that patients with SAPHO and different bone lesion sites may present with different clinical characteristics.
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Affiliation(s)
- Hongji Duan
- Department of Orthopedic Medicine, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East St, Xicheng District, Beijing, 100035, China
| | - Shuang Gao
- Department of Hematology, Lymphoma Center, Peking University Third Hospital, Beijing, China
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
| | - Jiayu Zhai
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Xiaoli Deng
- Department of Orthopedic Medicine, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East St, Xicheng District, Beijing, 100035, China.
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Awadh NI, Gorial FI, Al-Obaidi AD, Hashim HT, Al-Obaidi MN, Hammadi RA. Unusual cause of inflammatory backache: SAPHO syndrome. Int J Rheum Dis 2024; 27:e14878. [PMID: 37592395 DOI: 10.1111/1756-185x.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is a rare chronic inflammatory disease that develops in adults. We present a case of SAPHO syndrome in a 37-year-old male presenting with gradually worsening back and neck pain for a 7-year period. The episodes were preceded by a history of pustular skin eruptions, which first appeared on the upper trunk and then involved his face and were pustular and scarring. The purpose of presenting this case report from Iraq is to raise awareness about this rare condition, which is frequently misdiagnosed and under-recognized.
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Affiliation(s)
- Nabaa Ihsan Awadh
- Rheumatology Unit, Department of Internal Medicine, Baghdad Teaching Hospital, Baghdad, Iraq
| | - Faiq I Gorial
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | | | | | - Reem Abbas Hammadi
- Rheumatology Unit, Department of Internal Medicine, Baghdad Teaching Hospital, Baghdad, Iraq
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Xu T, Ding H, Fan D, Shu Q, Liu G, Zhang S, Chen Y. Prospective Comparison of the Imaging Value of 99m Tc-MDP Bone Scan and 68 Ga-FAPI-04 PET/CT in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome. Clin Nucl Med 2023; 48:768-774. [PMID: 37351858 PMCID: PMC10417241 DOI: 10.1097/rlu.0000000000004752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/05/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE This study aimed to explore the imaging value of 68 Ga-FAPI-04 PET/CT in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and compare it with that of 99m Tc-MDP bone scan. METHODS Nineteen participants with SAPHO syndrome underwent 68 Ga-FAPI-04 PET/CT and 99m Tc-MDP bone scan. Demographic data and clinical features were recorded, SAPHO imaging features were analyzed, and the osteoarticular lesion detection rate in both methods was calculated. RESULTS This prospective study recruited 4 men and 15 women aged 52.4 ± 8.6 years. The anterior chest wall was involved in all participants (100%). Palmoplantar pustulosis was the most common (36.8%) skin symptom. 99m Tc-MDP bone scan and 68 Ga-FAPI-04 PET/CT together detected 84 osteoarticular lesions, of which 91.7% (77/84) were detected by the former and 96.4% (81/84) by the latter. Furthermore, 68 Ga-FAPI-04 PET/CT detected 5 cases of knee and hip joint synovitis. CONCLUSIONS 68 Ga-FAPI-04 PET/CT was more sensitive than 99m Tc-MDP bone scan when evaluating osteoarticular lesions in SAPHO syndrome and could also evaluate synovial lesions. 68 Ga-FAPI-04 PET/CT could be a good imaging method for SAPHO syndrome but requires further verification in a more extensive research cohort.
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Affiliation(s)
- Tingting Xu
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
| | - Haoyuan Ding
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
| | - Dongmei Fan
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
| | - Qingxue Shu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Guangfu Liu
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
| | - Shumao Zhang
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
| | - Yue Chen
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province
- Institute of Nuclear Medicine, Southwest Medical University
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8
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Leerling AT, Dekkers OM, Appelman-Dijkstra NM, Winter EM. Clinical and therapeutic diversity in adult chronic nonbacterial osteomyelitis (CNO) of the sternocostoclavicular region: a meta-analysis. Rheumatology (Oxford) 2023; 62:512-522. [PMID: 35961032 PMCID: PMC9891421 DOI: 10.1093/rheumatology/keac443] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Chronic nonbacterial osteomyelitis (CNO) is a rare inflammatory bone disease. The distinct CNO subtype that affects the anterior chest wall is descriptively named sternocostoclavicular hyperostosis (SCCH) and mainly occurs in adults. Literature on CNO/SCCH is scattered and lacks diagnostic and therapeutic consensus. METHODS Systematic review and meta-analysis aiming to characterize clinical presentation and therapeutic modalities applied in adult CNO/SCCH patients. Untransformed numerical data and double-arcsine transformed proportional data were pooled in a random effects model in R-4.0.5; proportions were reported with 95% CI. RESULTS Forty studies were included, containing data on 2030 and 642 patients for aim 1 and 2, respectively. A female predisposition (67%, 95% CI 60, 73) and major diagnostic delay (5 years 95% CI 3, 7) were noted. Clinical presentation included chest pain (89%, 95% CI 79, 96) and swelling (79%, 95% CI 62, 91). Patients suffered from pustulosis palmoplantaris (53%, 95% CI 37, 68), arthritis (24%, 95% CI 11, 39) and acne (8%, 95% CI 4, 13). Inflammatory markers were inconsistently elevated. Autoantibody and HLA-B27 prevalence was normal, and histopathology unspecific. Increased isotope uptake (99%, 95% CI 96, 100) was a consistent imaging finding. Among manifold treatments, pamidronate and biologicals yielded good response in 83%, 95% CI 60, 98 and 56%, 95% CI 26, 85, respectively. CONCLUSION CNO/SCCH literature proves heterogeneous regarding diagnostics and treatment. Timely diagnosis is challenging and mainly follows from increased isotope uptake on nuclear examination. Biopsies, autoantibodies and HLA status are non-contributory, and biochemical inflammation only variably detected. Based on reported data, bisphosphonates and biologicals seem reasonably effective, but due to limitations in design and heterogeneity between studies the precise magnitude of their effect is uncertain. Fundamentally, international consensus seems imperative to advance clinical care for CNO/SCCH.
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Affiliation(s)
- Anne T Leerling
- Department of Internal Medicine, Division of Endocrinology.,Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Internal Medicine, Division of Endocrinology
| | - Natasha M Appelman-Dijkstra
- Department of Internal Medicine, Division of Endocrinology.,Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Elizabeth M Winter
- Department of Internal Medicine, Division of Endocrinology.,Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
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Jessen M, Schnetzke M, Studier-Fischer S, Grützner PA, Gühring T, Porschke F. Morphologic Alterations of the Sternoclavicular Joint following Ipsilateral Clavicle Fractures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15011. [PMID: 36429729 PMCID: PMC9690708 DOI: 10.3390/ijerph192215011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
RATIONALE To our knowledge, no study has investigated concomitant injuries of the sternoclavicular joint (SCJ) in acute clavicle fractures. The purpose of this study was to determine the effect of an ipsilateral clavicle fracture on the SCJ in a systematic computer tomography (CT) morphologic evaluation. METHODS CT scans in the axial and coronal plane of 45 consecutive patients with clavicle fractures were retrospectively analyzed. The scans were assessed regarding anatomic congruence of bilateral SCJs-joint space width (JSW); the position of bilateral medial clavicles (PC); and the non-fusion of epiphyses, arthritis, calcifications, and intra-articular gas. RESULTS The mean SCJ JSW was significantly different in the coronal (cJSW; 8.70 mm ± 2.61 mm in affected vs. 7.63 mm ± 2.58 mm in non-affected side; p = 0.001) and axial plane (aJSW; 9.40 mm ± 2.76 mm in affected vs. 9.02 ± 2.99 in non-affected SCJs; p = 0.044). The position of the medial clavicle showed a significant difference in the coronal plane (cPC; 14.31 mm ± 3.66 mm in the affected vs. 13.49 ± 3.34 in the non-affected side; p = 0.011), indicating a superior shift. CONCLUSION Acute clavicle fractures may be associated with an enlargement of the ipsilateral SCJ space width and a superior shift of the proximal clavicle. Both morphologic alterations could indicate concomitant injuries of the SCJ as well as a potential increase in the risk of SCJ instability.
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Affiliation(s)
- Malik Jessen
- Department of Trauma Surgery, Clinic Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Marc Schnetzke
- German Joint Center Heidelberg, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115 Heidelberg, Germany
| | - Stefan Studier-Fischer
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
| | - Thorsten Gühring
- Orthopedic Clinic Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstr. 38, 70176 Stuttgart, Germany
| | - Felix Porschke
- BG Trauma Center Ludwigshafen, Heidelberg University, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany
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Efthimiou P, Petryna O, Nakasato P, Kontzias A. New insights on multigenic autoinflammatory diseases. Ther Adv Musculoskelet Dis 2022; 14:1759720X221117880. [PMID: 36081748 PMCID: PMC9445512 DOI: 10.1177/1759720x221117880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Autoinflammatory diseases are disorders of the innate immune system, which can be either monogenic due to a specific genetic mutation or complex multigenic due to the involvement of multiple genes. The aim of this review is to explore and summarize the recent advances in pathogenesis, diagnosis, and management of genetically complex autoinflammatory diseases, such as Schnitzler's syndrome; adult-onset Still's disease; synovitis, acne, pustulosis, hyperostosis, osteitis syndrome/chronic recurrent multifocal osteomyelitis/chronic non-bacterial osteomyelitis; Adamantiades-Behçet's disease; Yao syndrome; and periodic fever with aphthous stomatitis, pharyngitis, and adenitis syndrome. The PubMed database was screened for relevant articles using free text words and specific search strings. The search was limited to English-language articles, reporting the results of studies in humans, published through March 2021. Evidence from literature suggest that these rare multigenic autoinflammatory diseases can present with different clinical features and the diagnosis of these diseases can be challenging due to a combination of nonspecific manifestations that can be seen in a variety of other conditions. Diagnostic delays and disease complications may occur due to low disease awareness and the lack of pathognomonic markers. The pathogeneses of these diseases are complex and in some cases precise pathogenesis is not clearly understood. Conventional treatments are commonly used for the management of these conditions, but biologics have shown promising results. Biologics targeting proinflammatory cytokines including IL-1, IL-6, TNF-α, IL-17A and IL-18 have been shown to ameliorate signs and symptoms of different multigenic autoinflammatory diseases.
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Affiliation(s)
- Petros Efthimiou
- New York Rheumatology Care, Ross University School of Medicine, New York, USA
| | - Olga Petryna
- NYU Grossman School of Medicine, New York, NY, USA
| | | | - Apostolos Kontzias
- Department of Rheumatology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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11
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Takeuchi S, Hanakita J, Takahashi T, Minami M, Kanematsu R, Suda I, Nakamura S. Destructive spondylodiscitis associated with SAPHO syndrome: A case report and literature review. Surg Neurol Int 2022; 13:345. [PMID: 36128106 PMCID: PMC9479651 DOI: 10.25259/sni_626_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare sterile inflammatory disease characterized by cutaneous and osteoarticular lesions. Associated spinal lesions chronically manifest slight or no neurological symptoms. Only rarely does destructive spondylodiscitis occur. Case Description: A 62-year-old female with palmoplantar pustulosis presented with a rapidly progressive quadriparesis. When the cervical MR showed destructive spondylodiscitis at the C5–C7 level, the patient underwent anterior debridement followed by posterior reconstruction/fixation. The histopathology showed a nonspecific inflammatory process with vertebral sclerosis consistent with the diagnosis of SAPHO; cultures were negative. Postoperatively, the patient’s symptoms improved and SAPHO did not recur. Conclusion: Destructive spondylodiscitis associated with SAPHO syndrome is uncommon. Early diagnosis and surgical treatment result in the best outcomes.
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Furer V, Kishimoto M, Tomita T, Elkayam O, Helliwell PS. Pro and contra: is synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) a spondyloarthritis variant? Curr Opin Rheumatol 2022; 34:209-217. [PMID: 35699334 DOI: 10.1097/bor.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to present the up-to-date evidence on the epidemiology, pathogenesis, musculoskeletal manifestations, and imaging of the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and to discuss its relationship with spondyloarthritis (SpA). RECENT FINDINGS SAPHO is a rare inflammatory disorder of bone, joints, and skin, with a worldwide distribution that predominantly affects the middle-age adults. The hallmark of the syndrome is a constellation of sterile inflammatory osteitis, hyperostosis, and synovitis involving the anterior chest wall, associated with acneiform and neutrophilic dermatoses, such as palmoplantar pustulosis and severe acne. The axial skeleton, sacroiliac, and peripheral joints can be involved in a similar fashion to SpA. The pathogenesis of the syndrome is multifactorial. The diagnosis is mainly based on the clinical and typical radiological features. The treatment approach is based on the off-label use of antibiotics, bisphosphonates, disease-modifying antirheumatic drugs, and anticytokine biologics. SUMMARY The SAPHO syndrome shares common features with SpA-related diseases, yet also shows some unique pathogenetic and clinical features. The nosology of SAPHO remains a subject of controversy, awaiting further research into the pathogenetic and clinical aspects of this syndrome. A better understanding of these aspects will improve the diagnostics and clinical care of patients with SAPHO.
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Affiliation(s)
- Victoria Furer
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ori Elkayam
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Maranini B, Ciancio G, Rinaldi R, Borrelli M, Pugliatti M, Govoni M. SAPHO Syndrome Presenting With Atlo-Epistrophic Synovitis and Left Vocal Cord Paresis: A Challenging Diagnosis. CLINICAL MEDICINE INSIGHTS: ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441221118918. [PMID: 36090594 PMCID: PMC9459495 DOI: 10.1177/11795441221118918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a rare
syndrome mainly characterized by cutaneous and osteoarticular
manifestations. The most typical osteoarticular manifestations are
localized to the anterior chest wall and include a usually
noninfectious osteitis, hyperostosis, and synovitis of the
sternoclavicular joints. However, clinical presentation of SAPHO
syndrome can be quite heterogeneous. Several clinical and radiological
features are shared with other well-defined pathological entities, and
clinical signs and symptoms often occur at different timepoints.
Mainly due to this complexity and its rarity, there are currently no
validated diagnostic criteria for SAPHO syndrome. Inflammation of the
soft tissues around the bones and possible nerve compression could
contribute to dysphagia, hypophonia, or obstruction of the airways.
Neurologic manifestations could therefore be part of this multiorgan
involvement. Here, we present a case of SAPHO syndrome with atypical
onset symptoms, characterized by left vocal cord paralysis, acute neck
pain due to osteolytic atlantoepistrophic lesion, and an unusual
cutaneous manifestation, diagnosed as mid-dermal elastolysis. The
latest two, to the best of our knowledge, have been here first
described in a case of SAPHO syndrome.
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Affiliation(s)
- Beatrice Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Rosa Rinaldi
- Pathology Unit, ASST Mantova, Ospedale Carlo Poma, Mantova, Italy
| | - Massimo Borrelli
- Neurororadiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Sant’Anna, Ferrara, Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Stowell JT, Walker CM, Chung JH, Bang TJ, Carter BW, Christensen JD, Donnelly EF, Hanna TN, Hobbs SB, Johnson BD, Kandathil A, Lo BM, Madan R, Majercik S, Moore WH, Kanne JP. ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. J Am Coll Radiol 2021; 18:S394-S405. [PMID: 34794596 DOI: 10.1016/j.jacr.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 10/19/2022]
Abstract
Chest pain is a common reason that patients may present for evaluation in both ambulatory and emergency department settings, and is often of musculoskeletal origin in the former. Chest wall syndrome collectively describes the various entities that can contribute to chest wall pain of musculoskeletal origin and may affect any chest wall structure. Various imaging modalities may be employed for the diagnosis of nontraumatic chest wall conditions, each with variable utility depending on the clinical scenario. We review the evidence for or against use of various imaging modalities for the diagnosis of nontraumatic chest wall pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Jonathan H Chung
- Panel Chair; and Vice-Chair, Quality and Section Chief, Chest Imaging, Department of Radiology, University of Chicago, Chicago, Illinois
| | - Tami J Bang
- Co-Director, Cardiothoracic Imaging Fellowship Committee, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; Co-Chair, membership committee, NASCI; and Membership committee, ad-hoc online content committee, STR
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jared D Christensen
- Vice-Chair, Department of Radiology, Duke University Medical Center, Durham, North Carolina; and Chair, Lung-RADS
| | - Edwin F Donnelly
- Chief, Thoracic Imaging, Ohio State University, Columbus, Ohio; Co-Chair Physics Module Committee, RSNA
| | - Tarek N Hanna
- Associate Director, Emergency and Trauma Imaging, Emory University, Atlanta, Georgia; and Director-at-Large, American Society of Emergency Radiology
| | - Stephen B Hobbs
- Vice-Chair, Informatics and Integrated Clinical Operations and Division Chief, Cardiovascular and Thoracic Radiology, University of Kentucky, Lexington, Kentucky
| | | | | | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Medical School, Norfolk, Virginia; and Board Member, American College of Emergency Physicians
| | - Rachna Madan
- Associate Fellowship Director, Division of Thoracic Imaging, Brigham & Women's Hospital, Boston, Massachusetts
| | - Sarah Majercik
- Vice-Chair, Surgery for Research and Director, Trauma Research, Intermountain Medical Center, Salt Lake City, Utah; and American Association for the Surgery of Trauma
| | - William H Moore
- Associate Chair, Clinical Informatics and Chief, Thoracic Imaging, New York University Langone Medical Center, New York, New York
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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15
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Sun Y, Li C, Yu W, Huo G, Zhu M, Zhao P, Wang T, Huang G, Xu A. Complement system deregulation in SAPHO syndrome revealed by proteomic profiling. J Proteomics 2021; 251:104399. [PMID: 34718201 DOI: 10.1016/j.jprot.2021.104399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/25/2021] [Accepted: 09/26/2021] [Indexed: 12/24/2022]
Abstract
SAPHO syndrome is an inflammatory disease invading the skin and bones, whose diagnosis has been difficult due to its low incidence and diversified manifestation. We investigated the serum proteomic profile of SAPHO patients to identify key proteins associated with SAPHO syndrome, trying to find clinical biomarkers or functional molecules for this rare disease. Blood samples from 8 SAPHO patients and 8 healthy controls were detected and analyzed using data independent acquisition (DIA) method to identify differentially expressed proteins (DEPs) specific to SAPHO. A total of 57 differentially expressed proteins were identified (p < 0.05, fold change >1.2), in which 27 proteins were upregulated and 30 downregulated. DEPs may participate in GO terms such as "lipid particle" and "Notch signaling pathway", as well as KEGG pathways including "complement and coagulation cascades" and "mTOR signaling pathway". The overexpression of inhibitors of the complement system (CFH and C4BP), were verified in a larger cohort (16 SAPHO patients, 8 AS patients and 24 healthy controls) with ELISA, and the combined diagnostic ability of CFH and C4BP was predicted by ROC curve with an AUC of 0.91, which may be molecular candidates for further study on diagnosis and pathology of this rare disease. SIGNIFICANCE: Our research provided the first insight into plasma proteomic profile for SAPHO patients,offering potential biomarkers for disease diagnosis. We found that inhibitors of complement system such as CFH and C4BP were up-regulated in SAPHO syndrome, which may play important roles in the pathogenesis of SAPHO syndrome.
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Affiliation(s)
- Yuxiu Sun
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wanchen Yu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Guiyang Huo
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Mengmeng Zhu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Pengfei Zhao
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Ting Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Guangrui Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Anlong Xu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
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16
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SAPHO Syndrome Mimicking Infectious Spondylodiscitis and Bone Metastasis. Case Rep Rheumatol 2021; 2021:5577257. [PMID: 34527384 PMCID: PMC8437625 DOI: 10.1155/2021/5577257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/27/2021] [Accepted: 07/28/2021] [Indexed: 02/04/2023] Open
Abstract
The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) includes diseases with similar osteoarticular manifestations and skin conditions. Making this diagnosis is not always obvious, especially when the clinical presentation does not fit the typical pattern of the disease or it occurs in a particular field. We described three cases where the diagnosis was difficult. A 46 year-old woman presented with cervical pain. The cervical X-ray showed the aspect of an ivory C5 vertebra. The patient had, however, preserved general condition, no signs of underlying neoplasia, nor other joint complaints. Blood analysis was normal. Tomography did not find any suspect lesion but showed sclerosis and hyperostosis of the manubrium. Scintigraphy showed the characteristic “bullhead” appearance. A 61-year-old woman had thoracic and lumbar pain. MRI showed spondylodiscitis in D3-D4, D4-D5, D5-D6, D6-D7, and L1-L2 with paraspinal soft tissue involvement, simulating infectious spondylodiscitis. Infectious investigations and discovertebral biopsy performed twice were negative. SAPHO syndrome was then suspected. Bone scintigraphy showed uptake in the chondrosternal articulations and D4 to D7 vertebrae. The diagnosis of SAPHO was established. The third case was a 46-year-old man with a lung adenocarcinoma. Staging for metastatic disease, a TAP tomography was performed and showed osteosclerosis of D8 to D12 and intra-articular bridges in the sacroiliac joints. MRI and scintigraphy eliminated malignancy and confirmed the diagnosis of SAPHO. In our cases, imaging findings could facilitate differentiating SAPHO syndrome from other diseases.
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Kubo Y, Ito K, Fujiwara Y, Yoshida T, Kusumoto M. Case Report: SAPHO Syndrome Mimicking Bone Metastases During Treatment With Pembrolizumab for Non-small Cell Lung Cancer. Front Med (Lausanne) 2021; 8:679111. [PMID: 34368186 PMCID: PMC8339402 DOI: 10.3389/fmed.2021.679111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
A 69-year-old female with recurrent stage IV squamous cell lung carcinoma and metastatic abdominal lymph node but not bone metastases was being treated with pembrolizumab. Four months after starting the recurrent treatment, the tumour reduced in size but she began to complain of back pain and palmar rash. A bone scan showed uptake lesions in the left sternocostal joints and vertebrae, while spine magnetic resonance imaging (MRI) showed multiple lesions in the thoracic vertebrae. Her heterogeneous lesions, such as skin and multiple bone manifestations, were comprehensively diagnosed as SAPHO syndrome by different experts. Furthermore, the SAPHO syndrome was suspected to be an immune-related adverse event induced by pembrolizumab, and pembrolizumab withdrawal and prednisolone treatment were performed. Subsequently, her symptoms improved and the follow-up imaging findings showed that the bone lesions had almost disappeared. This case demonstrates that SAPHO syndrome mimicking bone metastases developed during treatment with pembrolizumab. SAPHO syndrome is rare and bone lesions related to the disease may be misdiagnosed as bone metastases. Therefore, it is important in the future for various physicians to have a better understanding of SAPHO syndrome and to consider the potential relationship between this disease and immunotherapy.
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Affiliation(s)
- Yuko Kubo
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kimiteru Ito
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuya Yoshida
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
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Finucci Curi P, Ramos L, Agolti M. The Bull's Head Sign of SAPHO Syndrome. REUMATOLOGIA CLINICA 2021; 17:300-301. [PMID: 32576534 DOI: 10.1016/j.reuma.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 06/11/2023]
Affiliation(s)
| | - Lorena Ramos
- Sección de Dermatología, Hospital San Martín, Paraná, Argentina
| | - Mariela Agolti
- Departamento de Medicina Nuclear, Clínica Modelo, Paraná, Argentina
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Abstract
PURPOSE OF REVIEW To describe the main clinical differences of children and adults with chronic nonbacterial osteomyelitis (CNO). RECENT FINDINGS CNO is a severe systemic autoinflammatory syndrome characterized by multiple bone lesions because of inflammatory osteitis. Delay to diagnosis of CNO can lead to functional impairment, fractures, and chronic pain. Key clinical aspects and disease patterns differ in children and adults, including onset and time to diagnosis, symptom localization, associated comorbidities (i.e. skin, joints), bone lesion distribution pattern, and treatment approach. Novel biomarkers, such as urine N-terminal telopeptide in children and serum IgG4 in adults, are being studied for possible future use in improving diagnosis and guiding treatment. Despite recent advances in our understanding of CNO, many children and adults have a high disease burden and poor long-term outcomes. Recent findings suggest that adults with CNO tend to have a more chronic disease course and are less likely to achieve remission in follow-up. SUMMARY The clinical presentation of CNO differs in children and adults, highlighting the importance of these key features for the accurate diagnosis and early treatment in CNO.
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Meier-Schiesser B, French LE. Autoinflammationssyndrome. J Dtsch Dermatol Ges 2021; 19:400-428. [PMID: 33709590 DOI: 10.1111/ddg.14332_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lars E French
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwigs-Maximilians-Universität München, Deutschland
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Meier-Schiesser B, French LE. Autoinflammatory syndromes. J Dtsch Dermatol Ges 2021; 19:400-426. [PMID: 33620111 DOI: 10.1111/ddg.14332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023]
Abstract
Autoinflammatory syndromes are a steadily growing group of inflammatory diseases caused by abnormal regulations of the innate immune system. The clinical presentation is multifaceted, but recurrent fever, skin involvement, joint inflammation and other systemic symptoms of inflammation are characteristic. In contrast to classic autoimmune diseases, autoantibodies or specific T cells are not involved in the pathogenesis. In fact, innate immunity plays the most important role in autoinflammation. While activation of the innate immune system is usually self-limiting in healthy individuals, mutations and dysregulation can lead to chronic and excessive activation of innate immune responses and to the development of autoinflammatory diseases.
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Affiliation(s)
| | - Lars E French
- Department of Dermatology, Ludwig-Maximilians University Hospital, Munich, Germany
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22
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Orofacial manifestations of SAPHO syndrome: a systematic review of case reports. Clin Rheumatol 2020; 39:3277-3286. [DOI: 10.1007/s10067-020-05084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
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Furer V, Kishimoto M, Tsuji S, Taniguchi Y, Ishihara Y, Tomita T, Helliwell PS, Elkayam O. The Diagnosis and Treatment of Adult Patients with SAPHO Syndrome: Controversies Revealed in a Multidisciplinary International Survey of Physicians. Rheumatol Ther 2020; 7:883-891. [PMID: 32974863 PMCID: PMC7695776 DOI: 10.1007/s40744-020-00235-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/10/2020] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION This study aimed to investigate the current practice in the diagnosis and treatment of SAPHO syndrome among the international rheumatology and dermatology communities. METHODS We conducted an electronic survey among the members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), the Japan Spondyloarthritis, and Israeli Societies of Rheumatology. RESULTS A total of 78 physicians participated in the survey: rheumatologists (83%, n = 65), dermatologists (11.5%, n = 9), and orthopedics (3.8%, n = 3). SAPHO was considered a subtype of spondyloarthritis by 48.7% (n = 38), a subtype of psoriatic arthritis by 19.2% (n = 15), a separate entity by 25.6% (n = 20), and a subtype of reactive arthritis by 6.4% (n = 5). Palmoplantar pustulosis was the most prevalent cutaneous manifestation (n = 44, 56.4%) and anterior chest pain-the most prevalent osteoarticular manifestation (n = 66, 84.6%). The majority (84.6%, n = 66) voted for the update of the present diagnostic criteria by Khan 1994. Magnetic resonance imaging was considered the preferred imaging modality for the diagnosis of SAPHO by 41% (n = 32). Conduction of bone biopsy for diagnosis of non-infectious osteitis was supported only by 10.3% (n = 8). Patient-reported outcomes were considered the most appropriate measure for the assessment of disease activity by 47.4% (n = 37). The treatment approach was overall similar among the rheumatology and dermatology communities, including non-steroidal anti-inflammatory drugs, bisphosphonates, conventional disease-modifying anti-inflammatory drugs, and biologics. CONCLUSIONS Our study underlines the controversy on diagnosis and treatment of SAPHO syndrome among specialists in rheumatology and dermatology and emphasizes an unmet need for update and validation of diagnostic criteria and treatment approach.
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Affiliation(s)
- Victoria Furer
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shigeyoshi Tsuji
- Department of Rheumatology and Orthopaedic Surgery, Osaka Minami Medical Center, Osaka, Japan
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | | | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Philip S Helliwell
- Leeds Institute of Molecular and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Xiang Y, Jiao R, Cao Y, Liang D, Zhang W, Yu Y, Zhang W, Li C. Fibromyalgia in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome: prevalence and screening. Clin Rheumatol 2020; 40:1559-1565. [PMID: 32949312 DOI: 10.1007/s10067-020-05394-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/21/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore the prevalence, clinical characteristics, and screening strategy for fibromyalgia (FM) in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. METHODS A total of 313 patients from a cohort of 354 SAPHO patients volunteered to participate in this study. Demographic, clinical and laboratory data were collected at baseline. Acute-phase reactants during the last 3 months were obtained. Patient-reported outcomes (PROs) and FM evaluation were recorded by questionnaires. RESULTS A total of 57 (18.2%) patients met the 2016 research criteria for FM. Compared to those without FM, these patients had significantly higher visual analog scale (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores (all p < 0.001). However, no differences in the erythrocyte sedimentation rate (ESR) or hypersensitive C-reactive protein (hs-CRP) levels were identified between the two groups. Patients with FM were also markedly older [odds ratio (OR) 1.072, p = 0.032] and had higher Fibromyalgia Rapid Screening Tool (FiRST) scores (OR 1.607, p = 0.016). The FiRST score showed a sensitivity of 50.9% and a specificity of 89.8%, and with a cutoff of 3, the FiRST score presented a high sensitivity of 84.2%. CONCLUSION The prevalence of FM among SAPHO patients was similar to that among patients with other rheumatic diseases. Concomitant FM in SAPHO syndrome was associated with older age and worse PROs. Different cutoff values for FiRST screening should be used in patients with SAPHO syndrome. Key Points • The prevalence of FM among SAPHO patients was similar to that among patients with other rheumatic diseases. • Concomitant FM in SAPHO syndrome was associated with older age, widespread pain, and worse PROs. • Different cutoff values for FiRST screening should be used in patients with SAPHO syndrome.
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Affiliation(s)
- Yirong Xiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Jiao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yihan Cao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dongfeng Liang
- Department of Rheumatology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Weihong Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yanying Yu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Wu N, Shao Y, Huo J, Zhang Y, Cao Y, Jing H, Zhang F, Yu C, Yu Y, Li C, Song H, Zhang W. Clinical characteristics of pediatric synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome: the first Chinese case series from a single center. Clin Rheumatol 2020; 40:1487-1495. [PMID: 32929648 DOI: 10.1007/s10067-020-05393-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/04/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pediatric SAPHO syndrome is regarded as the equivalent of chronic recurrent multifocal osteomyelitis or chronic non-bacterial osteomyelitis. This study aimed to evaluate the clinical features and treatment options for Chinese pediatric patients with SAPHO syndrome. METHOD We conducted a single-center, retrospective study on a sample of 24 pediatric patients with SAPHO syndrome who were diagnosed at Peking Union Medical College Hospital from April 2014 to August 2018. The demographic, clinical, laboratory, imaging, histological, and therapeutic data were collected and analyzed. RESULTS A total of 15 boys and 9 girls were included. The mean age of onset of bone and skin symptoms was 11.7 ± 3.8 and 14.4 ± 2.7 years, respectively. The mean follow-up period was 39.2 months. Seventeen patients had skin manifestations (46% had severe acne, 100% were boys; 21% had palmoplantar pustulosis, 100% were girls). Bone lesions were localized in four of the following major regions: anterior chest wall (42%), mandible (29%), peripheral bones (50%), and spine and sacroiliac joints (21%). Six patients had been treated with non-steroidal anti-inflammatory drugs, 10 with bisphosphonate, 10 with a tumor necrosis factor-α antagonist, and 1 with glucocorticoids, with variable responses. A total of 70% of the patients had complete remission after bisphosphonate or TNF-α antagonist therapy. CONCLUSION Pediatric patients with SAPHO syndrome have different characteristics from other cohorts in the sex ratio, frequency of mandibular involvement, and sex distribution of skin lesions. Bisphosphonate and TNF-α antagonists show a favorable response in pediatric SAPHO syndrome treatment. Key points •Being the first study that describes an Asian pediatric SAPHO case series. •Chinese pediatric patients with SAPHO syndrome have different characteristics from Chinese adult patients and Caucasian pediatric patients.
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Affiliation(s)
- Nan Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Department of genetic research, Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuming Shao
- Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jianwei Huo
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Yanan Zhang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongli Jing
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fa Zhang
- Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chenyang Yu
- Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yanying Yu
- Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, No. 1 Shuaifuyuan, Beijing, 100730, China.
| | - Hongmei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Hussain A, Gondal M, Abdallah N, Yousuf H, Iqbal M. Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO): An Interesting Clinical Syndrome. Cureus 2020; 12:e10184. [PMID: 32905195 PMCID: PMC7465995 DOI: 10.7759/cureus.10184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare disorder that classically involves the musculoskeletal system, i.e. bone, joint and skin. The exact pathogenesis of this syndrome is unknown. However, autoimmunity, infections, immune malfunction and genetic factors are attributed to its pathophysiology. Bone and joint involvements are the hallmark of SAPHO syndrome and not necessarily require cutaneous involvement at the time of diagnosis. X-ray of the affected joints could show osteitis with sclerosis. Anterior chest wall involvement particularly ''bullhead appearance'' seen on bone scan is a striking feature of the syndrome. Erythrocyte sedimentation rate (ESR) is usually elevated amongst the majority of patients. Diagnosis of SAPHO is always challenging and often delayed because of a multitude of symptoms. The mainstay of treatment is control of pain and inflammation with both non-steroidal anti-inflammatory drugs (NSAIDs) and rescue courses of systemic steroids. If failed to control symptoms with first-line agents and in those with severe disease, disease-modifying anti-inflammatory drugs (DMARDs) may be needed eventually. Despite a chronic inflammatory condition, it remains stable in the majority of cases. Here in this case report, we reiterate the importance of early recognition, timely diagnosis and prompt treatment initiation.
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Affiliation(s)
- Ali Hussain
- Acute Medicine, Pinderfields General Hospital, Wakefield, GBR
| | - Mohsin Gondal
- Cardiology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, GBR
| | - Nizar Abdallah
- Endocrinology, Diabetes and Metabolism, Pinderfields General Hospital, Wakefield, GBR
| | - Hira Yousuf
- Oncology, Pinderfields General Hospital, Wakefield, GBR
| | - Mubashar Iqbal
- Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
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Li C, Ye Y, Cao Y, Zhang W, Xu W, Wu N, Zhang S, Zhang W. Axial skeletal lesions and disease duration in SAPHO syndrome: A retrospective review of computed tomography findings in 81 patients. Int J Rheum Dis 2020; 23:1152-1158. [PMID: 32588963 DOI: 10.1111/1756-185x.13899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 11/29/2022]
Abstract
AIMS To explore the relevance of disease duration with axial skeletal lesions in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome based on computed tomography (CT). METHODS Patients who had undergone whole-spine CT were included from a previously reported single-center cohort of SAPHO syndrome. Patients with previous treatments of bisphosphates, biological agents or surgeries were excluded. Sites of axial skeletal involvement were reviewed including the spine, sacroiliac joints, and anterior chest wall. Duration of osteoarticular involvement was defined as the interval between the onset of osteoarticular symptoms and the CT evaluation. RESULTS Eighty-one patients (54 female and 27 male) were included in the study. The mean disease duration was 26.9 ± 34.9 months. Fifty (63.0%) patients showed spinal lesions on CT. The average numbers of involved vertebral segments for corner and endplate lesions were 3.16 ± 3.51 and 0.73 ± 1.85 respectively. Sixty-eight (84.0%) patients exhibited abnormalities in the anterior chest wall. The number of involved vertebral segments showed poor correlation with disease duration for both corner lesions (r2 = 0.051, P = 0.043) and endplate lesions (r2 = 0.137, P = 0.001). Patients with costoclavicular involvement showed remarkably longer disease duration than those without (49.3 ± 47.7 months vs 18.0 ± 23.5 months, P = 0.006), while no significant difference was detected regarding other structures in the anterior chest wall. CONCLUSION Costoclavicular involvement is a hallmark of long disease duration in SAPHO syndrome. Corner and endplate lesions in the vertebrae and sacroiliac involvement may not relate to disease course.
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Affiliation(s)
- Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Yuqian Ye
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Beijing, China
| | - Wenrui Xu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Nan Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China.,Medical Research Center of Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Weihong Zhang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
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28
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Imaging features in patients with SAPHO/CRMO: a pictorial review. Jpn J Radiol 2020; 38:622-629. [PMID: 32356235 DOI: 10.1007/s11604-020-00953-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and chronic recurrent multifocal osteomyelitis (CRMO) have been described as disorders of chronic osteoarthritic inflammation frequently associated with skin manifestations, and SAPHO and CRMO (SAPHO/CRMO) are rare autoinflammatory disorders of unknown etiology. SAPHO tends to occur in adults and CRMO predominantly occurs in children and adolescents. SAPHO/CRMO can affect any skeletal region (e.g., anterior chest wall, spine, or long bones). As SAPHO/CRMO are diagnoses of exclusion, the diagnoses might be difficult if skin manifestations are not clearly evident. However, knowledge of the imaging findings of skeletal disorders is helpful for correcting the diagnosis and avoiding unnecessary invasive procedures, as well as in facilitating early diagnosis and adequate treatment. This pictorial review describes the appearance of increased skeletal uptake for SAPHO/CRMO on bone scintigraphy along with findings from radiography, computed tomography, and magnetic resonance imaging.
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Abstract
SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome is a chronic inflammatory disease involving multiple organs such as skin and bones. At present, its etiology and pathogenesis are still unclear. Due to the variety of clinical manifestations and the small number of SAPHO syndrome involving the mandible, accurate diagnosis is difficult for oral and maxillofacial surgeons. Here, the authors report that a male patient with SAPHO syndrome involving the maxillofacial skin and mandible, followed for 3 years. We used Tc-MDP (technetium-99 conjugated with methylene disphosphonate) (commercially known as Yunke) to treat this disease and achieved significant clinical treatment. This suggests that Tc-MDP can be used as a bisphosphonate to treat SAPHO syndrome.
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30
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Huhn CK, Schauer F, Schempp CM, Venhoff N, Finzel S. Hautentzündungen mit Arthritis, Synovitis und Enthesitis. Teil 1: Psoriasisarthritis, SAPHO-Syndrom, Morbus Still, Morbus Behçet. J Dtsch Dermatol Ges 2019; 17:43-66. [PMID: 30615292 DOI: 10.1111/ddg.13742_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Christian K Huhn
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg
| | - Franziska Schauer
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg
| | - Christoph M Schempp
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg
| | - Nils Venhoff
- Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Stephanie Finzel
- Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
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31
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Sun Y, Li C, Zhu M, Zhang S, Cao Y, Yang Q, Zhao P, Huang G, Xu A. Enhanced migration and adhesion of peripheral blood neutrophils from SAPHO patients revealed by RNA-Seq. Orphanet J Rare Dis 2019; 14:192. [PMID: 31395074 PMCID: PMC6688242 DOI: 10.1186/s13023-019-1169-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 07/26/2019] [Indexed: 02/08/2023] Open
Abstract
Background SAPHO syndrome is a rare disease characterized by inflammatory lesions on skin and bones. Diversified manifestation and inadequate understanding of etiology has limited its diagnosis and treatment. The co-occurrence of other immune-mediated diseases strongly suggests an involvement of autoimmunity in SAPHO syndrome. However, the role of the largest population of circulating immune cells, neutrophils, is still not well explored. In this study, we performed RNA sequencing to profile the mRNA expression of neutrophils purified from peripheral blood of SAPHO patients to identify key genes associated with SAPHO syndrome, trying to find new functional molecules or biomarkers for this rare disease. Results A total of 442 differentially expressed genes were identified (p < 0.05, fold change > 2), in which 294 genes were upregulated and 148 genes were downregulated. Five differentially expressed genes of interest were verified by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR), among which S100A12 was upregulated and positively related to high-sensitivity C-reactive protein (hsCRP), while the downregulated gene MYADM was positively related to osteocalcin. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that differentially expressed genes were enriched in “systemic lupus erythematosus” and “ECM-receptor interaction”. Gene ontology (GO) enrichment showed that differentially expressed genes may participate in biological processes such as “cell migration” and “cell adhesion”. Conclusions In conclusion, this study provides a first insight into transcriptome characteristics of SAPHO syndrome, indicating an over-active neutrophil recruitment in patients and possibly suggesting molecular candidates for further study on diagnosis and pathology of this disease. Electronic supplementary material The online version of this article (10.1186/s13023-019-1169-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuxiu Sun
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Mengmeng Zhu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Shen Zhang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qiao Yang
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Pengfei Zhao
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Guangrui Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Anlong Xu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China. .,State Key Laboratory of Biocontrol, Department of Biochemistry, School of Life Sciences, Sun Yat-Sen (Zhongshan) University, Guangzhou, Guangdong, China.
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32
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Skrabl-Baumgartner A, Singer P, Greimel T, Gorkiewicz G, Hermann J. Chronic non-bacterial osteomyelitis: a comparative study between children and adults. Pediatr Rheumatol Online J 2019; 17:49. [PMID: 31337412 PMCID: PMC6651954 DOI: 10.1186/s12969-019-0353-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To compare clinical presentation, diagnostic and treatment strategies, and outcome between pediatric and adult patients with chronic non-bacterial osteomyelitis (CNO). METHODS Retrospective single-centre comparative study of pediatric and adult patients diagnosed with chronic recurrent multifocal osteomyelitis (CRMO)/CNO or synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome treated at the Medical University of Graz. RESULTS 24 pediatric patients diagnosed with CRMO/CNO and 10 adult patients diagnosed with SAPHO syndrome were compared. Median age at diagnosis was 12.3 years (range 7.9-18.9) in the pediatric group and 32.5 years (range 22-56) in the adult group. Median time to diagnosis was shorter in children than in adults (0.3 vs. 1.0 years). Initial clinical presentation, laboratory and histopathological findings were similar in children and adults. Mean numbers of bone lesions were comparable between pediatric and adult patients (3.1 vs. 3.0), as were rates of skin involvement (33% vs. 30%). Sternal involvement was more frequent in adults whereas involvement of clavicle and long bones was more frequent in children (41.7% vs.10, 33% vs. 10%). Computerized tomography (CT) was used more often in adults, whereas whole-body magnetic resonance imaging (MRI) was used only in children. Bisphosphonates were applied more often in children and outcome was better in children than in adults (62.5% vs.30%). CONCLUSION Results of our study suggest that CNO/CRMO and SAPHO syndrome in children and adults might represent a single clinical syndrome that needs a similar diagnostic and therapeutic approach.
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Affiliation(s)
- Andrea Skrabl-Baumgartner
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Peter Singer
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Theresa Greimel
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Gregor Gorkiewicz
- Diagnostic & Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - Josef Hermann
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University Graz, Graz, Austria
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33
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Huhn CK, Schauer F, Schempp CM, Venhoff N, Finzel S. Skin inflammation associated with arthritis, synovitis and enthesitis. Part 1: psoriatic arthritis, SAPHO syndrome, Still's disease, Behçet's disease. J Dtsch Dermatol Ges 2019; 17:43-64. [DOI: 10.1111/ddg.13742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/13/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Christian K. Huhn
- Department of Dermatology and Venereology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
| | - Franziska Schauer
- Department of Dermatology and Venereology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
| | - Christoph M. Schempp
- Department of Dermatology and Venereology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology; Freiburg University Medical Center; Medical Faculty of the Albert Ludwigs University; Freiburg Germany
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34
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Mandibular osteomyelitis related to SAPHO syndrome following dental implant surgery: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2018. [DOI: 10.1016/j.ajoms.2018.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Síndrome SAPHO en la infancia. Presentación de un caso clínico. ACTA ACUST UNITED AC 2018; 14:109-112. [DOI: 10.1016/j.reuma.2016.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/15/2016] [Accepted: 09/30/2016] [Indexed: 11/22/2022]
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36
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Li C, Cao Y, Zhang W. Clinical heterogeneity of SAPHO syndrome: Challenge of diagnosis. Mod Rheumatol 2018; 28:432-434. [PMID: 29251057 DOI: 10.1080/14397595.2017.1416733] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Chen Li
- a Department of Traditional Chinese Medicine, Peking Union Medical College Hospital , Peking Union Medical College and Chinese Academy of Medical Sciences , Beijing , China
| | - Yihan Cao
- b Department of Rheumatology and Clinical Immunology , Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences , Beijing , China
| | - Wen Zhang
- b Department of Rheumatology and Clinical Immunology , Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences , Beijing , China
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37
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Schaub S, Sirkis HM, Kay J. Imaging for Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome. Rheum Dis Clin North Am 2017; 42:695-710. [PMID: 27742022 DOI: 10.1016/j.rdc.2016.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multifocal osteomyelitis and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome constitute a spectrum of disease that includes inflammatory bone lesions and dermatologic findings. Radiographic features resemble those of the spondyloarthropathies with anterior chest wall involvement. Early radiographic findings are osteodestructive with lytic lesions. Bone scintigraphy of the sternoclavicular region classically yields a 'bull's head' pattern of radionuclide uptake. Magnetic resonance imaging (MRI) can demonstrate corner lesions of vertebral bodies. Ultrasound often reveals peripheral enthesitis. Late radiographic features are usually osteoproliferative. PET/CT can identify chronic lesions. Differential diagnostic considerations include osteomyelitis and malignancy, which often prompt bone biopsy.
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Affiliation(s)
- Steven Schaub
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605, USA
| | - Hartley M Sirkis
- Division of Musculoskeletal Imaging, Department of Radiology, UMass Memorial Medical Center and University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605, USA.
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Okuno H, Watanuki M, Kuwahara Y, Sekiguchi A, Mori Y, Hitachi S, Miura K, Ogura K, Watanabe M, Hosaka M, Hatori M, Itoi E, Sato K. Clinical features and radiological findings of 67 patients with SAPHO syndrome. Mod Rheumatol 2017; 28:703-708. [PMID: 28880693 DOI: 10.1080/14397595.2017.1372874] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this study was to facilitate the understanding of the SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis) syndrome by analyzing the clinical and radiological features of 67 Japanese patients with SAPHO syndrome. METHODS Sixty-seven Japanese patients (female/male: 44/23, mean age at onset: 48.5 years) were diagnosed with SAPHO syndrome from 2002 to 2013 at our hospital. Medical records and radiological imaging of these patients were retrospectively reviewed. RESULTS Among the 67 patients, 41 had dermatological manifestations, such as palmoplantar pustulosis, acne, and psoriasis. Initial symptom was local pain in all patients, and the most common initial site of the symptom was the anterior chest. Bacterial and fungal cultures from 20 bone biopsies were all negative. Histopathological diagnosis of the specimens was non-specific inflammation in all cases. Bone lesions were observed in 65 patients (97.0%). On the other hand, articular lesions including enthesitis were found in 31 patients (46.2%). CONCLUSION SAPHO syndrome had different clinical and radiological aspects. The clinical features were not remarkable, except the dermatological manifestations and the involvement of the anterior chest. Bone lesions including hyperostosis and osteitis were found radiographically in the majority of patients with SAPHO syndrome. These are the characteristics of the SAPHO syndrome, with the exclusion of other bone diseases.
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Affiliation(s)
- Hiroshi Okuno
- a Department of Orthopaedic Surgery , Tohoku Rosai Hospital , Sendai , Japan.,b Department of Orthopaedic Surgery , Tohoku University Hospital , Sendai , Japan
| | - Munenori Watanuki
- b Department of Orthopaedic Surgery , Tohoku University Hospital , Sendai , Japan
| | - Yoshiyuki Kuwahara
- b Department of Orthopaedic Surgery , Tohoku University Hospital , Sendai , Japan
| | - Akira Sekiguchi
- b Department of Orthopaedic Surgery , Tohoku University Hospital , Sendai , Japan
| | - Yu Mori
- b Department of Orthopaedic Surgery , Tohoku University Hospital , Sendai , Japan
| | - Shin Hitachi
- c Department of Diagnostic Radiology , Tohoku University Hospital , Sendai , Japan
| | - Keiki Miura
- b Department of Orthopaedic Surgery , Tohoku University Hospital , Sendai , Japan
| | - Ken Ogura
- b Department of Orthopaedic Surgery , Tohoku University Hospital , Sendai , Japan
| | - Mika Watanabe
- d Department of Pathology , Tohoku University Hospital , Sendai , Japan
| | - Masami Hosaka
- b Department of Orthopaedic Surgery , Tohoku University Hospital , Sendai , Japan
| | - Masahito Hatori
- e Department of Orthopaedic Surgery , Tohoku Kosai Hospital , Sendai , Japan
| | - Eiji Itoi
- b Department of Orthopaedic Surgery , Tohoku University Hospital , Sendai , Japan
| | - Katsumi Sato
- a Department of Orthopaedic Surgery , Tohoku Rosai Hospital , Sendai , Japan
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39
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Vekic DA, Woods J, Lin P, Cains GD. SAPHO syndrome associated with hidradenitis suppurativa and pyoderma gangrenosum successfully treated with adalimumab and methotrexate: a case report and review of the literature. Int J Dermatol 2017; 57:10-18. [PMID: 28884797 DOI: 10.1111/ijd.13740] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/13/2017] [Accepted: 07/27/2017] [Indexed: 01/06/2023]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a rare inflammatory condition describing the combination of skin, bone, and joint manifestations that has a heterogeneous presentation. We report a case of severe SAPHO syndrome in association with hidradenitis suppurativa and pyoderma gangrenosum in a 27-year-old male. The patient had an initial migratory arthritis affecting the knees, ankles, metacarpophalangeal joints, proximal interphalangeal joints, wrists, shoulder, and lower back, which progressed to a persistent arthritis and swelling at the sternum, shoulders, wrists, hands, feet, and lower back. Radiographic changes were consistent with the diagnosis of SAPHO syndrome. Serum proinflammatory cytokine levels were significantly elevated and improved substantially after 3 months of therapy. Rationale for therapy in this patient was the observation that tumor necrosis alpha antagonists have been successfully used in SAPHO syndrome, and since arthropathy was so prominent in our patient, we elected to use adalimumab combined with methotrexate.
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Affiliation(s)
- Dunja A Vekic
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Ingham Institute of Applied Medical Research, Liverpool, Sydney, Australia
| | - Jane Woods
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Ingham Institute of Applied Medical Research, Liverpool, Sydney, Australia
| | - Peter Lin
- University of New South Wales, Sydney, Australia.,Department of Nuclear Medicine, Liverpool Hospital, Sydney, Australia.,Western Sydney University, Sydney, Australia
| | - Geoffrey D Cains
- Ingham Institute of Applied Medical Research, Liverpool, Sydney, Australia.,University of New South Wales, Sydney, Australia
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40
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Greenwood S, Leone A, Cassar-Pullicino VN. SAPHO and Recurrent Multifocal Osteomyelitis. Radiol Clin North Am 2017; 55:1035-1053. [DOI: 10.1016/j.rcl.2017.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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41
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Gianfaldoni S, Tchernev G, Wollina U, Lotti T. Pustular Palmoplantar Psoriasis Successfully Treated with Nb-UVB Monochromatic Excimer Light: A Case-Report. Open Access Maced J Med Sci 2017; 5:462-466. [PMID: 28785333 PMCID: PMC5535658 DOI: 10.3889/oamjms.2017.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/05/2017] [Accepted: 05/21/2017] [Indexed: 11/11/2022] Open
Abstract
Barber’s palmoplantar pustulosis (PPP) is a form of localised pustular psoriasis, affecting the palmar and plantar surfaces. It is a chronic disease, with a deep impact on the patients’ quality of life. The Authors discuss a case of Baber Psoriasis successfully treated with monochromatic excimer light.
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Affiliation(s)
- Serena Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Georgi Tchernev
- Medical Institute of the Ministry of Interior, Dermatology, Venereology and Dermatologic Surgery; Onkoderma, Private Clinic for Dermatologic Surgery, Dermatology and Surgery, Sofia 1606, Bulgaria
| | - Uwe Wollina
- Krankenhaus Dresden-Friedrichstadt, Department of Dermatology and Venereology, Dresden, Sachsen, Germany
| | - Torello Lotti
- Universitario di Ruolo, Dipartimento di Scienze Dermatologiche, Università degli Studi di Firenze, Facoltà di Medicina e Chirurgia, Dermatology, Via Vittoria Colonna 11, Rome 00186, Italy
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Cianci F, Zoli A, Gremese E, Ferraccioli G. Clinical heterogeneity of SAPHO syndrome: challenging diagnose and treatment. Clin Rheumatol 2017; 36:2151-2158. [PMID: 28725947 DOI: 10.1007/s10067-017-3751-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 12/11/2022]
Abstract
Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a rare disease which is often misdiagnosed and under-recognized, because of its peculiar and heterogeneous clinical presentation. Its main features consist of cutaneous and osteoarticular manifestations, the latter affecting more often the anterior chest wall and having typical radiologic findings. There are no validated diagnostic criteria for SAPHO and no guidelines for treatment, due mainly to its rarity; as a consequence, therapy is empirical and aimed to control pain and modifying inflammatory process. To date, the use of anti-TNF agents has been proved to be a valid alternative for patients unresponsive to conventional treatments, such as NSAIDs, corticosteroids, DMARDs and biphosphonates. The clinical heterogeneity of the disease, possibly due to differences in pathogenic mechanism of different manifestations, is challenging for both diagnosis and treatment, which should aim to control both skin and bone involvement in different clinical subsets. Here, we summarize the current status of knowledge about the SAPHO syndrome and present two cases of patients with very different disease manifestations, suggesting the need for personalized treatment.
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Affiliation(s)
- Francesco Cianci
- Istituto di Reumatologia e Scienze Affini, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Zoli
- Istituto di Reumatologia e Scienze Affini, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Gremese
- Istituto di Reumatologia e Scienze Affini, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Ferraccioli
- Istituto di Reumatologia e Scienze Affini, Università Cattolica del Sacro Cuore, Rome, Italy. .,Institute of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico Gemelli, CIC-Via Moscati 31, 00168, Rome, Italy.
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Ata Y, Inaba Y, Choe H, Kobayashi N, Machida J, Nakamura N, Saito T. Bone metabolism and inflammatory characteristics in 14 cases of chronic nonbacterial osteomyelitis. Pediatr Rheumatol Online J 2017; 15:56. [PMID: 28693592 PMCID: PMC5504748 DOI: 10.1186/s12969-017-0183-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/03/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic nonbacterial osteomyelitis (CNO) is a multifocal autoinflammatory disease that often impairs daily life in children. This study aimed to investigate the bone metabolic and inflammatory characteristics of patients with CNO, and to assess the differences between responders and nonresponders to conservative treatment. METHODS We investigated the clinical symptoms; laboratory data including inflammatory and bone metabolic biomarkers; and imaging findings from plain radiography, magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), and dual-energy x-ray absorption (DEXA) in 14 patients with CNO. All patients underwent first-line treatment comprising systemic nonsteroidal anti-inflammatory drugs with or without bisphosphonate. According to the response to the first-line treatment, the patients were divided into the clinical remission/partial response group and the no response group. The differences in bone metabolic and inflammatory characteristics between the two groups were assessed. RESULTS All patients had low bone mineral density assessed with DEXA. The bone metabolic biomarkers (bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b) were increased in boys of all ages and in young girls. Multiple inflammatory regions were detected in all patients by using FDG-PET including asymptomatic regions. The no response group had higher immunoglobulin G (IgG) and a greater number of bone inflammatory lesions detected on MRI than the clinical remission/partial response group. CONCLUSION Our data indicate the involvement of abnormal bone turnover, necessity of whole-body scanning, and association of higher serum IgG levels and greater numbers of inflammatory lesions with prolonged disease activity in patients with CNO.
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Affiliation(s)
- Yurika Ata
- 0000 0001 1033 6139grid.268441.dDepartment of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan ,0000 0004 0377 7528grid.414947.bDepartment of Orthopaedic Surgery, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
| | - Hyonmin Choe
- 0000 0001 1033 6139grid.268441.dDepartment of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Naomi Kobayashi
- 0000 0001 1033 6139grid.268441.dDepartment of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Jiro Machida
- 0000 0004 0377 7528grid.414947.bDepartment of Orthopaedic Surgery, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Japan
| | - Naoyuki Nakamura
- 0000 0004 0377 7528grid.414947.bDepartment of Orthopaedic Surgery, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Japan
| | - Tomoyuki Saito
- 0000 0001 1033 6139grid.268441.dDepartment of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
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Xu W, Li C, Zhao X, Lu J, Li L, Wu N, Zuo Y, Jing H, Dong Z, Zhang W, Zhang W. Whole-spine Computed Tomography Findings in SAPHO Syndrome. J Rheumatol 2017; 44:648-654. [PMID: 28250144 DOI: 10.3899/jrheum.161075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We evaluated the whole-spine computed tomography (CT) findings in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome to improve our understanding of this rare disease. METHODS Whole-spine CT images obtained in 69 patients with SAPHO were reviewed. For each individual, a total of 25 vertebrae were evaluated for the distribution of affected vertebrae, CT manifestations of vertebral lesions, symmetry and location of distribution of the lesions on vertebrae, involvement pattern, and narrowing of adjacent intervertebral disc space. Paravertebral ligamentous ossifications, apophyseal joint disorders, and costovertebral joint disorders were also evaluated. RESULTS All the 69 patients with SAPHO exhibited abnormalities on whole-spine CT. Sixty-four had vertebral lesions, 52 had paravertebral ossifications, and 47 had both. The vertebral lesions were observed in 441 vertebrae, with a predilection for thoracic spine. The lesions exhibited a mixture of cortical erosion, reactive osteosclerosis of surrounding cancellous bone, and syndesmophyte. They may be confined to the vertebral corner (65.1%) or be extensive, involving the endplate (34.9%). Corner lesions could start in any part of the epiphyseal ring. The lesions were asymmetrically distributed. The affected vertebrae were more consecutively involved in a "kissing" appearance (78.2%). Intervertebral disc spaces were usually normal or mildly narrowed. There were 320 foci of paravertebral ossifications observed, with a predilection for the supraspinous ligament. Paravertebral ossifications were delicate and segmental. Ossifications throughout annulus fibrosis and apophyseal joint were not observed. CONCLUSION Our investigation of the distributional, morphological features and the involvement pattern of spinal lesions in patients with SAPHO demonstrated distinct CT characteristics.
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Affiliation(s)
- Wenrui Xu
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Chen Li
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Xue Zhao
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Jie Lu
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Li Li
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Nan Wu
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Yuzhi Zuo
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Hongli Jing
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Zhenhua Dong
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Wen Zhang
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Weihong Zhang
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China. .,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences.
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Valkema PA, Luymes CH, Witteveen JE, le Cessie S, Appelman-Dijkstra NM, Hogendoorn PCW, Hamdy NAT. High prevalence of autoimmune disease in the rare inflammatory bone disorder sternocostoclavicular hyperostosis: survey of a Dutch cohort. Orphanet J Rare Dis 2017; 12:20. [PMID: 28122596 PMCID: PMC5267408 DOI: 10.1186/s13023-017-0573-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 01/18/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sternocostoclavicular hyperostosis (SCCH; ORPHA178311) is a rare inflammatory disorder of the axial skeleton, the precise pathophysiology of which remains to be established. We addressed the potential association of SCCH with autoimmune processes by evaluating the lifetime prevalence of autoimmune disease in 70 patients with adult-onset SCCH and 518 SCCH-unaffected first-degree relatives (parents, siblings and children). Danish hospital registry data for autoimmune diseases were used as reference data. RESULTS The mean age of interviewed patients was 56.3 years (range 26-80 years) and 86% were female. Interviewed patients belonged to 63 families, with four families having clusters of 2-3 patients. A diagnosis of at least one autoimmune disease was reported in 20 SCCH patients (29%) and in 47 relatives (9.1%), compared to an estimated 3.9% prevalence of autoimmune disease in the Danish reference population. A diversity of autoimmune diseases was reported in SCCH patients and relatives, most frequently psoriasis vulgaris (14%). Palmoplantar pustulosis was reported by 28 patients (40%). In SCCH patients, inclusion of palmoplantar pustulosis as putative autoimmune disease increased the overall prevalence to 54%. CONCLUSIONS The high prevalence of autoimmune disease in patients with sternocostoclavicular hyperostosis and their first-degree relatives suggests that autoimmunity may play a role in the still elusive pathophysiology of the intriguing osteogenic response to inflammation observed in this rare bone disorder.
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Affiliation(s)
- Pieter A Valkema
- Department of Medicine, Division of Endocrinology & Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands
| | - Clare H Luymes
- Department of Medicine, Division of Endocrinology & Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Janneke E Witteveen
- Department of Medicine, Division of Endocrinology & Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands
| | - Saskia le Cessie
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Natasha M Appelman-Dijkstra
- Department of Medicine, Division of Endocrinology & Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands
| | | | - Neveen A T Hamdy
- Department of Medicine, Division of Endocrinology & Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands.
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Abstract
SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a rare autoimmune disease which, due to its clinical presentation and symptoms, is often misdiagnosed and unrecognized. Its main features are prominent inflammatory cutaneous and articular manifestations. Treatments with immunosuppressive drugs have been used for the management of SAPHO with variable results. To date, the use of anti-TNF-α agents has proved to be an effective alternative to conventional treatment for unresponsive or refractory SAPHO cases. TNF-α is a pro-inflammatory cytokine and pivotal regulator of other cytokines, including IL-1 β, IL-6, and IL-8, involved in inflammation, acute-phase response induction, and chemotaxis. IL-1 inhibition strategies with anakinra have shown efficacy as first and second lines of treatment. In this review, we will describe the main characteristics of biological drugs currently used for SAPHO syndrome. We also describe some of the promising therapeutic effects of ustekinumab, an antibody against the p40 subunit of IL-12 and IL-23, after failure of multiple drugs including anti-TNF-α and anakinra. We discuss the use and impact of the new anti-IL-1 antagonists involved in the IL-17 blockade, in particular for the most difficult-to-treat SAPHO cases.
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Umeda M, Kawashiri SY, Nishino A, Koga T, Ichinose K, Michitsuji T, Shimizu T, Fukui S, Nakashima Y, Hirai Y, Iwamoto N, Aramaki T, Tamai M, Nakamura H, Origuchi T, Ueki Y, Kawakami A. Synovitis of sternoclavicular and peripheral joints can be detected by ultrasound in patients with SAPHO syndrome. Mod Rheumatol 2016; 27:881-885. [DOI: 10.1080/14397595.2016.1259971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Masataka Umeda
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan,
| | - Shin-ya Kawashiri
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
- Department of Community Medicine, and
| | - Ayako Nishino
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Toru Michitsuji
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Shoichi Fukui
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Yoshikazu Nakashima
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Yasuko Hirai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | | | - Mami Tamai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Tomoki Origuchi
- Department Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yukitaka Ueki
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan,
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
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Duan N, Chen X, Liu Y, Wang J, Wang Z. Multimodal imaging findings of SAPHO syndrome with no skin lesions: A report of three cases and review of the literature. Exp Ther Med 2016; 12:2665-2670. [PMID: 27698770 DOI: 10.3892/etm.2016.3689] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/28/2016] [Indexed: 11/05/2022] Open
Abstract
Synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis syndrome (SAPHO) is a rare syndrome that affects the skin, bones and joints. Diagnosis of SAPHO syndrome is established on clinical appearance and imaging features. The present case report described the imaging features of three cases of SAPHO with sternoclavicular joint arthritis but without skin manifestations using multiple imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and bone scintigraphy. The first case was a 52-year-old male who suffered from progressive sternoclavicular arthritis for 2 years. The second case was a 62-year-old female with arthritis in the larger joints for 5 years, particularly on the right thoracic area. The third case was a 44-year-old male who exhibited a slight bulge accompanied by pain in the upper anterior chest wall for 4 years. All of them lacked cutaneous lesions. CT demonstrated sclerosis and hyperostosis with subchondral erosions in the sternocostoclavicular joints. MRI revealed bone marrow edema that was slightly hypointense on T1-weighted imaging, and hyperintense on T2-weighted imaging. Typical 'bull head' signs were observed in bone scintigraphy images. The present case study demonstrated that SAPHO syndrome should be suspected in patients with multifocal osteitis or arthritis affecting the chest wall that lack skin manifestations. Multimodal imaging modalities in combination are helpful for SAPHO diagnosis.
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Affiliation(s)
- Na Duan
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Yongkang Liu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
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De Maeseneer M, Lenchik L, Buls N, Boulet C, Döring S, de Mey J, Willekens I. High-resolution CT of the sternoclavicular joint and first costochondral synchondrosis in asymptomatic individuals. Skeletal Radiol 2016; 45:1257-62. [PMID: 27357311 DOI: 10.1007/s00256-016-2414-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/10/2016] [Accepted: 05/20/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess CT features of the sternoclavicular joint (SCJ) and first costochondral junction in asymptomatic patients. MATERIALS AND METHODS In 66 patients transverse and coronal oblique high-resolution multiple detector CT images of the SCJ and first costochondral junction were obtained. Images were reviewed by consensus of two radiologists. Joint space width was measured at three levels, and osteophytes, geodes, and erosions were evaluated. Variants and degree of ossification were noted. Statistical analysis consisted of Shapiro-Wilk test, Pearson's test, and paired sample t test. RESULTS There were 34 men and 32 women with a mean age of 60 years (age range, 17-98 years). The width of the joint spaces showed a normal distribution. There was no significant difference between the left and right sides. On coronal images the joint space was wider superiorly and on transverse images posteriorly. There was a trend toward decreasing joint space with age, although it did not reach significance (p > 0.05). Clavicular osteophytes were seen in 16 out of 66 patients (24 %) and sternal osteophytes in 16 out of 66 patients. Clavicular geodes were seen in 10 out of 66 patients (15 %) and sternal geodes in 14 out of 66 patients (14 %). No erosions were seen. Clefts of the first costochondral junction were seen in 31 out of 66 patients (47 %). CONCLUSION In asymptomatic patients, there is no significant asymmetry of the SCJ. The joint spaces did not significantly decrease with age, although such a trend could be observed. Pronounced joint space narrowing with large geodes and osteophytes was not seen. Clefts of the first costochondral junction are common and not significant.
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Affiliation(s)
- Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Leon Lenchik
- Department of Radiology, Wake Forest University, Medical Center Boulevard, Winston Salem, NC, 27103, USA
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Cedric Boulet
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Seema Döring
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Inneke Willekens
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Yeo I, Cha HS, Yoon YC, Park YS, Lim SJ. A case report of severely damaged hip joint caused by SAPHO syndrome treated with 2-stage total hip arthroplasty. Medicine (Baltimore) 2016; 95:e4168. [PMID: 27399138 PMCID: PMC5058867 DOI: 10.1097/md.0000000000004168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an increasingly recognized entity. The hip joint is known as a less frequently affected site in SAPHO syndrome, and there has been limited reports about hip joint diseases caused by SAPHO syndrome, and as such adequate treatment for this disease spectrum is still not fully elucidated. CASE We describe the case of a 52-year-old man admitted for SAPHO syndrome who went on to be diagnosed with advanced secondary hip arthritis associated with disabling right hip pain. The diagnosis of SAPHO syndrome was delayed; the patient was given a clinical diagnosis of osteomyelitis and treated with prolonged courses of antibiotics and open surgical debridement at previous tertiary health facility. The patient underwent 2-stage joint replacement surgery in our hospital. At 1 year after the surgery, he is well, with minimal right hip pain and the prosthesis is functioning well. CONCLUSION This case shows the safety and effectiveness of the 2-stage joint replacement in treating destructive hip disease caused by SAPHO syndrome mimicking infectious arthritis.
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Affiliation(s)
- Ingwon Yeo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
- Correspondence: Seung-Jae Lim, Department of Orthopedic Surgery, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea ()
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