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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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2
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Li SWS, Roberts E, Hedrich C. Treatment and monitoring of SAPHO syndrome: a systematic review. RMD Open 2023; 9:e003688. [PMID: 38151265 PMCID: PMC10753757 DOI: 10.1136/rmdopen-2023-003688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Synovitis acne pustulosis hyperostosis osteitis (SAPHO) is a rare heterogeneous disease of unknown aetiopathology. Externally validated and internationally agreed diagnostic criteria or outcomes and, as a result, prospective randomised controlled trials in SAPHO are absent. Consequently, there is no agreed treatment standard. This study aimed to systematically collate and discuss treatment options in SAPHO. METHODS Following 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' guidance, a systematic literature search was conducted using PubMed, Scopus and Web of Science databases. Prospective clinical studies and retrospective case collections discussing management and outcomes in SAPHO involving five or more participants were included. Articles not published in English, studies not reporting defined outcomes, and studies solely relying on patient-reported outcomes were excluded. RESULTS A total of 28 studies (20 observational, 8 open-label clinical studies) reporting 796 patients of predominantly European ethnicity were included. Reported therapies varied greatly, with many centres using multiple treatments in parallel. Most patients (37.1%) received non-steroidal anti-inflammatory drugs alone or in combination. Bisphosphonates (22.1%), conventional (21.7%) and biological (11.3%) disease-modifying antirheumatic drugs were the next most frequently reported treatments. Reported outcomes varied and delivered mixed results, which complicates comparisons. Bisphosphonates demonstrated the most consistent improvement of osteoarticular symptoms and were associated with transient influenza-like symptoms. Paradoxical skin reactions were reported in patients treated with TNF inhibitors, but no serious adverse events were recorded. Most treatments had limited or mixed effects on cutaneous involvement. A recent study investigating the Janus kinase inhibitor tofacitinib delivered promising results in relation to skin and nail involvement. CONCLUSIONS No single currently available treatment option sufficiently addresses all SAPHO-associated symptoms. Variable, sometimes descriptive outcomes and the use of treatment combinations complicate conclusions and treatment recommendations. Randomised clinical trials are necessary to generate reliable evidence.
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Affiliation(s)
- Sophie W S Li
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Eve Roberts
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Christian Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
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3
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Khodeir M, Poerio A, Colina M. 68Ga-FAPI-04 PET/CT in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome. Clin Nucl Med 2023:00003072-990000000-00849. [PMID: 38049977 DOI: 10.1097/rlu.0000000000005005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
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4
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Anwer Khan SE, Khattak UM, Nousherwani MD. A Case Report on the Atypical Symptoms of the Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome: Could COVID-19 Be a Cause? Cureus 2023; 15:e41498. [PMID: 37551213 PMCID: PMC10404349 DOI: 10.7759/cureus.41498] [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: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a rare disorder with a spectrum of manifestations and overlapping osseous and cutaneous symptoms, shares pathogenesis with various autoimmune diseases. SARS-CoV-2 has been previously linked to various autoimmune diseases like Guillain-Barré syndrome (GBS), a multi-inflammatory syndrome in children (MIS-C), or rheumatoid arthritis, but there is no existing work showing a link between SAPHO syndrome and COVID-19 yet. Here, we present a case of a middle-aged Asian male who presented with minimum swelling of his right second toe, 21 days post-COVID. After a series of investigations, namely, MRI scans, 99mTc-methylene diphosphonate three-phase bone scan, and bone biopsy, followed by a positive culture and sensitivity test of the same toe, a trial of vancomycin was given to the patient to treat bacterial osteomyelitis. This resulted in no improvement, pointing toward a misdiagnosis. A conclusion of sterile osteomyelitis of his right second and third metatarsal heads and phalanges due to SAPHO syndrome, as a possible complication of SARS-CoV-2 infection, was made. There are a number of classification systems for diagnosing this syndrome, one of which was modified by Kahn and was used in our case. Atypical presentations of rare disorders like SAPHO syndrome and their relation to SARS-CoV-2 infection are still to be fully discovered and investigated. Their prevention, timely diagnosis, and management may help in alleviating the discomfort and fear associated with the unknown for the patients.
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Affiliation(s)
- Saira E Anwer Khan
- Rheumatology, Shalamar Hospital/Shalamar Institute of Health Sciences, Lahore, PAK
| | - Umaima M Khattak
- Internal Medicine, Shalamar Hospital/Shalamar Institute of Health Sciences, Lahore, PAK
| | - Maira D Nousherwani
- Internal Medicine, Shalamar Hospital/Shalamar Institute of Health Sciences, Lahore, PAK
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5
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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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Yousaf A, Muhammad S, Abdelazeem B, Alam SI, Elsyaed AM. Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO): A Case Report. Cureus 2021; 13:e19636. [PMID: 34956762 PMCID: PMC8676056 DOI: 10.7759/cureus.19636] [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] [Accepted: 11/16/2021] [Indexed: 11/07/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is an uncommon adulthood disorder that presents as focal swellings and pain accompanied by abnormal changes in bone and surrounding soft tissues. X-rays of the involved region are usually insignificant; however, CT and MRI show excellent visualization of the affected structures. Typical radiological images show cortical thickening leading to decreased marrow cavity, bony erosion, and ligament ossifications. Other associated findings are synovitis and joint effusions. It is usually diagnosed on the basis of clinical as well as radiological findings. The treatment initially relies on non-steroidal anti-inflammatory drugs (NSAIDs). Patients showing poor response are started on corticosteroids and disease-modifying antirheumatic drugs (DMARDs). We report two patients who presented with joint swellings. Their workup unmasked the underlying SAPHO, which was managed well with NSAIDs.
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Affiliation(s)
- Amman Yousaf
- Internal Medicine, McLaren Flint, Flint, USA.,Radiology, Services Institute of Medical Sciences, Lahore, PAK
| | - Shoaib Muhammad
- Department of Urology, Ghulab Devi Hospital, Al-Aleem Medical College, Lahore, PAK
| | | | | | - Ahmed Mounir Elsyaed
- Orthopaedics, Weill Cornell School of Medicine - Qatar, Doha, QAT.,Orthopaedics Surgery, Hamad Medical Corporation, Doha, QAT
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Nedley A, Ramos O, Zuppan C, Wongworawat YC, Danisa O. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome presenting with a cervical vertebral fracture: A case report. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 5:100050. [PMID: 35141616 PMCID: PMC8820063 DOI: 10.1016/j.xnsj.2021.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Allen Nedley
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, United States
| | - Omar Ramos
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, United States
- Corresponding author.
| | - Craig Zuppan
- Department of Pathology, Loma Linda University, Loma Linda, CA, United States
| | - Yan C. Wongworawat
- Department of Pathology, Loma Linda University, Loma Linda, CA, United States
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, United States
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8
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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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Andreasen CM, Jurik AG, Deleuran BW, Horn HC, Folkmar TB, Herlin T, Hauge EM. Pamidronate in chronic non-bacterial osteomyelitis: a randomized, double-blinded, placebo-controlled pilot trial. Scand J Rheumatol 2020; 49:312-322. [PMID: 32484386 DOI: 10.1080/03009742.2020.1724324] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This is the first randomized double-blinded, placebo-controlled pilot trial to investigate the efficacy of pamidronate in reducing radiological and clinical disease activity in chronic non-bacterial osteomyelitis (CNO). METHOD Patients received pamidronate or placebo at baseline and weeks 12 and 24. Whole-body magnetic resonance imaging was performed at baseline and weeks 12 and 36, and computed tomography of the anterior chest wall (ACW) at baseline and week 36. Radiological disease activity was systematically scored in the ACW and spine. Patient-reported outcomes [visual analogue scale (VAS) pain, VAS global health, Health Assessment Questionnaire (HAQ), EuroQol-5 Dimensions (EQ-5D), and 36-item Short-Form Health Survey (SF-36)] and biomarkers of bone turnover and inflammation were assessed at baseline and weeks 1, 4, 12, 24, and 36. Data are expressed as median [interquartile range]. RESULTS Fourteen patients were randomized and 12 were analysed. From baseline to week 36, the radiological disease activity score in the ACW decreased from 5 [4-7] to 2.5 [1-3] in the pamidronate group, but did not change in the placebo group (p = 0.04). From baseline to week 36, VAS pain and VAS global health tended to decrease more in the pamidronate than in the placebo group (p = 0.11, p = 0.08). Physical functioning (HAQ) and health-related quality of life (EQ-5D, SF-36) did not change. Biomarkers of bone turnover decreased only in the pamidronate group (p ≤ 0.02). CONCLUSION Pamidronate may improve radiological and clinical disease activity in CNO. Methods to score radiological disease activity in adult CNO were suggested. Clinical Trials: NCT02594878.
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Affiliation(s)
- C M Andreasen
- Department of Rheumatology, Aarhus University Hospital , Aarhus, Denmark
| | - A G Jurik
- Department of Radiology, Aarhus University Hospital , Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University , Aarhus, Denmark
| | - B W Deleuran
- Department of Rheumatology, Aarhus University Hospital , Aarhus, Denmark.,Department of Biomedicine, Aarhus University , Aarhus, Denmark
| | - H C Horn
- Department of Rheumatology, Odense University Hospital , Odense, Denmark
| | - T B Folkmar
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital , Aarhus, Denmark
| | - T Herlin
- Department of Clinical Medicine, Aarhus University , Aarhus, Denmark.,Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital , Aarhus, Denmark
| | - E M Hauge
- Department of Rheumatology, Aarhus University Hospital , Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University , Aarhus, Denmark
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10
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Hirosawa T, Kawamoto S, Shimizu T. SAPHO syndrome. BMJ Case Rep 2019; 12:12/12/e233221. [PMID: 31796447 DOI: 10.1136/bcr-2019-233221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Takanobu Hirosawa
- Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Shun Kawamoto
- Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Taro Shimizu
- Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
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11
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Daoussis D, Konstantopoulou G, Kraniotis P, Sakkas L, Liossis SN. Biologics in SAPHO syndrome: A systematic review. Semin Arthritis Rheum 2019; 48:618-625. [DOI: 10.1016/j.semarthrit.2018.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/30/2018] [Accepted: 04/16/2018] [Indexed: 02/08/2023]
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12
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Steen C, Durgakeri P. Chest pain that does not make the cut: a case study of a surgical patient with Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis syndrome. ANZ J Surg 2018; 89:1672-1674. [PMID: 30239087 DOI: 10.1111/ans.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/26/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher Steen
- Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Pramod Durgakeri
- Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
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13
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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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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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15
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Abstract
Neutrophilic dermatoses are a group of inflammatory skin disorders characterized by an overactive innate immune system with dysregulation of neutrophils without underlying infectious etiology. The major representative conditions discussed are Sweet syndrome; pyoderma gangrenosum; neutrophilic eccrine hidradenitis; palmoplantar eccrine hidradenitis; subcorneal pustular dermatoses; bowel-associated dermatosis arthritis syndrome; and synovitis, acne, pustulosis, hyperostosis, and osteitis. We will also discuss other neutrophilic conditions present almost exclusively in the pediatric population, including congenital erosive and vesicular dermatosis with reticulated supple scarring and the recently described group of autoinflammatory diseases. The clinical characteristics, diagnostic approach, and treatment management in the pediatric and adult population are discussed.
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Affiliation(s)
- Grace L Lee
- Department of Pediatrics and Dermatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Amy Y-Y Chen
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT.
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16
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Wendling D, Aubin F, Verhoeven F, Prati C. IL-23/Th17 targeted therapies in SAPHO syndrome. A case series. Joint Bone Spine 2017; 84:733-735. [PMID: 28532819 DOI: 10.1016/j.jbspin.2017.05.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022]
Abstract
SAPHO syndrome is a rare entity with skin and rheumatologic inflammatory presentation. The treatment is not standardized, and in case of inadequate response to anti-inflammatory drugs, the use of anti-TNF or anti-IL-1 biologic treatments has been reported. The IL-23/Th17 axis may be involved in SAPHO syndrome. We report the results of six courses of IL-23 and IL-17 targeted therapies (3 ustekinumab and 3 secukinumab) in patients with SAPHO syndrome unresponsive to previous treatments (csDMARDs and bDMARDs). With a mean treatment duration of 5.5 months, improvement of skin symptoms was noticed in three cases, one improvement with secukinumab and two remissions (one with secukinumab, one with ustekinumab). Regarding the rheumatic symptoms, no major improvement was obvious under any of the six treatment courses. No particular safety concerns were reported, except cases of paradoxical psoriasis flare in one under ustekinumab and the other case under secukinumab.
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Affiliation(s)
- Daniel Wendling
- Department of Rheumatology, CHRU de Besançon and université Bourgogne Franche-Comté, 25030 Besançon, France.
| | - François Aubin
- Department of Dermatology, CHRU de Besançon and université Bourgogne Franche-Comté, 25030 Besançon, France
| | - Frank Verhoeven
- Department of Rheumatology, CHRU de Besançon and université Bourgogne Franche-Comté, 25030 Besançon, France
| | - Clément Prati
- Department of Rheumatology, CHRU de Besançon and université Bourgogne Franche-Comté, 25030 Besançon, France
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Nishimura T, Kikuta S, Ishihara S, Nakayama S. Heart failure complicating with SAPHO syndrome. BMJ Case Rep 2017; 2017:bcr-2016-218605. [PMID: 28232375 DOI: 10.1136/bcr-2016-218605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 65-year-old man was referred to our hospital with dyspnoea due to acute heart failure. He presented with swelling in the left clavicle and pustulosis on both soles. An antihypertensive drug and non-invasive positive pressure ventilation improved his condition rapidly. Since all his physical symptoms were compatible with the criteria of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteomyelitis) syndrome, we suspected that the SAPHO syndrome might cause acute heart failure. The aetiology between SAPHO syndrome and heart failure is unclear. Further studies are needed to clarify their relationship.
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Zimmermann P, Curtis N. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome - A challenging diagnosis not to be missed. J Infect 2016; 72 Suppl:S106-14. [PMID: 27263075 DOI: 10.1016/j.jinf.2016.04.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
SAPHO syndrome manifests as chronic inflammation of bones and joints, which may or may not be accompanied by skin changes. The term SAPHO is an acronym that stands for synovitis, acne, pustulosis (usually palmoplantar), hyperostosis and osteitis. The bones most commonly affected are those in the anterior chest wall (mainly the sternum, clavicles and sternocostoclavicular joints), the vertebrae and the sacroiliac joints, but peripheral and flat bones may also be involved, especially in children. There are no validated diagnostic criteria for SAPHO, and diagnosis is based on clinical and radiological findings. One of the main challenges in diagnosis is that the clinical features may occur many years apart. Additionally, patients may not develop all manifestations. Delayed diagnosis, as a result of a lack of awareness of SAPHO, can lead to patients suffering ongoing pain and disfiguring skin manifestations. One theory is that Propionibacterium acnes (isolated from bone biopsies in many SAPHO patients) triggers an auto-immune mediated chronic inflammation in genetically predisposed individuals. Treatment involves the use of nonsteroidal anti-inflammatory drugs, intra-articular steroids, bisphosphonates and biologicals. The course of SAPHO is often prolonged but, despite the challenges in diagnosis and treatment, the long-term prognosis is good.
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Affiliation(s)
- Petra Zimmermann
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases & Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Australia.
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Zwaenepoel T, Vlam KD. SAPHO: Treatment options including bisphosphonates. Semin Arthritis Rheum 2016; 46:168-173. [PMID: 27369452 DOI: 10.1016/j.semarthrit.2016.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/07/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Both the diagnosis and treatment of the syndrome of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) remain difficult. We describe a case series of 21 patients with SAPHO and their response to several pharmacological treatments. METHODS Clinical and biochemical data, along with medical imaging, were collected from the medical records of 21 patients, diagnosed as SAPHO during follow-up between 2005 and 2013. Symptoms and inflammatory markers were recorded twice, once at first patient presentation, and once at the end of follow-up. Synovitis, acne, pustulosis, hyperostosis, and osteitis were labeled as defining features. All treatment options were categorized according to their respective responses (full remission, partial remission, and no disease control). RESULTS There was a female predominance and a median age of 32 years (range: 12-54 years). Median follow-up duration was 45 months (range: 0-188 months). Total prevalence of defining features in this cohort increased for each defining feature during follow-up, except for acne. All patients reached full or partial remission at the end of follow-up. A total of 14 patients were treated with bisphosphonates. Of which 8 of them went into full or partial remission. DISCUSSION AND CONCLUSION In our case series, none of the patients had the full presentation of SAPHO at the first consultation. Some presented with symptoms suggestive for psoriatic arthritis. This explains why diagnosis of SAPHO can be challenging. Full remission was induced in the majority of individuals. Bisphosphonates seem to be a noteworthy treatment option. We suggest a prospective placebo-controlled clinical trial with bisphosphonates to confirm this observation.
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Affiliation(s)
- Tom Zwaenepoel
- Department of Rheumatology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Kurt de Vlam
- Department of Rheumatology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Sanna M, Firinu D, Manconi PE, Pisanu M, Murgia G, Piras V, Castagnola M, Messana I, del Giacco SR, Cabras T. The salivary proteome profile in patients affected by SAPHO syndrome characterized by a top-down RP-HPLC-ESI-MS platform. MOLECULAR BIOSYSTEMS 2016; 11:1552-62. [PMID: 25671558 DOI: 10.1039/c4mb00719k] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SAPHO syndrome is a rare and often unrecognized disease with prominent inflammatory cutaneous and articular symptoms characterized by musculoskeletal manifestations (synovitis, hyperostosis, osteomyelitis) associated with dermatological conditions (severe acne and pustulosis). The acidic soluble fraction of whole saliva from 10 adult women affected by SAPHO syndrome and from a group of 28 healthy women was analysed by RP-HPLC-ESI-MS with the aim of discovering salivary biomarkers of the disorder. The levels of the oral proteins and peptides were correlated with clinical data. The following proteins showed a significant decreased concentration in saliva of SAPHO subjects with respect to controls: cystatin S1 and SN, histatins, the major acidic PRPs, P-C and P-B peptides. The cystatin SN abundance lowered according to the disease duration and histatins showed positive correlations with the C reactive protein. Statistical analysis performed excluding one patient with a different pattern of salivary proteins/peptides highlighted a positive relationship between cystatin S1, histatins 3, histatin 5, and the neutrophil count. Moreover, histatin 3 correlated positively with the total white cell count and negatively with the erythrocyte sedimentation rate. Levels and frequency of S100A12 protein showed a trend to increase in SAPHO patients. The high expression of this pro-inflammatory protein is probably related to the inflammatory response and to the altered neutrophil responses to functional stimuli that characterize SAPHO syndrome suggesting a possible application as a salivary biomarker.
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Affiliation(s)
- Monica Sanna
- Department of Life and Environmental Sciences, Biomedical section, University of Cagliari, Monserrato Campus, 09042 Monserrato, CA, Italy.
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Divya BL, Rao PN. SAPHO syndrome with acne fulminans and severe polyosteitis involving axial skeleton. Indian Dermatol Online J 2016; 7:414-417. [PMID: 27730042 PMCID: PMC5038107 DOI: 10.4103/2229-5178.190495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), a rare inflammatory disorder, is an association of distinct skin disorders with pustules with osteoarticular inflammation. Its etiology remains unclear, and various treatment regimens frequently fail to control the disease. An 18-year-old male patient presented to the outpatient department with severe nodulocystic acne on the face with pain at both the wrists and lower back associated with high-grade fever and chills. On physical examination, he had severe tenderness at both wrist joints and lower back, along with swelling of right wrist. Magnetic resonance imaging revealed osteitis of the distal end of the right radius. Technetium-99m-MDP Whole Body Bone Scan revealed increased metaphyseal uptake in distal radius on both sides and prominent uptake at the sacroiliac joints, vertebral end plate, left 7th costo-vertebral joint and bilateral sternoclavicular joints and manubrium sternum (resulting in “bull's head” sign, which is characteristic of SAPHO syndrome). He responded very well to a combination therapy of nonsteroid anti-inflammatory drugs, antibiotics, colchicine, and isotretinoin over a 12-week period.
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Affiliation(s)
- B Lakshmi Divya
- Department of Dermatology, Bhaskar Medical College, Telangana, India
| | - P Narasimha Rao
- Department of Dermatology, Bhaskar Medical College, Telangana, India
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A Case of SAPHO Syndrome with Endodontic Implications and Treatment with Biologic Drugs. J Endod 2015; 41:1565-70. [DOI: 10.1016/j.joen.2015.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/06/2015] [Accepted: 04/09/2015] [Indexed: 11/21/2022]
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Garraud T, Barbarot S, Berthelot JM, Le Goff B. Occurrence of a granulomatous mastitis and aseptic osteitis after anti-TNF therapy in a patient with pustular psoriasis. Joint Bone Spine 2015; 83:107-8. [PMID: 26054447 DOI: 10.1016/j.jbspin.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas Garraud
- Service de rhumatologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 01, France
| | - Sébastien Barbarot
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 01, France
| | - Jean-Marie Berthelot
- Service de rhumatologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 01, France
| | - Benoit Le Goff
- Service de rhumatologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
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The SAPHO syndrome revisited with an emphasis on spinal manifestations. Skeletal Radiol 2015; 44:9-24. [PMID: 25331355 DOI: 10.1007/s00256-014-2025-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 09/17/2014] [Accepted: 09/28/2014] [Indexed: 02/02/2023]
Abstract
The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome includes a group of chronic, relapsing, inflammatory musculoskeletal disorders with similar manifestations, in particular synovitis, hyperostosis, and osteitis, which may or may not be associated with neutrophilic skin eruptions such as palmoplantar pustulosis and acne conglobata. The syndrome occurs at any age, can involve any skeletal site, and its imaging appearances are variable, depending on the stage/age of the lesion and imaging method. The diagnosis is difficult if there is no skin disease. Awareness of the imaging appearances, especially in the spine, may help the radiologist in avoiding misdiagnosis (e.g., infection, tumor) and unnecessary invasive procedures, while facilitating early diagnosis and selection of an effective treatment. In this article, we provide an overview of the radiological appearances of SAPHO syndrome, focusing on the magnetic resonance imaging findings of vertebral involvement, and present relevant clinical and pathological features that assist early diagnosis.
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Aljuhani F, Tournadre A, Tatar Z, Couderc M, Mathieu S, Malochet-Guinamand S, Soubrier M, Dubost JJ. The SAPHO syndrome: a single-center study of 41 adult patients. J Rheumatol 2014; 42:329-34. [PMID: 25512472 DOI: 10.3899/jrheum.140342] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) is a rare disease and only a few series have been published about it. We describe the experience of a rheumatology department with a focus on the therapeutic aspects. METHODS All cases of SAPHO fulfilling the Benhamou criteria and seen between 1992 and 2013 in our unit were retrospectively included. RESULTS Forty-one patients (11 men and 30 women) were included. The average age was 45 years (20-80 yrs) at the time of diagnosis. Nineteen patients had palmoplantar pustulosis, 3 had psoriasis vulgaris, 3 had severe acne, and 15 had no dermatological involvement. Bone symptoms involved mainly the anterior chest wall (n = 28, 68%), followed by the spine (n = 16, 39%) and sacroiliac joints (n = 12, 29%). Four patients had peripheral osteitis and 2 had mandibular osteitis. Ten patients had peripheral arthritis affecting mainly the knees and wrists. None of the 36 patients tested was HLA-B27-positive. At least a partial response was achieved with colchicine, methotrexate, or sulfasalazine in 0/6, 2/4, and 1/6 of patients, respectively. Antibiotic therapy (azithromycin, n = 7; doxycycline, n = 2) was effective in 2/9 patients. Pamidronate was prescribed in 26 patients with bone involvement and 18/22 patients evaluable at 6 months responded to this therapy. Two patients were treated with tumor necrosis factor blockers: 1 with infliximab and 1 with adalimumab, followed by etanercept. CONCLUSION Based on our experience, SAPHO can be diagnosed in the elderly. It was not associated with HLA-B27. Soft tissue involvement was common and the bisphosphonates were generally effective on bone involvement.
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Affiliation(s)
- Faisal Aljuhani
- From the Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.F. Aljuhani, MD; A. Tournadre, MD; Z. Tatar, MD; M. Couderc, MD; S. Mathieu, MD; S. Malochet-Guinamand, MD; M. Soubrier, MD, PhD; J-J. Dubost, MD; Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand
| | - Anne Tournadre
- From the Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.F. Aljuhani, MD; A. Tournadre, MD; Z. Tatar, MD; M. Couderc, MD; S. Mathieu, MD; S. Malochet-Guinamand, MD; M. Soubrier, MD, PhD; J-J. Dubost, MD; Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand
| | - Zuzana Tatar
- From the Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.F. Aljuhani, MD; A. Tournadre, MD; Z. Tatar, MD; M. Couderc, MD; S. Mathieu, MD; S. Malochet-Guinamand, MD; M. Soubrier, MD, PhD; J-J. Dubost, MD; Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand
| | - Marion Couderc
- From the Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.F. Aljuhani, MD; A. Tournadre, MD; Z. Tatar, MD; M. Couderc, MD; S. Mathieu, MD; S. Malochet-Guinamand, MD; M. Soubrier, MD, PhD; J-J. Dubost, MD; Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand
| | - Sylvain Mathieu
- From the Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.F. Aljuhani, MD; A. Tournadre, MD; Z. Tatar, MD; M. Couderc, MD; S. Mathieu, MD; S. Malochet-Guinamand, MD; M. Soubrier, MD, PhD; J-J. Dubost, MD; Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand
| | - Sandrine Malochet-Guinamand
- From the Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.F. Aljuhani, MD; A. Tournadre, MD; Z. Tatar, MD; M. Couderc, MD; S. Mathieu, MD; S. Malochet-Guinamand, MD; M. Soubrier, MD, PhD; J-J. Dubost, MD; Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand
| | - Martin Soubrier
- From the Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.F. Aljuhani, MD; A. Tournadre, MD; Z. Tatar, MD; M. Couderc, MD; S. Mathieu, MD; S. Malochet-Guinamand, MD; M. Soubrier, MD, PhD; J-J. Dubost, MD; Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand
| | - Jean-Jacques Dubost
- From the Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.F. Aljuhani, MD; A. Tournadre, MD; Z. Tatar, MD; M. Couderc, MD; S. Mathieu, MD; S. Malochet-Guinamand, MD; M. Soubrier, MD, PhD; J-J. Dubost, MD; Department of Rheumatology, Gabriel Montpied Hospital, Centre Hospitalier Universitaire de Clermont-Ferrand.
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Song X, Sun W, Meng Z, Gong L, Tan J, Jia Q, Yu C, Yu T. Diagnosis and treatment of SAPHO syndrome: A case report. Exp Ther Med 2014; 8:419-422. [PMID: 25009594 PMCID: PMC4079404 DOI: 10.3892/etm.2014.1758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/20/2014] [Indexed: 11/11/2022] Open
Abstract
The present study reports a rare case of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome in an adult male. The 42-year-old man complained of skin lesions, chest pain and lumbago. Laboratory evaluations demonstrated an elevated erythrocyte sedimentation rate and increased levels of C-reactive protein. Computerized tomography, bone scintigraphy and magnetic resonance imaging revealed multiple bone lesions. A diagnosis of SAPHO syndrome was made. Non-steroidal anti-inflammatory drugs, alendronate sodium and steroids were administered, which resulted in clinical improvement. The current case study demonstrates that skin manifestation and multiple imaging modalities are important in generating a definite diagnosis of SAPHO syndrome, and that early treatment is vital for a positive outcome.
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Affiliation(s)
- Xinghua Song
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Wenwen Sun
- Department of Rheumatology and Immunological Diseases, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Lu Gong
- Department of Rheumatology and Immunological Diseases, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Chunshui Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Tielian Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
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Naves JE, Cabré E, Mañosa M, Grados D, Olivé A, Domènech E. A systematic review of SAPHO syndrome and inflammatory bowel disease association. Dig Dis Sci 2013; 58:2138-47. [PMID: 23543087 DOI: 10.1007/s10620-013-2653-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/19/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND The association between inflammatory bowel disease (IBD) and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome (SAPHO syndrome) was first reported in 1992. To date, only case reports and short series have been published. AIMS The purpose of this study was to report new cases and systematically review the literature on this association. MATERIALS AND METHODS All patients with concomitant diagnosis of SAPHO syndrome and IBD were identified from the databases of the rheumatology and gastroenterology departments of our institution. In addition, we systematically searched for published full articles in Medlars Online International Literature via PubMed. Relevant information of each positive match was collected and all authors were contacted for additional clinical data. RESULTS Three patients sharing both SAPHO syndrome and IBD were identified among the 62 patients with SAPHO syndrome (4.8 % of the SAPHO cohort) and the 1,309 patients with IBD (0.2 % of the IBD cohort) from our hospital database. After a systematic review, a total of 39 reported patients with concomitant diagnosis of SAPHO syndrome and IBD were identified. There was a female predominance and most had Crohn's disease with colonic involvement. CONCLUSIONS The association of SAPHO syndrome and IBD seems to be rare among IBD patients but not so among SAPHO patients. SAPHO could be underdiagnosed because of the similarity of its clinical manifestations and some more common extraintestinal manifestations or drug-related side effects in IBD.
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Affiliation(s)
- Juan E Naves
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Ctra. del Canyet s/n, 08916, Badalona, Catalonia, Spain
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Kodama Y, Tanaka R, Kurokawa A, Ohnuki H, Sultana S, Hayashi T, Iizuka T, Takagi R. Severe destruction of the temporomandibular joint with complete resorption of the condyle associated with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e128-33. [PMID: 23664782 DOI: 10.1016/j.oooo.2013.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 02/26/2013] [Accepted: 03/06/2013] [Indexed: 11/16/2022]
Abstract
The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome consists of a combination of inflammatory bone disorders and dermatologic pathology. Bone lesions as a form of diffuse sclerosing osteomyelitis in the mandible occur in the posterior body and ramus. Bone lesions rarely spread to the temporomandibular joint (TMJ) where ankylosis may result. Herein we present an unusual case of SAPHO syndrome with TMJ involvement in which severe destruction of the TMJ occurred. We observed an extension of the invasive soft tissue lesion into the infratemporal fossa from the TMJ with complete resorption of the condyle. In contrast to other previously reported cases, in our case the condyle was strongly suspected as the primary site of the bone lesion with subsequent extension to the ramus and infratemporal fossa. The destructive nature and related symptoms resembled a malignant tumor.
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Affiliation(s)
- Yasumitsu Kodama
- Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Abstract
SAPHO syndrome is a disorder characterized by Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis. As the osteoarticular and skin manifestations often do not occur simultaneously and there are no validated diagnostic criteria, the diagnosis can be difficult. Clinical and imaging investigation is necessary to establish the many differential diagnoses of SAPHO syndrome. The etiopathogenesis involves infectious (probably Propionibacterium acnes), immunologic, and genetic factors. Treatment is based on information gathered from case reports and small series, and is related to specific skin or articular symptoms.
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Affiliation(s)
- Sueli Carneiro
- State University of Rio de Janeiro - Rua Farme de Amoedo 140/601, Ipanema, Rio de Janeiro 22420-020, Brazil
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Anić B, Padjen I, Barešić M, Težak S. The lobster sign in SAPHO syndrome: unusually extensive osteitis of the anterior chest wall partially responsive to infliximab. Rheumatol Int 2012; 34:281-2. [DOI: 10.1007/s00296-012-2606-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 12/08/2012] [Indexed: 11/30/2022]
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Sweeney SA, Kumar VA, Tayar J, Weber DM, Safdar A, Alonso C, Hymes S. Case 181: synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome. Radiology 2012; 263:613-7. [PMID: 22517965 DOI: 10.1148/radiol.12101436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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The SAPHO syndrome--are microbes involved? Best Pract Res Clin Rheumatol 2012; 25:423-34. [PMID: 22100290 DOI: 10.1016/j.berh.2011.01.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 01/27/2011] [Indexed: 01/18/2023]
Abstract
The syndrome of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) includes a rare group of chronic, relapsing, inflammatory osteoarticular disorders that is conventionally associated with manifestations in the skin. Diagnostic dilemmas can arise due to incomplete manifestations or confusion generated through mimicking of other conditions, such as osteomyelitis. The aetiology of this syndrome remains unclear, but probably involves genetic, immunological and infectious mechanisms. The possible pathogenetic role of infectious agents in genetically predisposed individuals, resulting in a 'reactive osteitis', has been suggested because microbes such as Propionibacterium acnes have been recovered from bone biopsy samples. However, this hypothesis has not been demonstrated as yet. Current knowledge with regard to treatment of this syndrome is based on results reported from small case studies and, thus, is still empiric. The use of antibiotics, instituted based on the isolation of Propionibacterium acnes, has been reported to show conflicting results. Promising results for potential future application have recently been reported for treatment of SAPHO with bisphosphonates and antagonists of tumour necrosis factor-α. This review aims to evaluate the existing knowledge on the SAPHO syndrome and to provide information on symptoms, diagnosis and treatment options for this disease.
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Queiro R, Alonso S, Alperi M, Fernández M, Tejón P, Riestra JL, Arboleya L, Ballina J. Entheseal ultrasound abnormalities in patients with SAPHO syndrome. Clin Rheumatol 2012; 31:913-9. [PMID: 22349879 DOI: 10.1007/s10067-012-1959-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/23/2011] [Accepted: 02/03/2012] [Indexed: 11/26/2022]
Abstract
This study was conducted to investigate the presence and characteristics of the ultrasound lesions that may be found in the entheses of patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. This cross-sectional study included 15 patients with SAPHO syndrome and 30 healthy controls matched for age, sex and body mass index. Subjects with regular sport activities as well as those with other rheumatic conditions were excluded from the study. Ultrasonography was used in both groups to study 14 entheses of the upper and lower extremities. Different elementary lesions representative of enthesis damage were defined. A total of 210 entheses in the study group and 420 in the control group were evaluated. Only one patient presented clinical enthesitis. In the study group, seven of the 15 patients (47%) showed morpho-structural entheseal alterations, versus only four of the 30 controls (13.3%; p < 0.001). The subjects with SAPHO showed ultrasound alterations in 32/210 entheses (15%), while the controls showed alterations in 20/420 entheses (4.8%), p < 0.001. The entheses with the largest number of morpho-structural alterations were those of the patellar and Achilles tendon. None of the controls showed power Doppler signal at enthesis or perienthesis level. Ultrasound evidence of enthesopathy seems to be a common feature in this series of patients with SAPHO syndrome.
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Affiliation(s)
- Rubén Queiro
- Department of Rheumatology, Hospital Universitario Central de Asturias, C/ Celestino Villamil s/n, Oviedo, Spain.
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Kim YJ, Bae SI, Choi SJ, Lee YH, Ji JD, Song GG. A Case of Refractory SAPHO Syndrome Treated with Etanercept. JOURNAL OF RHEUMATIC DISEASES 2012. [DOI: 10.4078/jrd.2012.19.1.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ye Ji Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Song I Bae
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jong Dae Ji
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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Depasquale R, Kumar N, Lalam RK, Tins BJ, Tyrrell PNM, Singh J, Cassar-Pullicino VN. SAPHO: What radiologists should know. Clin Radiol 2011; 67:195-206. [PMID: 21939963 DOI: 10.1016/j.crad.2011.08.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 08/09/2011] [Accepted: 08/10/2011] [Indexed: 11/17/2022]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is an umbrella acronym for inflammatory clinical conditions whose common denominator is aseptic osteoarticular involvement with characteristic skin lesions. It involves all ages, can involve any skeletal site, and has variable imaging appearances depending on the stage/age of the lesion and imaging method. It mimics important differentials including infection and neoplasia. Awareness of the imaging features, especially in the spine, facilitates early diagnosis, prevents repeated biopsies, and avoids unnecessary surgery, while initiating appropriate treatment.
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Affiliation(s)
- R Depasquale
- Radiology Department, Robert Jones and Agnes Hunt Orthopaedic and District Hospitals NHS Trust, Gobowen, Oswestry, Shropshire, UK
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McPhillips A, Wolford LM, Rodrigues DB. SAPHO syndrome with TMJ involvement: review of the literature and case presentation. Int J Oral Maxillofac Surg 2010; 39:1160-7. [PMID: 20832246 DOI: 10.1016/j.ijom.2010.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 07/01/2010] [Accepted: 07/27/2010] [Indexed: 11/26/2022]
Abstract
Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare group of sterile, inflammatory osteoarticular disorders classically associated with skin manifestations. The etiology is unknown but probably involves genetic, infectious, and immunological components. The characteristic feature of the disease is found in the bone lesions, which typically involve the anterior chest wall and axial skeleton. In the literature review, six case reports discussed involvement of the TMJ. Treatment of SAPHO is geared toward symptom management as there is no cure. Surgery for mandibular lesions is usually a last resort as results are reported to be temporary with symptoms recurring within a year. Surgery appears to be performed early after diagnosis of TMJ related pathology; probably because lesions affecting the TMJ involve some limitation in mouth opening with varying degrees of ankylosis. The authors provide a literature review and describe a case of SAPHO syndrome with ankylosis of the left TMJ. The patient was treated with joint reconstruction using a patient-fitted total joint prosthesis (TMJ Concepts Inc., Ventura CA) in single stage surgery. This paper is the first to report maxillary involvement in SAPHO syndrome.
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Affiliation(s)
- A McPhillips
- Department of Oral and Maxillofacial Surgery, Baylor College of Dentistry, Texas A&M University System, Baylor University Medical Center, Dallas, TX, USA
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van der Kloot WA, Hamdy NAT, Hafkemeijer LCS, den Dulk FMC, Chotkan SA, van Emmerik AAP, Kaptein AA. The psychological burden of an initially unexplained illness: patients with sternocostoclavicular hyperostosis before and after delayed diagnosis. Health Qual Life Outcomes 2010; 8:97. [PMID: 20828391 PMCID: PMC2954978 DOI: 10.1186/1477-7525-8-97] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 09/09/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sternocostoclavicular hyperostosis (SCCH) is a rare, debilitating, chronic inflammatory disorder of the anterior chest wall due to a chronic sterile osteomyelitis of unknown origin. SCCH is largely underdiagnosed and often misdiagnosed. In individual cases it can remain unrecognized for years. The purpose of this study is twofold. Firstly, to evaluate the psychological condition of SCCH patients, both in the sometimes quite extended pre-diagnostic period between first manifestations and confirmed diagnosis of the disease, and in the current situation. Secondly, to investigate the relationships between the pre-diagnostic and the current psychological conditions of confirmed SCCH patients. METHODS Structured interviews were held with 52 confirmed SCCH patients. Questionnaires were included to assess posttraumatic stress symptoms, social support, aspects of pain, illness perceptions, self-reported health status, and quality of life. RESULTS SCCH patients reported stronger posttraumatic stress symptoms, more unfavorable illness perceptions, lower health status, and poorer quality of life than healthy individuals and patients with other diseases or traumatic experiences. Psychological distress in the pre-diagnostic period was associated with unfavorable conditions in the current situation. CONCLUSION SCCH is an illness with serious psychological consequences. Psychological monitoring of patients with unexplained complaints is recommended as long as a diagnosis has not been reached.
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Affiliation(s)
| | - Neveen AT Hamdy
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center (LUMC), The Netherlands
| | | | | | - Sadhna A Chotkan
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center (LUMC), The Netherlands
| | | | - Ad A Kaptein
- Unit of Psychology, Leiden University Medical Center (LUMC), The Netherlands
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Abstract
The understanding of the genetic and immunological basis of human periodic fever syndromes, in particular cryopyrin-associated periodic syndromes (CAPS), has led to important new insights into the pathogenesis of monogenic and complex interleukin-1beta-associated autoinflammatory diseases. Currently the focus of attention is on the nucleotide-binding oligomerization domain (NOD)-like receptors (NLR), which take part in the regulation of the synthesis and maturation of cytokines in the IL-1 families, NOD-signalosomes and inflammasomes.
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Siau K, Laversuch CJ. SAPHO syndrome in an adult with ulcerative colitis responsive to intravenous pamidronate. Joint Bone Spine 2010; 77:176-7. [DOI: 10.1016/j.jbspin.2009.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 05/27/2009] [Indexed: 11/25/2022]
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van der Kloot WA, Chotkan SA, Kaptein AA, Hamdy NAT. Diagnostic delay in sternocostoclavicular hyperostosis: Impact on various aspects of quality of life. Arthritis Care Res (Hoboken) 2010; 62:251-7. [DOI: 10.1002/acr.20075] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Grosjean C, Hurtado-Nedelec M, Nicaise-Roland P, Ferreyra-Dillon R, Bollet C, Quintin E, Dieude P, Palazzo E, Wattiaux MJ, Kahn MF, Meyer O, Chollet-Martin S, Hayem G. Prevalence of autoantibodies in SAPHO syndrome: a single-center study of 90 patients. J Rheumatol 2010; 37:639-43. [PMID: 20110527 DOI: 10.3899/jrheum.090863] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the prevalence of the most often tested autoantibodies in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. METHODS We identified 90 patients seen in our unit between June 2002 and June 2009, and diagnosed according to the proposed criteria for SAPHO syndrome. Demographic and clinical data were collected as well as immunological results, including antinuclear, antithyroid peroxydase (TPO), antithyroid globulin (Tg), antigastric parietal cell, antismooth muscle, antimitochondria, and anti-liver-kidney microsome (LKM) antibodies. Anticyclic citrullinated peptide (CCP) antibodies were analyzed in 69 patients, antibodies to soluble extractable nuclear antigens in 43, anti-double-stranded DNA (dsDNA) antibodies in 22 [depending on the type of fluorescence of antinuclear antibody (ANA)], and antiendomysium antibodies in 55. RESULTS Autoantibodies were found in 20 patients (22.2%): 14 patients (15.5%) had positive ANA (titer >/= 1/160); among them, 10 (11%) patients never took a lupus-inducing drug. Antithyroid antibodies (anti-TPO and/or anti-Tg antibodies) were found in only 3 patients (3.3%). Three patients (3.3%) were positive for antigastric parietal cell antibodies and 4 (4.4%) were weakly positive for antismooth muscle antibodies. Antimitochondria and LKM antibodies were negative in all 90 patients. Anti-CCP and anti-dsDNA antibodies were negative in the 69 and 22 patients tested, respectively. One out of 43 patients (2.3%) had anti-SSA antibodies. Antiendomysium antibodies were negative in the 55 patients tested. CONCLUSION Our study indicates an increased prevalence of autoantibodies in SAPHO syndrome, with no specific profile. We failed to confirm the reports of an increased prevalence of antithyroid antibodies. These results tend to support a link between autoimmunity and SAPHO syndrome.
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Affiliation(s)
- Céline Grosjean
- Department of Rheumatology and Department of Immunology, Bichat Teaching Hospital, Paris, France
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Magrey M, Khan MA. New insights into synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Curr Rheumatol Rep 2009; 11:329-33. [PMID: 19772827 DOI: 10.1007/s11926-009-0047-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In 1987, synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome was proposed as an umbrella term for a group of diseases with similar musculoskeletal manifestations, in particular hyperostosis of anterior chest wall, synovitis, and multifocal aseptic osteomyelitis, observed in association with dermatologic conditions such as palmoplantar pustulosis, severe acne, and hidradenitis suppurativa. Despite recent advances in our understanding of the epidemiologic, pathophysiologic, and immunogenetic mechanisms involved in SAPHO syndrome, etiopathogenesis remains poorly understood. Propionibacterium acnes, the microorganism associated with acne, has been recovered on bone biopsy in some patients, but the possible pathogenetic role of an infectious agent in a genetically predisposed individual, resulting in exaggerated inflammatory response as "reactive osteitis," is a largely unproven hypothesis. The newly available whole-body MRI will assist early diagnosis by detecting multifocal osteitis lesions, some of them asymptomatic, in axial (anterior chest wall, spine, and jaws) and nonaxial sites. Moreover, outcomes are vastly improved by treatment with bisphosphonates and tumor necrosis factor-alpha antagonists.
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Affiliation(s)
- Marina Magrey
- Division of Rheumatology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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Rozin AP. SAPHO syndrome: is a range of pathogen-associated rheumatic diseases extended? Arthritis Res Ther 2009; 11:131. [PMID: 19895718 PMCID: PMC3003498 DOI: 10.1186/ar2837] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SAPHO syndrome, representing a constellation of synovitis, acne, palmo-plantar pustulosis, hyperostosis, and osteitis, is now recognized as a distinct medical entity: a reactive infectious osteitis. Genetic, immunological, and bacterial mechanisms are implicated in the development of the disease. Diagnostic problems may arise due to non-complete manifestations of SAPHO: either acne and arthritis or acne and anterior wall osteitis with an unclear pustulosis history. The interventional study of Assmann et al. is a significant addition to a long range of publications showing an association of SAPHO with Propionibacterium acnes. Randomized control studies are needed to confirm the effects of antibiotic therapy.
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Mishriki YY. Puzzles in practice. Syndrome of synovitis, acne, pustulosis, hyperostosis, and osteitis. Postgrad Med 2009; 121:190-2. [PMID: 19820290 DOI: 10.3810/pgm.2009.09.2068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yehia Y Mishriki
- Penn State University College of Medicine, Allentown, PA 18103, USA.
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Eyigör S, Karapolat H, Adanur H, Kirazli Y. SAPHO syndrome with adrenal deficiency: a case report. CASES JOURNAL 2009; 2:6281. [PMID: 20184675 PMCID: PMC2827074 DOI: 10.1186/1757-1626-0002-0000006281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 07/23/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteomyelitis) is a rare painful disorder, usually with a good long-term prognosis. Its etiology remains unclear, and various treatment regimens frequently fail to control the disease. CASE PRESENTATION A 46-year-old Caucasian female was referred for anterior chest wall and back pain. Physical examination was unremarkable except for skin lesions noted on soles of both feet, extremities and the face. A thoracic magnetic resonance imaging study demonstrated a lesion characterized with bone marrow edema and proliferation of soft tissue in the sternum. A brain MRI was requested secondary to the elevated prolactin level which was compatible with empty sella syndrome. CONCLUSION The case presented here has the unique feature of adrenal deficiency presenting alongside the SAPHO syndrome and is presented as the first case reported. This syndrome could become complicated with different organ system involvement other than bone and skin. There is a need further studies that will explore the weak relationship between SAPHO syndrome and adrenal deficiency.
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Affiliation(s)
- Sibel Eyigör
- Physical Therapy and Rehabilitation Department, Ege University Faculty of Medicine, 35100 Bornova, Izmir, Turkey
| | - Hale Karapolat
- Physical Therapy and Rehabilitation Department, Ege University Faculty of Medicine, 35100 Bornova, Izmir, Turkey
| | - Hilal Adanur
- Physical Therapy and Rehabilitation Department, Ege University Faculty of Medicine, 35100 Bornova, Izmir, Turkey
| | - Yeşim Kirazli
- Physical Therapy and Rehabilitation Department, Ege University Faculty of Medicine, 35100 Bornova, Izmir, Turkey
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Colina M, Govoni M, Orzincolo C, Trotta F. Clinical and radiologic evolution of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: a single center study of a cohort of 71 subjects. ACTA ACUST UNITED AC 2009; 61:813-21. [PMID: 19479702 DOI: 10.1002/art.24540] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the basic features and outcomes of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. METHODS We identified all patients seen in our unit between 1990 and 2008 diagnosed according to the proposed inclusion criteria with SAPHO syndrome, who had a followup of at least 2 years. RESULTS Seventy-one patients (48 women, 23 men) with SAPHO syndrome were identified. The median disease duration at the end of followup was 10 years (interquartile range [IQR] 7-15 years), and the median followup duration was 11 years (IQR 6-11.5 years). Six patients were diagnosed with Crohn's disease. Fourteen patients had never had cutaneous involvement, but 8 patients presented >1 skin manifestation. Nine patients (13%) presented a limited (<6 months) monophasic disease course, 25 cases (35%) had a relapsing-remitting course, and 37 patients (52%) had an acute painful phase with a prolonged course lasting >6 months. A total of 4% of the patients were HLA-B27 positive. Female sex (odds ratio [OR] 7.2, 95% confidence interval [95% CI] 2.2-22.9) and the presence at onset of anterior chest wall (ACW) involvement (OR 5.7, 95% CI 1.8-18.1), peripheral synovitis (P = 0.0036), skin involvement (OR 10.3, 95% CI 3.4-31.1), and high values of acute-phase reactants (OR 7.7, 95% CI 2.7-22) were correlated with a chronic disease course and involvement of new osteoarticular sites. CONCLUSION A chronic course is the more common evolution of SAPHO syndrome. Female sex, elevated erythrocyte sedimentation rate and C-reactive protein values, ACW involvement, peripheral synovitis, and skin involvement at the onset seem to be associated with a chronic course.
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Abstract
The syndrome of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) encompasses a broad spectrum of cutaneous manifestations associated with osteitic and hyperostotic lesions, which typically may involve the anterior chest wall (ACW). The aetiopathogenetic mechanisms as well as the nosographic framing of the disease are still not fully defined although an important role has been suggested for Propionibacterium acnes (P. acnes). This germ might be able to stimulate both the innate and the T-cell-mediated immune system. The elicited immunological response could be an attempt to eliminate the germ thus inducing the perpetuation of the inflammation. Whether the osteo-articular changes seen in SAPHO could be attributable directly to the infection or to an inflammatory reaction induced by pathogenic material remains a debated issue. The current concept of SAPHO syndrome as a reactive infectious osteitis in genetic predisposed subjects seems appealing, but it has not been yet demonstrated.
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Affiliation(s)
- Marcello Govoni
- Rheumatology Section, Department of Clinical and Experimental Medicine, University of Ferrara, Italy
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Hurtado-Nedelec M, Chollet-Martin S, Nicaise-Roland P, Grootenboer-Mignot S, Ruimy R, Meyer O, Hayem G. Characterization of the immune response in the synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. Rheumatology (Oxford) 2008; 47:1160-7. [PMID: 18559374 DOI: 10.1093/rheumatology/ken185] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The aetiology of SAPHO (synovitis, acne, palmoplantar pustulosis, hyperostosis, osteitis) syndrome seems to involve genetic, infectious and immunological components. We examined innate and adaptive immune responses in SAPHO syndrome, as compared with PsA and RA. We also studied the effect of etanercept on immunological parameters. METHODS We studied 29 patients with SAPHO syndrome, as well as 22 patients with RA, 21 patients with PsA and 15 healthy controls. Adaptive immune responses were investigated by assaying total serum immunoglobulins and several autoantibodies. Innate immunity was studied by quantifying blood PMN functions and plasma cytokine levels. PMN responses to Propionibacterium acnes were tested ex vivo. Eight patients who received etanercept for refractory rheumatic disorders were tested before and after 28 days of treatment. RESULTS SAPHO syndrome was associated with elevated IL-8 and IL-18 plasma levels. IL-8 and TNF-alpha production by purified PMN was higher in the three patient groups than in the healthy controls, but the oxidative burst and IL-18 production were normal. No autoantibodies were detected in SAPHO patients. Induction of PMN IL-8 and TNF-alpha production by P. acnes was impaired in the SAPHO group as compared with the RA and PsA groups. After 28 days of etanercept therapy, PMN IL-8 and TNF-alpha production was down-regulated and TNF-alpha plasma levels were increased. CONCLUSIONS These results support the view that the SAPHO syndrome may be triggered by an infectious state involving P. acnes, contributing to the strong humoral and cellular pro-inflammatory responses. Etanercept modulation of PMN activation status emphasizes these new immunological findings.
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Affiliation(s)
- M Hurtado-Nedelec
- Immunology, Auto-immunity and Hypersensibility Unit, AP-HP Bichat Claude Bernard Hospital, Paris, France
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