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Zhang C, Hou X, Lu S, Qian T, Meng F, Li M, Li C. SAPHO syndrome with involvement of the navicular, talus and heel bones. Rheumatology (Oxford) 2024; 63:e201. [PMID: 38290774 DOI: 10.1093/rheumatology/keae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Chen Zhang
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Siyi Lu
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tangliang Qian
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fanzhang Meng
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Meiling Li
- Department of Rheumatology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
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2
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Liu A, Mao C, Jiang H, Men L, Huang S, Li C, Ying Z. Clavicle fractures recur with extending to lumbar vertebrae in SAPHO syndrome. Int J Rheum Dis 2024; 27:e15217. [PMID: 38842293 DOI: 10.1111/1756-185x.15217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/05/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Aihui Liu
- Department of Rheumatology and Immunology, Center for General Practice Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chengliang Mao
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, Hangzhou, Zhejiang, China
- School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Hongyang Jiang
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Department of Radiology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Liying Men
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Shan Huang
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Jinzhou Medical University Zhejiang Provincial People's Hospital Postgraduate Training Base, Hangzhou, Zhejiang, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhenhua Ying
- Department of Rheumatology and Immunology, Center for General Practice Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Rheumatology and Immunology Research Institute, Hangzhou Medical College, Hangzhou, Zhejiang, China
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Sarikaya Solak S, Yelgen Ilyas H. Tofacitinib: a successful treatment option for SAPHO syndrome. Int J Dermatol 2024; 63:671-674. [PMID: 38357788 DOI: 10.1111/ijd.17075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/10/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Sezgi Sarikaya Solak
- Faculty of Medicine, Department of Dermatology, Trakya University, Edirne, Turkey
| | - Hande Yelgen Ilyas
- Faculty of Medicine, Department of Dermatology, Trakya University, Edirne, Turkey
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Qiu C, Li M, Wu Q, Zhou J, Liu T, Li J, Liu J, Cheng L, Hong Y, Luo D, Yan J, Pan W, Wang Z, Wang Q, Liu X, Wang L. A statistical symptomatic evaluation on SAPHO syndrome from 56 cases of confirmed diagnosis and 352 cases of non-SAPHO involvement. Clin Rheumatol 2024; 43:1763-1775. [PMID: 38446355 DOI: 10.1007/s10067-024-06887-7] [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: 08/10/2023] [Revised: 01/01/2024] [Accepted: 01/23/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To report a statistical evaluation of symptomatology based on 56 cases of SAPHO syndrome and 352 non-SAPHO involvement cases, to propose a symptomatic scoring system in consideration of early warning for SAPHO syndrome. METHODS A cohort comprising 56 subjects diagnosed with SAPHO syndrome was reported, as well as 352 non-SAPHO involvement cases, including their chief complaints, skin manifestations, radiological findings, and laboratory tests. We systematically reviewed previous published five representative huge cohorts from different countries to conclude several specific features of SAPHO by comparing with our case series. The score of each specific index is based on respective incidence and comparison of two cohorts was performed. RESULT In terms of complaint rates, all subjects of two cohorts suffered from osseous pain, which appeared in the anterior chest wall, spine, and limb which were calculated. In respect to dermatological lesions, SAPHO patients suffered from severe acne, and other patients (82.14%) accompanied with palmoplantar pustulosis. Having received radiological examinations, most SAPHO subjects rather than non-SAPHO involvement cases showed abnormal osteoarticular lesions under CT scanning and more detailed information under whole-body bone scintigraphy. Differences also emerged in elevation of inflammation values and rheumatic markers like HLA-B27. Based on our cases and huge cohorts documented, the early warning standard is set to be 5 scores. CONCLUSIONS SAPHO syndrome case series with 56 subjects were reported and an accumulative scoring system for the early reminder on SAPHO syndrome was proposed. The threshold of this system is set to be 5 points. Key Points • Fifty-six patients diagnosed by SAPHO syndrome with detailed symptoms and radiological findings were reported. • Comparison was made between the 56 SAPHO patients and 352 non-SAPHO involvement cases. • An accumulative scoring system for the early reminder on SAPHO syndrome was proposed and the threshold of this system is set to be five points.
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Affiliation(s)
- Cheng Qiu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Manyu Li
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Qingrong Wu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Jian Zhou
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Tianyi Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Jinghang Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Jingwei Liu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Lin Cheng
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Yu Hong
- Department of Radiology, the First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, 250014, People's Republic of China
| | - Dan Luo
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, People's Republic of China
| | - Jun Yan
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Wenping Pan
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, Jinan, Shandong, 250014, People's Republic of China
| | - Zhankui Wang
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, Jinan, Shandong, 250014, People's Republic of China.
| | - Qing Wang
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, Jinan, Shandong, 250014, People's Republic of China.
| | - Xinyu Liu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China.
| | - Lianlei Wang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China.
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Ferraioli M, Fiannacca L, Greco E, Cela E, Fatica M, Bergamini A, Chimenti MS. Risankizumab Efficacy in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Remission: A Case Report on Rheumatologic and Dermatologic Disease Manifestations with Literature Review. Case Reports Immunol 2024; 2024:9076852. [PMID: 38533274 PMCID: PMC10965285 DOI: 10.1155/2024/9076852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
SAPHO syndrome is a complex disease that encompasses both inflammatory arthritis and/or osteitis and dermatologic manifestations. It is considered a rare disease, in fact, no clinical trials have been conducted on its therapy and management. Therefore, therapeutic approach is based on small case studies. Here, we described the case of a 63-year-old woman affected by SAPHO syndrome, treated with the selective IL-23p19 antagonist, Risankizumab, after unsuccessful therapies with Methotrexate, Infliximab, Adalimumab, and an allergic reaction to Secukinumab. At the beginning of therapy, in November 2022, the patient presented with arthritis in both knees associated with palmar pustulosis and guttate psoriasis on the trunk. DAPSA score was 24, PtGA 80 mm, PASI score 11.1, and BSA 40%. Thereafter, Risankizumab was started at the standard dosage of 150 mg. At week 24 patient achieved clinical remission, DAPSA score was 8, PtGA was 30 mm, PASI was 1, and BSA 2.5. Patient maintained clinical remission state at the subsequent week 52 evaluation. At the same time, the patient did not report any adverse effects. Health-related quality of life was also assessed at the same time points aforementioned, showing significant improvement. In conclusion, this case report wants to point out the efficacy and safety of Risankizumab in SAPHO syndrome, reporting a sustained disease remission through a 12 months long follow-up period. We can consider IL-23p19 targeted therapy as a novel treatment option for SAPHO-with a high efficacy potential-especially on patients that have already been treated with other biologics.
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Affiliation(s)
- Mario Ferraioli
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Fiannacca
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Elisabetta Greco
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Eneida Cela
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Fatica
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Bergamini
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, Rome, Italy
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Fan D, Li F, Liu Z, Tang Z, Lv S. Successful Treatment of Refractory Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome and Paradoxical Psoriasis with Secukinumab: A Case Report. Clin Cosmet Investig Dermatol 2024; 17:547-552. [PMID: 38476341 PMCID: PMC10929232 DOI: 10.2147/ccid.s454057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic inflammatory disease mainly manifested as skin and osteoarticular lesions. Herein, we describe a female patient with SAPHO syndrome exhibited paradoxical psoriasis and primary palmoplantar pustulosis (PPP) worsened during treatment with adalimumab. We then switched to secukinumab and obtained significant improvement in both skin lesions and osteoarticular pain. These findings suggest that secukinumab might be an appropriate option for patients with SAPHO syndrome who present with TNF-α-inhibitor-induced paradoxical psoriasis.
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Affiliation(s)
- Danyang Fan
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, 130000, People’s Republic of China
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, 130000, People’s Republic of China
| | - Zhe Liu
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, 130000, People’s Republic of China
| | - Zhanhan Tang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, 130000, People’s Republic of China
| | - Sha Lv
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, 130000, People’s Republic of China
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Yang J, Yuan C, Zhou S, Teng Z, Li M. Successful Treatment of Refractory Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome with Baricitinib, a Janus Kinase Inhibitor. Clin Cosmet Investig Dermatol 2024; 17:529-537. [PMID: 38463557 PMCID: PMC10921886 DOI: 10.2147/ccid.s446468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a rare immune-mediated inflammatory disease, poses diagnostic and therapeutic challenges owing to its multi-system involvement, high heterogeneity, and lack of specific laboratory tests. Additionally, lacking evidence-based treatment recommendations, with the primary approach focusing on symptomatic relief. Herein, we report the case of a 32-year-old Chinese woman who presented with recurrent, generalized multiple osteoarticular pain lasting over one year and skin erythema pustulosis for 11 months. Traditional treatments, including non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and other traditional approaches, yielded no significant effects. Despite the prior use of adalimumab and acitretin capsules, the treatment remained unsatisfying, especially regarding the skin lesions. Considering the complex pathogenesis of SAPHO syndrome, the patient was orally administered baricitinib (2 mg), a Janus kinase (JAK) inhibitor, twice daily. A notable improvement in both skin lesions and osteoarticular pain was observed within two weeks of treatment initiation. Subsequently, the dosage of baricitinib was halved and continued for an additional three months, during which regular follow-ups revealed neither disease recurrence nor adverse effects. Collectively, the successful treatment of refractory SAPHO syndrome with baricitinib presents a promising implication for addressing the therapeutic challenges of this rare autoimmune condition, offering a potential breakthrough in managing its complex manifestations.
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Affiliation(s)
- Jianqiu Yang
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University), Suzhou, People’s Republic of China
- Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
| | - Chunyu Yuan
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University), Suzhou, People’s Republic of China
| | - Shengru Zhou
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University), Suzhou, People’s Republic of China
| | - Zhicheng Teng
- Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
| | - Min Li
- Department of Dermatology, Dushu Lake Hospital Affiliated to Soochow University (Medical Center of Soochow University), Suzhou, People’s Republic of China
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Ruan DD, Wang RL, Hu YN, Lin X, Luo JW, Yu QH, Wu JB. Clinical and imaging features of six Han patients with SAPHO syndrome. Acta Radiol 2024; 65:211-224. [PMID: 36503262 DOI: 10.1177/02841851221142783] [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] [Indexed: 02/17/2024]
Abstract
BACKGROUND Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoimmune disease characterized by skin or osteoarticular damage. SAPHO syndrome is often misdiagnosed or missed diagnosis due to lack of overall understanding of the disease by clinicians. PURPOSE To analyze the clinical symptoms and imaging features of six Han patients with SAPHO syndrome in order to provide reference for doctors to diagnose SAPHO syndrome. MATERIAL AND METHODS This study retrospectively analyzed the clinical data of six Han patients with SAPHO syndrome. RESULTS All six Han patients with SAPHO syndrome had severe acne or pustulosis of the hands and feet, and all of them had osteoarticular damage, including five cases involving the sternoclavicular joint. Some patients showed a specific and typical "bull's head" sign on 99mTc-labeled methylene diphosphonate bone imaging. Among the six patients recruited, there was one thoracic vertebra, one cervical vertebra, one sacroiliac joint, and one peripheral joint involvement. Two patients had limited activity due to severe osteoarticular damage. CONCLUSION Due to the atypical clinical symptoms of SAPHO syndrome, most patients will experience a tortuous and long diagnostic process, while a correct understanding and timely intervention of SAPHO syndrome are essential to improve the prognosis of patients.
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Affiliation(s)
- Dan-Dan Ruan
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, PR China
| | - Ruo-Li Wang
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, PR China
| | - Ya-Nan Hu
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, PR China
| | - Xing Lin
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, PR China
- Thoracic Surgery Department, Fujian Provincial Hospital, Fuzhou, PR China
| | - Jie-Wei Luo
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, PR China
- Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, PR China
| | - Qing-Hua Yu
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, PR China
- Radiology Department, Fujian Provincial Hospital, Fuzhou, PR China
| | - Jia-Bin Wu
- Fujian Provincial Hospital, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, PR China
- Nephrology Department, Fujian Provincial Hospital, Fuzhou, PR China
- Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, Fuzhou, China
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9
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Wang T, Gong X, Xia C, Kong W, Geng S, Jiang H, Xiao E, Wang H, Yu Y, Li C, Yuan K. An integrated transcriptomics and network pharmacology approach to explore the mechanism of Wang-Bi tablet against SAPHO syndrome. Int J Rheum Dis 2024; 27:e15077. [PMID: 38402418 DOI: 10.1111/1756-185x.15077] [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: 09/01/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND SAPHO syndrome is recognized as a rare entity with damage to skin and bones due to inflammation. Currently, the treatment for SAPHO syndrome is still a challenge in clinical practice. In this study, an integrated transcriptomics and network pharmacology approach was applied to explore the therapeutic effect and mechanism of Wang-Bi tablet (WBT) on SAPHO syndrome. METHODS The main components of WBT and their targets, as well as the targets of SAPHO syndrome, were collected from databases. Network visualization was performed using Cytoscape software. The GO and KEGG enrichment analysis was executed by David dataset. Then, the molecular mechanism of WBT improving SAPHO syndrome was validated by transcriptomics of peripheral blood neutrophils in SAPHO syndrome. Finally, the above results were validated by molecular docking. RESULTS The Network Pharmacology results showed there are 152 core targets for WBT treatment on SAPHO syndrome. RNA-seq data showed 442 differentially expressed genes (DEGs) in peripheral blood neutrophils of SAPHO patients. Intriguingly, NIK/NF-kappaB-, MyD88-dependent toll-like receptor-, and MAPK pathway were included in the enrichment results of network pharmacology and RNA-seq. Moreover, we verified that the core components of WBT have good affinity with the core targets of NIK/NF-kappaB-, MyD88-dependent toll-like receptor-, and MAPK pathway by molecular docking. CONCLUSIONS This study illustrated that the possible mechanisms of WBT against SAPHO syndrome may be related to NIK/NF-kappaB-, MyD88-dependent toll-like receptor-, and MAPK pathway, and further experiments are needed to prove these predictions.
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Affiliation(s)
- Ting Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Xun Gong
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Congmin Xia
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weijia Kong
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Shaohui Geng
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Haixu Jiang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Enfan Xiao
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Hesong Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Yingcai Yu
- Department of Biochemistry, College of Life Sciences, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kai Yuan
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
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Yen H, Lalor L. Non-syndromic and Syndromic Severe Acne in Adolescent Patients. Med Clin North Am 2024; 108:27-42. [PMID: 37951654 DOI: 10.1016/j.mcna.2023.05.014] [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] [Indexed: 11/14/2023]
Abstract
Acne is a common skin disorder in adolescents. However, severe acne that is persistent and refractory to conventional treatment or has other associated symptoms should raise suspicion for non-syndromic or syndromic acne.
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Affiliation(s)
- Hsi Yen
- Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, TBRC 2nd Floor Suite C2010, Milwaukee, WI 53226, USA
| | - Leah Lalor
- Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, TBRC 2nd Floor Suite C2010, Milwaukee, WI 53226, USA.
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11
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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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12
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Du H, Zhao Y, Zhu J, Li C. Spinal involvement in SAPHO syndrome mimics metastatic hematogenous lesions. Int J Rheum Dis 2023; 26:2581-2582. [PMID: 37681760 DOI: 10.1111/1756-185x.14885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Hongjia Du
- Department of Fifth Internal Medicine, Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, China
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Zhao
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Jing Zhu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
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Li Y, Hou X, Liu S, Lu S, Du M, Dong X, Liu X, Li C. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome with cranial bone involvement: Case report and literature review. Int J Rheum Dis 2023; 26:2304-2309. [PMID: 37218535 DOI: 10.1111/1756-185x.14740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoimmune inflammatory disease characterized by osteoarticular and dermatological manifestations. The most common osteoarticular manifestations involve the anterior chest wall, axial skeleton, and long bones. Cranial bone involvement is less reported in SAPHO syndrome. We herein present three cases of SAPHO syndrome with cranial bone involvement, and review the previous literature on similar manifestations. It was revealed that SAPHO syndrome could lead to cranial bone involvement, which could involve the dura mater, leading to hypertrophic pachymeningitis, but the outcome is usually good. Janus kinase inhibitors may be a potential treatment option.
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Affiliation(s)
- Yuan Li
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Shengyan Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, China
| | - Siyi Lu
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Mengmeng Du
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xia Dong
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoping Liu
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
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Ma M, Lu S, Hou X, Li C. Novel JAK-1 inhibitor upadacitinib as a possible treatment for refractory SAPHO syndrome: A case report. Int J Rheum Dis 2023; 26:2335-2337. [PMID: 37287393 DOI: 10.1111/1756-185x.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Mingwei Ma
- School of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyi Lu
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
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15
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Demirci Yildirim T, Sari İ. SAPHO syndrome: current clinical, diagnostic and treatment approaches. Rheumatol Int 2023:10.1007/s00296-023-05491-3. [PMID: 37889264 DOI: 10.1007/s00296-023-05491-3] [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: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023]
Abstract
This review provides an overview of SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis), a rare autoinflammatory disease that primarily affects bones, skin, and joints. We conducted a search on Medline/PubMed using keywords such as SAPHO syndrome, chronic recurrent multifocal osteitis/osteomyelitis, and related terms. SAPHO syndrome is rare, with a reported frequency of 1 in 10,000 in the Caucasian population. However, the actual incidence of SAPHO syndrome is unknown, and the incidence of the disease is likely higher. The pathogenesis of SAPHO syndrome remains incompletely understood. Current evidence suggests that SAPHO results from a complex interplay between immune dysregulation, genetic susceptibility, and environmental factors. It's not clear if SAPHO syndrome is an autoimmune disease or an autoinflammatory disease, but current evidence suggests that it's more likely an autoinflammatory disease because of things like neutrophil hyperactivity, fewer natural killer (NK) cells, high levels of interleukin (IL)-1, and a good response to treatments that block IL-1. Osteo-articular (OA) involvement is a key clinical feature of SAPHO. It affects the anterior chest wall, axial skeleton, peripheral joints, mandible, long bones of the extremities, and pelvis. Dermatological involvement is a common target in SAPHO, with lesions observed in 60-90% of cases. Common skin lesions include psoriasis and acne, with hidradenitis suppurativa and neutrophilic dermatoses being less commonly seen. Other clinical findings include constitutional symptoms caused by systemic inflammation, such as fever, weight loss, and fatigue. There is no specific laboratory finding for SAPHO syndrome. However, during active disease, there may be an increase in positive acute phase markers, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complement levels, mild leukocytosis, and thrombocytosis. Diagnosis is crucial for SAPHO syndrome, which lacks a specific diagnostic finding and is often underrecognized. A comprehensive evaluation of a patient's medical history and physical examination is crucial. Treatment options include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, conventional and synthetic disease-modifying agents (cDMARDs and sDMARDs), biological therapies, bisphosphonates, and antibiotics. Biological treatments have emerged as a viable alternative for SAPHO patients who do not respond to conventional treatments.
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Affiliation(s)
- Tuba Demirci Yildirim
- Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, Balçova/İzmir, Turkey.
| | - İsmail Sari
- Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, Balçova/İzmir, Turkey
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16
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Cao F, Hou X, Kang T, Shi X, Ma W, Zhang Y, Li C. SAPHO syndrome complicated with relapsing polychondritis: A case report. Int J Rheum Dis 2023; 26:2060-2063. [PMID: 37021927 DOI: 10.1111/1756-185x.14693] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic inflammatory disease. The main clinical manifestation of SAPHO syndrome is an osteoarthropathy with cutaneous involvement. Relapsing polychondritis (RP) characterized by chronic inflammation and cartilage degeneration is a rare systematic autoimmune disease. Here we report a RP case in a SAPHO syndrome patient, in which auricularitis happened 10 years after the diagnosed as SAPHO syndrome. Tofacitinib treatment can alleviate the symptoms.
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Affiliation(s)
- Fengjiao Cao
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Tianlun Kang
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiaojun Shi
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Weiguo Ma
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Yuan Zhang
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
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17
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Zhang Y, Luo Y, Ruan Y, Qian X, Feng Z. Relapse of Low Back Pain After Internal Lumbar Fixation Was Diagnosed with SAPHO Syndrome: A Case Report. Int Med Case Rep J 2023; 16:591-598. [PMID: 37789833 PMCID: PMC10542113 DOI: 10.2147/imcrj.s402752] [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: 01/19/2023] [Accepted: 04/27/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Early diagnosis of SAPHO syndrome is easily confused with other common spine-related diseases and infections. There is currently no consensus regarding the diagnosis of SAPHO syndrome, and specific treatments are empirical because of its rarity. Case Presentation A 62-year-old woman was referred to our department with complaints of low back and lower extremity pain for 2 years, 1.5 years after lumbar spine surgery, and recurrent low back pain for 1 year. Laboratory test results revealed elevated hs-CRP levels and erythrocyte sedimentation rate. Combined with her surgical history and lumbar CT results, adjacent segment degeneration (ASD) was first considered. NSAIDs, analgesics, and supplemental therapies were also administered. However, the patient's symptoms were not significantly relieved. During re-examination, hyperkeratosis with active pustulosis was observed on the patient's palms. Osteitis of the left sacroiliac joint was revealed on imaging. Skeletal ECT revealed a typical "horn sign". The patient was diagnosed with SAPHO syndrome. Based on the original treatment, sulfasalazine enteric-coated tablets, adalimumab (a biological agent of TNF-α), pregabalin, and tramadol sustained-release tablets were administered. The patient reported that her pain was significantly relieved. He was discharged from the hospital and received adalimumab treatment (40 mg once per fortnight in the first 6 months and 40 mg once per month after month 6) in the outpatient clinic. The hyperkeratosis with active pustulosis on both palms fully recovered after 12 months of treatment. The patient was followed up 6 months after full recovery, and no recurrence was found in the symptoms of low back and lower extremity pain and palmar hyperkeratosis with active pustulosis. Conclusion SAPHO syndrome should be suspected in patients present with osteoarticular and/or dermatological manifestations. Biological agents can be used to treat patients with refractory SAPHO syndrome.
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Affiliation(s)
- Yanfeng Zhang
- Department of Pain Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People’s Republic of China
| | - Yujia Luo
- Department of Pain Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People’s Republic of China
| | - Yachao Ruan
- Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People’s Republic of China
| | - Xiang Qian
- Stanford University School of Medicine Pain Management Center, Redwood City, CA, 94063, USA
| | - Zhiying Feng
- Department of Pain Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People’s Republic of China
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Scrivo R, D'Angelo S, Carriero A, Castellani C, Perrotta FM, Conti F, Vecellio M, Selmi C, Lubrano E. The Conundrum of Psoriatic Arthritis: a Pathogenetic and Clinical Pattern at the Midpoint of Autoinflammation and Autoimmunity. Clin Rev Allergy Immunol 2023; 65:72-85. [PMID: 35040085 DOI: 10.1007/s12016-021-08914-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 02/06/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory condition characterized by psoriasis, synovitis, enthesitis, spondylitis, and the possible association with other extra-articular manifestations and comorbidities. It is a multifaceted and systemic disorder sustained by complex pathogenesis, combining aspects of autoinflammation and autoimmunity. Features of PsA autoinflammation include the role of biomechanical stress in the onset and/or exacerbation of the disease; the evidence of involvement of the innate immune response mediators in the skin, peripheral blood and synovial tissue; an equal gender distribution; the clinical course which may encounter periods of prolonged remission and overlapping features with autoinflammatory syndromes. Conversely, the role of autoimmunity is evoked by the association with class I major histocompatibility complex alleles, the polyarticular pattern of the disease which sometimes resembles rheumatoid arthritis and the presence of serum autoantibodies. Genetics also provide important insights into the pathogenesis of PsA, particularly related to class I HLA being associated with psoriasis and PsA. In this review, we provide a comprehensive review of the pathogenesis, genetics and clinical features of PsA that endorse the mixed nature of a disorder at the crossroads of autoinflammation and autoimmunity.
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Affiliation(s)
- Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Salvatore D'Angelo
- Rheumatology Institute of Lucania (IReL) - Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna Delle Grazie Hospital of Matera, Potenza, Italy
| | - Antonio Carriero
- Rheumatology Institute of Lucania (IReL) - Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna Delle Grazie Hospital of Matera, Potenza, Italy
- Dipartimento Di Medicina E Scienze Della Salute, Università Degli Studi del Molise, Campobasso, Italy
| | - Chiara Castellani
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Massimo Perrotta
- Dipartimento Di Medicina E Scienze Della Salute, Università Degli Studi del Molise, Campobasso, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Vecellio
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Center, Oxford, UK
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Ennio Lubrano
- Dipartimento Di Medicina E Scienze Della Salute, Università Degli Studi del Molise, Campobasso, Italy
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Li C, Jiang H, Zhang Y, Huang G. Sexual function assessment in patients with SAPHO syndrome: a cross-sectional study. Orphanet J Rare Dis 2023; 18:217. [PMID: 37501151 PMCID: PMC10373282 DOI: 10.1186/s13023-023-02826-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION SAPHO syndrome is a group of special syndromes characterized by synovitis, acne, pustulosis, hyperostosis and osteitis. Skin lesions and joint damage are the main clinical manifestations. Among them, females mostly present with palm toe pustulosis, while males have severe acne as the main external manifestation. The bone and joint damage characterized by bone hypertrophy and osteitis is the core manifestation of SAPHO and affects all parts of the body. SAPHO syndrome causes great physical and mental suffering to patients, and it also brings a huge financial burden to the family. The purpose of this study is to explore the impact of SAPHO on the quality of sexual life of patients. METHODS We screened and included 249 SAPHO patients (169 women and 80 men) from Peking Union Medical College Hospital (Beijing, China). First, we recorded the basic situation of the patient through questionnaires (including gender, age, SAPHO duration, BMI, smoking, drinking, marital status, educational level, occupational status and work status.). Then, the patient needed to fill in the Short Form-36 quality of life questionnaire (SF-36 QoL) to record the quality of life. For Sexual dysfunction (SD), female patients needed to fill in the Female Sexual Function Index (FSFI) to assess the quality of sexual life; while the International Index of Erectile Function (IIEF) was used to assess the SD of male patients. At the same time, we used self-esteem and relationship questionnaire (SEAR) to analyze the psychological state of SAPHO patients. Finally, we performed statistical analysis on the data obtained, and then explored the connection between SAPHO and SD. RESULTS In this cross-sectional study, a total of 249 patients completed the questionnaire and constituted the study population. We found that among 169 female patients, 124 patients had FSD (73.4%); while 45 patients did not have FSD (26.6%); and among 80 male patients, 45 (56.3%) had ED; However, 35 patients did not have ED (43.7%). The results of the quality of life and mental state assessment showed that female patients with SD showed lower scores in terms of mental state. Among all male participants, we found no significant difference in quality of life and mental state among participants with or without SD. In addition, there was no significant difference in the duration of SAPHO between female and male participants with or without SD. CONCLUSION This study is the first to evaluate the SD of SAPHO patients. The incidence of SD in female SAPHO patients is higher than that in male patients; the cause of female SD may be mainly psychological factors. These results prove that it is particularly important to focus on regulating their psychological state while diagnosing and treating SAPHO patients in clinical practice.
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Affiliation(s)
- Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, 102401, China.
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Haixu Jiang
- School of Chinese Materia, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Yunan Zhang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Guangrui Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China.
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20
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Sun F, Zhu J. Refractory SAPHO syndrome involving the ilium. Rheumatology (Oxford) 2023; 62:e233-e234. [PMID: 36525375 DOI: 10.1093/rheumatology/keac701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Fei Sun
- Department of Rheumatology and Immunology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jian Zhu
- Department of Rheumatology and Immunology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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21
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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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22
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Successful Treatment of SAPHO Syndrome Complicated with Ankylosing Spondylitis by Secukinumab: A Case Report. J Pers Med 2023; 13:jpm13030516. [PMID: 36983699 PMCID: PMC10052174 DOI: 10.3390/jpm13030516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/15/2023] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is characterized by a wide range of dermatological and musculoskeletal manifestations, and its outcome has recently been improved greatly by optimizing management. However, the treatment strategies are not standardized and require further refinement. Secukinumab, a fully human monoclonal antibody targeting IL-17A, is approved for the treatment of autoimmune psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Here, a 53-year-old man was diagnosed with AS, and he presented scattered pustulosis in both hands and feet with a 5-year history of recurrent lumbosacral area pain and abnormal pain in the neck and front chest area. Secukinumab improved the patient’s cutaneous lesion and prevented musculoskeletal pain by substituting adalimumab. Although only a few cases have been reported that secukinumab can effectively treat SAPHO syndrome complicated with AS, the efficacy remains controversial. Therefore, we hope to provide a novel valuable therapeutic strategy for SAPHO syndrome management, particularly in patients with skin lesions.
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23
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Ma M, Wu X, Cao Y, Liu Y, Liu S, Li C. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome associated with pyoderma gangrenosum: report of two patients. Int J Dermatol 2023; 62:e186-e189. [PMID: 36345566 DOI: 10.1111/ijd.16492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Mingwei Ma
- School of Clinical Medicine, Peking Union Medical College, Beijing, China.,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xia Wu
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuchen Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, China.,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shengyan Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, China.,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chen Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
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24
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Ma M, Wei S, Yin D, Li W, Li C. A Case of Neutrophilic Dermatoses-Sweet’s Syndrome Coexisting with SAPHO Syndrome. Clin Cosmet Investig Dermatol 2023; 16:739-742. [PMID: 37008190 PMCID: PMC10065417 DOI: 10.2147/ccid.s404390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a rare disease characterized by osteoarticular and cutaneous manifestations. SAPHO syndrome mostly involves the skin, mainly presented as palmoplantar pustulosis and severe acne. Sweet's syndrome (SS) is a neutrophilic dermatosis of unknown cause, which may be caused by autoinflammation. So far, SAPHO syndrome complicated with SS has been rarely reported worldwide. Here, we present a rare case diagnosed in our hospital with detailed clinical information. This patient presented pain and swelling in her right leg. Later, she developed red papules on her right lower eyelid and a skin biopsy showed diffuse lymphocytic and neutrophilic infiltration in the superficial dermis. She was diagnosed with SAPHO syndrome and SS according to medical history and examination. These two diseases share parts of autoinflammatory signaling pathways and might be different variations of the spectrum of autoinflammatory diseases. Through this case, we aim to provide a new horizon for the regulation of neutrophils in SAPHO syndrome and skin lesions like SS.
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Affiliation(s)
- Mingwei Ma
- School of Clinical Medicine, Peking Union Medical College Hospital (PUMC and CAMS), Beijing, 100730, People’s Republic of China
| | - Shufeng Wei
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
| | - Dan Yin
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
| | - Weizhong Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, 102401, People’s Republic of China
- Correspondence: Chen Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No. 4, Chengguan Health Road, Fangshan District, Beijing, People’s Republic of China, Tel +86 13810988688, Email
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25
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Xia C, Lv Y. Severe Cervicodynia in a Patient With Pustules on the Palms. JAMA Neurol 2023; 80:323-324. [PMID: 36574254 DOI: 10.1001/jamaneurol.2022.4739] [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: 10/07/2023]
Abstract
A 51-year-old man had severe neck pain and pustules on both hands. What is your diagnosis?
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Affiliation(s)
- Cheng Xia
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yan Lv
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
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Jiang H, Chen N, Li C. SAPHO syndrome can cause masseter muscle involvement. Int J Rheum Dis 2023; 26:398-400. [PMID: 36482833 DOI: 10.1111/1756-185x.14513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Haixu Jiang
- School of Chinese Materia, Beijing University of Chinese Medicine, Beijing, China
| | - Naigang Chen
- Department of Medical Imaging, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China.,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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Ma M, Liu Y, Liu S, Li C. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome associated with inflammatory bowel disease: Report of four patients. Int J Rheum Dis 2023; 26:996-999. [PMID: 36641774 DOI: 10.1111/1756-185x.14565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/16/2023]
Affiliation(s)
- Mingwei Ma
- School of Clinical Medicine, Peking Union Medical College, Beijing, China.,Peking Union Medical College Hospital (CAMS and PUMC), Beijing, China
| | - Yuchen Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, China.,Peking Union Medical College Hospital (CAMS and PUMC), Beijing, China
| | - Shengyan Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, China.,Peking Union Medical College Hospital (CAMS and PUMC), Beijing, China
| | - Chen Li
- Peking Union Medical College Hospital (CAMS and PUMC), Beijing, China.,Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
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Han Y, Wu X, Cao Y, Du H, Li C. Skull involvement of SAPHO syndrome. Joint Bone Spine 2023; 90:105466. [PMID: 36180014 DOI: 10.1016/j.jbspin.2022.105466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Yuxiang Han
- Department of Rheumatology and Immunology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xia Wu
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongjia Du
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China; Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Li C, Xu H, Gong L, Wang A, Dong X, Yuan K, Huang G, Wei S, Sun L. Work productivity and activity in patients with SAPHO syndrome: a cross-sectional observational study. Orphanet J Rare Dis 2022; 17:381. [PMID: 36271426 DOI: 10.1186/s13023-022-02523-2] [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: 10/29/2021] [Revised: 08/23/2022] [Accepted: 10/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our understanding of work productivity impairment among patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is limited. The purpose of this study was to provide an overview of work productivity loss in SAPHO syndrome patients through the use of the work productivity and activity impairment (WPAI) questionnaire, as well as to investigate the relationship between the WPAI and other disease-related indicators. METHODS Patients for this cross-sectional study were recruited from Peking Union Medical College Hospital (Beijing, China). The questionnaires incorporating the WPAI were administered, along with the inclusion of demographic data, disease-specific measures, and general health variables. The construct validity of the WPAI was evaluated via the correlations between WPAI outcomes and other measures. Wilcoxon rank-sum tests and nonparametric Kruskal‒Wallis tests were used for the comparison of the WPAI outcomes between known groups. RESULTS A total of 376 patients were included, and 201 patients (53.5%) were employed. The medians (interquartile range [IQR]) of absenteeism, presenteeism, work productivity loss, and activity impairment were 0% (0-13%), 20% (0-40%), 20% (0-52%), and 30% (0-50%), respectively. All of the WPAI outcomes showed moderate to strong correlations with other generic and disease-specific measures (|r| = 0.43-0.75), except for absenteeism. Increasing disease activity and worse health status were significantly associated with increased impairments of work productivity and activity. CONCLUSION This study highlights the negative effects of SAPHO syndrome on the work productivity and activity of patients, thus indicating good construct validity and discriminative ability of the WPAI. To reduce the economic burden, it is important to improve the work productivity and daily activity of patients by ameliorating clinical care.
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Affiliation(s)
- Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China. .,Department of Traditional Chinese Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, 100730, Beijing, China.
| | - Heng Xu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Liang Gong
- Department of Traditional Chinese Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, 100730, Beijing, China
| | - Afang Wang
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xia Dong
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kai Yuan
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Guangrui Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Shufeng Wei
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Luying Sun
- Department of Nephrology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
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30
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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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31
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Adachi-Katayama M, Kondo Y, Okamoto S, Sato R, Morinaka S, Nishiyama T, Terasaki M, Terasaki T, Toko H, Yagishita M, Takahashi H, Hagiwara S, Tsuboi H, Sumida T, Matsumoto I. Synovitis-acne-pustulosis-hyperostosis-osteitis Syndrome with Bilateral Pleural Effusion. Intern Med 2022; 61:2671-2675. [PMID: 35135914 PMCID: PMC9492480 DOI: 10.2169/internalmedicine.8473-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pleural effusion is a rare manifestation in synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome, which is characterized by the presence of osteoarticular lesions and dermatological involvement. We herein report a 71-year-old man with pleural effusion resulting from SAPHO syndrome. He was successfully treated using corticosteroids and has experienced no recurrence for one year. We should consider SAPHO syndrome when encountering cases of anterior chest pain and pleural fluid.
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Affiliation(s)
- Maho Adachi-Katayama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
- Department of General Medicine, Mito Kyodo General Hospital, University of Tsukuba, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Shota Okamoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Ryota Sato
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Satoshi Morinaka
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Taihei Nishiyama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Mayu Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Toshihiko Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hirofumi Toko
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Mizuki Yagishita
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroyuki Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Shinya Hagiwara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
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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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Wang Y, Wang S, Zheng L, Wang X, Wang H, Zhong Z, Liu S, Zheng X, Gao M. Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome with Cutis Verticis Gyrata: Case Report and Review of Literature. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:1415-1420. [PMID: 35910507 PMCID: PMC9329683 DOI: 10.2147/ccid.s372522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/14/2022] [Indexed: 12/01/2022]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a rare disease clinically characterized by a wide range of cutaneous and osteoarticular manifestations. Here, we report a case of SAPHO syndrome with cutis verticis gyrata (CVG) and investigated the genetic causes in the four members of this pedigree. After failure of conventional treatments, a recombinant human TNF-α receptor II:IgG Fc fusion protein (rhTNFR:Fc, YISAIPU®) achieved good control of the disease at the 2-year follow-up. We did not identify any pathogenic mutation in this pedigree. We also summarized the clinical and therapeutic characteristics of 83 patients with SAPHO syndrome through the China National Knowledge Infrastructure (CKNI) database from 2016 to 2021. Patients with acne were young and predominantly male. About 45.8% patients were treated with biological therapies or traditional Chinese medicine (TCM), 84.2% of which showed positive effects against cutaneous and osteoarticular manifestations. We report a case of SAPHO syndrome with CVG that was successfully treated with rhTNFR:Fc. Our results reveal the genetic heterogeneity involved. Biologics and TCM are likely alternative options for the treatment of SAPHO syndrome.
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Affiliation(s)
- Yifan Wang
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People's Republic of China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Shan Wang
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People's Republic of China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Liyun Zheng
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People's Republic of China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Xiuli Wang
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People's Republic of China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Hui Wang
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People's Republic of China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Zhenyu Zhong
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People's Republic of China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Siqi Liu
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People's Republic of China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Xiaodong Zheng
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People's Republic of China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Min Gao
- Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, People's Republic of China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
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Fukuzawa F, Uehara T, Yamashita S, Hayashi Y, Ikusaka M. Group B Streptococcus Bacteremia Mimicking Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome. Cureus 2022; 14:e27468. [PMID: 36060405 PMCID: PMC9421099 DOI: 10.7759/cureus.27468] [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] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
Group B Streptococcus (GBS) causes septic arthritis in healthy adults, and a significant number of GBS septic arthritis cases involve multiple joints. Nevertheless, septic arthritis is commonly monoarticular. Here, we report a case of a 45-year-old man who complained of subacute fever and right shoulder and right buttock pain for three weeks despite undergoing garenoxacin treatment for one week. Although synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome could be a possible differential diagnosis for this patient, the fever and subacute clinical course could not be explained. Blood cultures revealed the presence of GBS; therefore, he was diagnosed with septic arthritis. After antibiotic treatment for six weeks, his symptoms resolved.
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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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Ravi S, Dey A, McKay D, Sharma P, Pillay S. The value of multi-modality imaging in establishing the diagnosis of Adolescent SAPHO. Radiol Case Rep 2022; 17:1236-1245. [PMID: 35198085 PMCID: PMC8844709 DOI: 10.1016/j.radcr.2022.01.048] [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: 12/24/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022] Open
Abstract
SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is a rare chronic autoinflammatory disorder of unknown etiology. Radiological investigation, including the use of magnetic resonance imaging and nuclear medicine is pivotal to the diagnosis of SAPHO syndrome. We present a case of a 15-year-old male diagnosed with SAPHO syndrome displaying the classic diagnostic findings of this condition on bone scan and magnetic resonance imaging.
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37
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Xia R, Diao Z, Zhang Z, Liu J, Yin Z. Successful treatment of synovitis, acne, pustulosis, hyperostosis and osteitis syndrome with ixekizumab. Clin Exp Dermatol 2022; 47:978-980. [PMID: 35089610 DOI: 10.1111/ced.15087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
We report the use of ixekizumab in treating synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, the first such report to our knowledge. The patient presented with palmoplantar pustulosis and sternoclavicular joint pain, which was markedly improved with ixekizumab treatment.
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Affiliation(s)
- RuiYuan Xia
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZiYue Diao
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZhiQin Zhang
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Liu
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZhiQiang Yin
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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38
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Sabooniha F. A case of SAPHO syndrome: a DISH of radiological features to be considered. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022; 49:65. [PMCID: PMC9753071 DOI: 10.1186/s43166-022-00159-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The acronym SAPHO stands for synovitis, acne, pustulosis, hyperostosis, and osteitis. It is a rare heterogenous disease with unknown etiology and a chronic relapsing and remitting course1. Its skin and osteoarticular manifestations including palmoplantar pustulosis (PPP) and synovitis may be transient which further complicate the diagnosis. So, awareness about all features of the syndrome throughout the time seems mandatory for correct diagnosis and avoidance of unnecessary procedures. Case presentation. A case of SAPHO syndrome being reported in a middle-aged man who presented with bilateral PPP and exacerbation of back pain which developed shortly after covid-19 vaccine injection with a history of more than 20 years of inflammatory thoracic back pain and psoriasis vulgaris who initially had been worked up for metastatic bony lesions based on radiologic studies, irrespective of his skin lesions. The patient had good response to alendronate 70 mg weekly and celecoxib 200 mg BID without aggravation of existing skin lesions or new psoriatic lesions. Conclusion This case report aims to inform rheumatologists and radiologists about various radiologic and dermatologic manifestations of SAPHO syndrome with emphasizing on taking into consideration of past and present skin lesions in the interpretation of the radiologic signs in order to prevent irrelevant procedures or hazardous imaging and to urge rheumatology societies to set up a SAPHO registry for future randomized controlled trials. Suggestion of PPP responsiveness to NSAIDs as a new potential diagnostic tool for SAPHO diagnosis is another goal. It also aims to point out the possible coexistence of SAPHO and SpA or DISH syndrome.
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Affiliation(s)
- Fakhreddin Sabooniha
- grid.412328.e0000 0004 0610 7204Sabzevar University of Medical Sciences, Sabzevar, 96137-95143 Iran
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39
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Wang G, Zhuo N, Li J. Off-label Use of Secukinumab: A Potential Therapeutic Option for SAPHO Syndrome. J Rheumatol 2021; 49:656. [PMID: 34911808 DOI: 10.3899/jrheum.211155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We read the recent article by Wang et al with great interest.1 The authors described a cohort of 4 patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome who showed substantial improvement in skin lesions, clinical conditions, and whole-body magnetic resonance imaging before and after treatment with secukinumab without concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), nonsteroidal antiinflammatory drugs (NSAIDs), or other biologics, and suggested a potential benefit of secukinumab in the treatment of SAPHO syndrome. However, there are some details that need further clarification.
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Affiliation(s)
- Gang Wang
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou; Department of Nephrology, Xiangya Second Hospital, Central South University, Changsha, Hunan, China. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J. Li, Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China.
| | - Ning Zhuo
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou; Department of Nephrology, Xiangya Second Hospital, Central South University, Changsha, Hunan, China. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J. Li, Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China.
| | - Jingyang Li
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou; Department of Nephrology, Xiangya Second Hospital, Central South University, Changsha, Hunan, China. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. J. Li, Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China.
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Li C, Geng S, Wei S, Guo S. Dr. Li et al reply. J Rheumatol 2021; 49:657. [PMID: 34911804 DOI: 10.3899/jrheum.211185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We appreciate Wang et al1 for their interest in our article2 and for highlighting the pathogenic role of cytokine dysregulation in SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. The authors also address the possible mechanism of secukinumab in the treatment of SAPHO syndrome: blocking the expression of Th17 cell-related cytokines.
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Affiliation(s)
- Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China. C. Li and S. Geng contributed equally to this work. This study was supported by the National Natural Science Foundation of China (81822030), Beijing Natural Science Foundation (7172175), the CAMS Initiative for Innovation Fund for Medical Sciences (CIFMS; 2017-I2M-3-001, 2017- I2M-3-003), the Central Level Public Interest Program for Scientific Research Institute (2018RC31003), the Capital Medical Research and Development Fund (2016-4-40112), and the National Key Research and Development Program of China (2016YFC0901500). The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No.4, Chengguan Health Care Road, Fangshan District, Beijing, China; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, 100730 Beijing, China.
| | - Shaohui Geng
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China. C. Li and S. Geng contributed equally to this work. This study was supported by the National Natural Science Foundation of China (81822030), Beijing Natural Science Foundation (7172175), the CAMS Initiative for Innovation Fund for Medical Sciences (CIFMS; 2017-I2M-3-001, 2017- I2M-3-003), the Central Level Public Interest Program for Scientific Research Institute (2018RC31003), the Capital Medical Research and Development Fund (2016-4-40112), and the National Key Research and Development Program of China (2016YFC0901500). The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No.4, Chengguan Health Care Road, Fangshan District, Beijing, China; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, 100730 Beijing, China.
| | - Shufeng Wei
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China. C. Li and S. Geng contributed equally to this work. This study was supported by the National Natural Science Foundation of China (81822030), Beijing Natural Science Foundation (7172175), the CAMS Initiative for Innovation Fund for Medical Sciences (CIFMS; 2017-I2M-3-001, 2017- I2M-3-003), the Central Level Public Interest Program for Scientific Research Institute (2018RC31003), the Capital Medical Research and Development Fund (2016-4-40112), and the National Key Research and Development Program of China (2016YFC0901500). The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No.4, Chengguan Health Care Road, Fangshan District, Beijing, China; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, 100730 Beijing, China.
| | - Shuwen Guo
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China. C. Li and S. Geng contributed equally to this work. This study was supported by the National Natural Science Foundation of China (81822030), Beijing Natural Science Foundation (7172175), the CAMS Initiative for Innovation Fund for Medical Sciences (CIFMS; 2017-I2M-3-001, 2017- I2M-3-003), the Central Level Public Interest Program for Scientific Research Institute (2018RC31003), the Capital Medical Research and Development Fund (2016-4-40112), and the National Key Research and Development Program of China (2016YFC0901500). The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No.4, Chengguan Health Care Road, Fangshan District, Beijing, China; Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, 100730 Beijing, China.
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Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context 2021; 10:dic-2021-8-6. [PMID: 34691199 PMCID: PMC8510514 DOI: 10.7573/dic.2021-8-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acne vulgaris is the most common skin disease that can lead to disfigurement and psychological distress. This article aims to provide a narrative updated review on the management of acne vulgaris. Methods A PubMed search was performed with Clinical Queries using the key term “acne”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to articles published in English. Results Treatments of acne include proper skin care, topical medications, oral medications and procedural therapies. Topical agents are the first-line treatment for mild-to-moderate acne and can be used as combination therapy for more severe acne. Systemic therapies are usually prescribed for the initial treatment of moderate-to-severe acne as well as for acne that is refractory to topical therapies. Conclusion Topical retinoids are the drugs of choice for the treatment and maintenance therapy of patients with mild-to-moderate acne vulgaris. Depending on the severity of the acne, topical retinoids may be used alone or in combination with benzoyl peroxide and topical or oral antibiotics. Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy. Neither topical nor oral antibiotics should be used as monotherapy. Oral contraceptives and/or spironolactone are useful for many women with acne. Oral isotretinoin is the drug of choice for severe, extensive, nodular acne vulgaris but is also often used in moderate cases where scarring is evident, acne-related psychosocial distress is significant or other treatment modalities have failed.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Joseph M Lam
- Department of Dermatology and Skin Sciences, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
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Gao Y, Chen Y, Wang L, Li C, Ge W. Serum-derived extracellular vesicles inhibit osteoclastogenesis in active-phase patients with SAPHO syndrome. Ther Adv Musculoskelet Dis 2021; 13:1759720X211006966. [PMID: 33948126 PMCID: PMC8053764 DOI: 10.1177/1759720x211006966] [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: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic inflammatory disorder and the underlying pathogenesis is unclear. In this study, 88 SAPHO patients and 118 healthy controls were recruited to investigate the role of serum-derived extracellular vesicles (SEVs) in SAPHO syndrome. Methods: Quantitative proteomics was applied for SEVs proteome identification, and ELISA and Western blotting was performed to verify the results of mass spectrum data. In vitro osteoclastogenesis and osteogenesis assay was used to confirm the effects of SEVs on bone metabolism. Results: Tandem mass tagging-based quantitative proteomic analysis of SAPHO SEVs revealed differential expressed proteins involved in bone metabolism. Of these, serum amyloid A-1 (SAA1) and C-reactive protein (CRP) were upregulated. Higher SAA1 levels in SAPHO patients were confirmed by ELISA. In addition, SAA1 levels were positively correlated with CRP, an inflammatory marker related to the condition of patients. In vitro celluler studies confirmed that SAPHO SEVs inhibited osteoclastogenesis in patients mainly in the active phase of the disease. Further analysis demonstrated that Nucleolin was upregulated in osteoclasts of active-phase patients under SAPHO SEVs stimulation. Conclusion: In this study, we identified SAA1 as an additional inflammation marker that can potentially assist the diagnosis of SAPHO syndrome, and speculated that Nucleolin is a key regulator of osteoclastogenesis in active-phase patients.
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Affiliation(s)
- Yanpan Gao
- State Key Laboratory of Medical Molecular Biology & Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanyu Chen
- State Key Laboratory of Medical Molecular Biology & Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Lun Wang
- 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 and Peking Union Medical College, No. 9 Dong Dan San Tiao, Beijing 100730, China
| | - Wei Ge
- State Key Laboratory of Medical Molecular Biology & Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 5 Dong Dan San Tiao, Beijing, 100005, China
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Wang L, Yu Y, Zhang S, Zhang W, Li C. Coexistence of Sjögren syndrome in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: A retrospective observational study. Medicine (Baltimore) 2021; 100:e23940. [PMID: 33761629 PMCID: PMC9281907 DOI: 10.1097/md.0000000000023940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
To identify the prevalence and clinical characteristics of Sjögren syndrome (SS) in a Chinese single-center cohort of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome.Patients diagnosed with SS were screened out from a cohort of 164 cases of SAHPO syndrome. Information regarding the patients' gender, age at onset, clinical features, laboratory tests, bone scintigraphy, and treatment was reviewed.Five patients were screened out. The prevalence of SS in SAPHO patients was 3.05% The mean onset age of SS was 48.0 ± 12.0 years old and no apparent time order in the occurrence of SAPHO and SS was observed. Compared with the general SAPHO cohort, the 5 SS patients exhibited no significant difference in the SAPHO related clinical features or inflammatory markers, except for a higher prevalence of peripheral joints and bones involvement in bone scintigraphy. Objective evidence of dryness and positive salivary gland biopsy were found in all the patients. However, the positive rates of SSA and SSB antibody were only 20%. Anti-inflammatory treatment for SS was recorded in 3 patients (ESSDAI score: 3 in 2 patients; 12 in 1 patient) with extra-glandular manifestations, severe complications or poor response to the basic treatment.The prevalence of SS is higher in the SAPHO cohort than in the general Chinese population. Objective tests or biopsy might be more indicative than the antibody detection for SS diagnosis. Anti-inflammatory treatment should be prescribed in consideration of both the severity of SS and the demand for disease activity control of SAPHO.
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Affiliation(s)
| | | | - Shuo Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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[SAPHO syndrome : An overview and nosological differentiation of 35 disease cases]. Z Rheumatol 2021; 80:456-466. [PMID: 33725179 PMCID: PMC8190029 DOI: 10.1007/s00393-021-00979-4] [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: 02/09/2021] [Indexed: 12/02/2022]
Abstract
Beim SAPHO-Syndrom handelt es sich nicht um eine Entität, sondern um einen inhomogenen, nosologisch wie pathogenetisch heterogenen Symptomenkomplex. Klinisch imponieren subakute, rezidivierende und/oder chronische Krankheitsprozesse mit charakteristisch gemeinsamer Haut-Knochen-Assoziation („ski[n]bo[ne]-disease“). Die chronisch rekurrierende multifokale Osteomyelitis (CRMO) ist die häufigste „SAPHO“-Erkrankung im Jugend- und Adoleszentenalter. Im Erwachsenenalter ist die Spondarthritis hyperostotica pustulo-psoriatica mit der Trias palmoplantare Pustulose, sternokostoklavikuläre Hyperostose und ossifizierenden Wirbelsäulenmanifestationen am häufigsten und generell als „SAPHO“ bekannt. Zusätzlich gibt es jedoch abortive Krankheitsformen: das entzündliche Anterior-chest-wall-Syndrom, das sternoklavikuläre Hyperostosesyndrom, die Akne-CRMO und die Akne-Spondarthritis. Insgesamt heilen die SAPHO-Krankheitsfälle meist mit relativ günstiger Prognose aus, es gibt aber auch ungünstige Verläufe mit funktionellen Einschränkungen. Neben der typischen Klinik dienen Bildgebung (Röntgen, Szintigraphie, Magnetresonanztomographie) und/oder histologische Knochenbiopsieanalyse der Diagnosestellung. Die Therapie sollte interdisziplinär erfolgen. Eine Antibiose ist obsolet. Der vorliegende Artikel vermittelt einen Überblick über das SAPHO-Syndrom und eine klinisch-rheumatologische wie bildgebende Differenzierung sowie nosologische Klassifizierung von 35 Fällen bei Erstvorstellung.
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Ohida H, Curuk C, Prescher H, Stegemann E, Bürger T. Thoracic outlet syndrome in a patient with SAPHO syndrome - A case report. Int J Surg Case Rep 2021; 80:105710. [PMID: 33667913 PMCID: PMC7937738 DOI: 10.1016/j.ijscr.2021.105710] [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: 02/07/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Thoracic outlet syndrome (TOS) includes disorders caused by compression of the neurovascular structures in the upper thoracic outlet (Roos and Owens, 1996 [1]; Bürger, 2014; Curuk, 2020 [3]). Depending on the compressed structure, it is categorized into neurological, arterial and venous TOS. SAPHO syndrome (synovitis-acne-pustulosis-hyperostosis-osteitis syndrome) is a rare chronic inflammatory disease of unknown etiology. With its typical involvement of sternoclavicular joint and clavicle, complication due to hyperostosis in this region, leading to thrombosis of the subclavian vein have been reported in some cases of SAPHO syndrome. Between 2015 and 2019 488 patients, suffering from neurological, vascular or combined TOS presented at our department. Depending on clinical and diagnostic results surgical therapy was performed in 175 cases via the transaxillary approach, including complete first rib and/or cervical rib resection, neurolysis of plexus brachialis, thoracic sympathectomy and vascular reconstruction if indicated (Curuk, 2020). During this period, only one single patient presented with SAPHO syndrome with thrombosis of the subclavian vein and neurovascular TOS. CASE PRESENTATION We present a 50-year-old female patient, in line with the SCARE 2020 criteria (Agha et al., 2020 [12]) suffering from extremely rare combination of neurovascular TOS and SAPHO syndrome with thrombosis of the left subclavian vein due to hyperostosis of the left clavicle. CONCLUSION Progressive bone changes associated with SAPHO syndrome can lead to narrowing of the thoracic outlet. Pharmacological therapies to avoid the progression of the hyperostosis of the costoclavicular joint and the clavicle do currently not exist. First rib resection is a therapeutic option to widen the space in the upper thoracic region. Surely, it is a rare condition and more long-term follow-up data are required.
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Affiliation(s)
- H Ohida
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119 Kassel, Germany.
| | - C Curuk
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119 Kassel, Germany
| | - H Prescher
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119 Kassel, Germany
| | - E Stegemann
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Angiology and Internal Medicine, Herkulesstraße 34, 34119 Kassel, Germany
| | - Th Bürger
- Agaplesion Diakonie Kliniken Kassel gGmbH, Department of Vascular and Endovascular Surgery, Herkulesstraße 34, 34119 Kassel, Germany
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Crowley JJ, Pariser DM, Yamauchi PS. A brief guide to pustular psoriasis for primary care providers. Postgrad Med 2020; 133:330-344. [PMID: 33118424 DOI: 10.1080/00325481.2020.1831315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pustular psoriasis refers to a heterogeneous group of chronic inflammatory skin disorders that are clinically, histologically, and genetically distinct from plaque psoriasis. Pustular psoriasis may present as a recurrent systemic illness (generalized pustular psoriasis [GPP]), or as localized disease affecting the palms and/or soles (palmoplantar pustulosis [PPP], also known as palmoplantar pustular psoriasis), or the digits/nail beds (acrodermatitis continua of Hallopeau [ACH]). These conditions are rare, but their possible severity and consequences should not be underestimated. GPP, especially an acute episode (flare), may be a medical emergency, with potentially life-threatening complications. PPP and ACH are often debilitating conditions. PPP is associated with impaired health-related quality of life and psychiatric morbidity, while ACH threatens irreversible nail and/or bone damage. These conditions can be difficult to diagnose; thus, primary care providers should not hesitate to contact a dermatologist for advice and/or patient referral. The role of corticosteroids in triggering and leading to flares of GPP should also be noted, and physicians should avoid the use of systemic corticosteroids in the management of any form of psoriasis.
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Affiliation(s)
- Jeffrey J Crowley
- Bakersfield Dermatology & Skin Cancer Medical Group, Bakersfield, CA, USA
| | - David M Pariser
- Eastern Virginia Medical School and Virginia Clinical Research, Inc., Norfolk, VA, USA
| | - Paul S Yamauchi
- Dermatology Institute & Skin Care Center, Santa Monica, CA, USA
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Abstract
The phenotypic trait of high bone mass (HBM) is an excellent example of the nexus between common and rare disease genetics. HBM may arise from carriage of many 'high bone mineral density [BMD]'-associated alleles, and certainly the genetic architecture of individuals with HBM is enriched with high BMD variants identified through genome-wide association studies of BMD. HBM may also arise as a monogenic skeletal disorder, due to abnormalities in bone formation, bone resorption, and/or bone turnover. Individuals with monogenic disorders of HBM usually, though not invariably, have other skeletal abnormalities (such as mandible enlargement) and thus are best regarded as having a skeletal dysplasia rather than just isolated high BMD. A binary etiological division of HBM into polygenic vs. monogenic, however, would be excessively simplistic: the phenotype of individuals carrying rare variants of large effect can still be modified by their common variant polygenic background, and by the environment. HBM disorders-whether predominantly polygenic or monogenic in origin-are not only interesting clinically and genetically: they provide insights into bone processes that can be exploited therapeutically, with benefits both for individuals with these rare bone disorders and importantly for the many people affected by the commonest bone disease worldwide-i.e., osteoporosis. In this review we detail the genetic architecture of HBM; we provide a conceptual framework for considering HBM in the clinical context; and we discuss monogenic and polygenic causes of HBM with particular emphasis on anabolic causes of HBM.
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Affiliation(s)
- Celia L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- *Correspondence: Celia L. Gregson, ; Emma L. Duncan,
| | - Emma L. Duncan
- Department of Twin Research & Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- *Correspondence: Celia L. Gregson, ; Emma L. Duncan,
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