1
|
Han L, Cao F, Zhang Y, Su M, Wu Y, Li C. SAPHO syndrome after COVID-19 vaccination. Int J Rheum Dis 2024; 27:e15221. [PMID: 38874318 DOI: 10.1111/1756-185x.15221] [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: 11/23/2023] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Luyao Han
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Fengjiao Cao
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Yuru Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Minhui Su
- Department of Rheumatology, Changzhou Hospital of Traditional Chinese Medicine, Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu Province, China
| | - Yuanhao Wu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Terui H, Segawa Y, Otake E, Omori R, Tsuchiyama K, Kikuchi K, Yamasaki K, Aiba S, Asano Y. Successful treatment of pustulotic arthro-osteitis with amoxicillin: A case report and review of the literature. J Dermatol 2023; 50:1478-1483. [PMID: 37269150 DOI: 10.1111/1346-8138.16855] [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: 02/27/2023] [Revised: 05/02/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
Palmoplantar pustulosis (PPP) is a chronic skin inflammatory disease characterized by sterile pustules on the palms and soles. Pustulotic arthro-osteitis (PAO) is a major comorbidity of PPP, frequently affecting the anterior chest wall. PPP and PAO are thought to be closely associated with focal infection. We report a female in her 40s who developed pustules on her palms and soles with tenderness of both sternoclavicular and left sacroiliac joints, which were not improved with non-steroidal anti-inflammatory drugs. Of note, she showed a great response to amoxicillin, resulting in the almost complete resolution of her skin lesions and arthralgia. We also reviewed previous reports to learn more about the potential therapeutic options of antibiotics for PAO.
Collapse
Affiliation(s)
- Hitoshi Terui
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuichiro Segawa
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eika Otake
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Yagiyama Internal Medicine and Dermatology Clinic, Sendai, Japan
| | - Ryoko Omori
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichiro Tsuchiyama
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Natori Tsuchiyama Dermatology Clinic, Natori, Japan
| | - Katsuko Kikuchi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Sendai Taihaku Dermatology Clinic, Sendai, Japan
| | - Kenshi Yamasaki
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Rifu Dermatology and Allergology Clinic, Rifu, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Dermatology, Matsuda Hospital, Sendai, Japan
| | - Yoshihide Asano
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Slouma M, Bettaieb H, Rahmouni S, Litaiem N, Dhahri R, Gharsallah I, Metoui L, Louzir B. Pharmacological Management of Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome Syndrome: A Proposal of a Treatment Algorithm. J Clin Rheumatol 2022; 28:e545-e551. [PMID: 33843770 DOI: 10.1097/rhu.0000000000001740] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic disease with marked clinical and radiological heterogeneity. It is characterized by a combination of dermatological and osteoarticular manifestations. The treatment of SAPHO syndrome is not yet codified. It includes several therapeutic options such as anti-inflammatory drugs, bisphosphonates, antibiotics, conventional disease-modifying antirheumatic drugs, and biological treatment.This article aims to provide an updated review of the different pharmacological options for SAPHO syndrome. We also propose a therapeutic algorithm for the management of this disease.
Collapse
|
6
|
Similarities and Differences between Clavicular Bacterial Osteomyelitis and Nonbacterial Osteitis: Comparisons of 327 Reported Cases. J Immunol Res 2021; 2021:4634505. [PMID: 33575360 PMCID: PMC7857900 DOI: 10.1155/2021/4634505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background Currently, both clavicular bacterial osteomyelitis (BO) and nonbacterial osteitis (NBO) remain not well understood owing to their much lower incidences. This study is aimed at summarizing similarities and differences between clavicular BO and NBO based on comparisons of literature-reported cases. Methods We searched the PubMed and Embase databases to identify English published literature between January 1st, 1980, and December 31st, 2018. Inclusion criteria were studies evaluating clinical features, diagnosis, and treatment of clavicular BO and NBO, with eligible data for synthesis analysis. Results Altogether, 129 studies with 327 patients were included. Compared with BO, clavicular NBO favored females (P < 0.001) and age below 20 years (P < 0.001) and mostly presented in a chronic phase (disease term exceeding 2 months) (P < 0.001). Although local pain and swelling were the top two symptoms for both disorders, fever, erythema, and a sinus tract were more frequently found in BO patients (P < 0.01). Although they both favored the medial side, lesions in the clavicular lateral side mostly occurred in BO patients (P = 0.002). However, no significant differences were identified regarding the serological levels of white blood cell count (P = 0.06), erythrocyte sedimentation rate (P = 0.27), or C-reactive protein (P = 0.33) between BO and NBO patients before therapy. Overall, the BO patients achieved a statistically higher cure rate than that of the NBO patients (P = 0.018). Conclusions Females, age below 20 years, and a long duration of clavicular pain and swelling may imply NBO. While the occurrence of a sinus tract and lesions in the lateral side may be clues of BO, inflammatory biomarkers revealed limited values for differential diagnosis. BO patients could achieve a better efficacy than the NBO patients based on current evidence.
Collapse
|
7
|
Guo C, Tian X, Han F, Liu L, Gao J, Ma X. Copy Number Variation of Multiple Genes in SAPHO Syndrome. J Rheumatol 2020; 47:1323-1329. [PMID: 31615912 DOI: 10.3899/jrheum.181393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a type of rare chronic aseptic inflammation of unknown etiology. To date, no research to our knowledge has reported copy number variation (CNV) of genes that could affect predisposition to SAPHO syndrome. We investigated the association between CNV profile and SAPHO syndrome. METHODS We used array comparative genomic hybridization (CGH) to screen for CNV in a nuclear family including 2 patients and a healthy control. We then validated the copy numbers of candidate genes found in the array CGH assay and other candidate genes by TaqMan real-time PCR in 360 case and control samples. RESULTS Ten regions from 8 chromosomes were found to have abnormal gene copies in the nuclear family, so the CNV of candidate genes (ADAM5, CSF2RA, IL3RA, and 9 other genes) were tested by TaqMan PCR. Significant copy number loss of CSF2RA (p = 0.000) and NOD2 (p = 0.005), and significant copy number gain of MEGF6 (p = 0.002) and ADAM5 (p = 0.000) were seen in patients with SAPHO compared with controls at the a = 0.05 level. There were no differences in the other 8 candidate genes between patient and control samples (p > 0.05). CONCLUSION Our study established the first association between CNV in CSF2RA, NOD2, MEGF6, and ADAM5 and SAPHO syndrome. These findings may offer insight into the pathogenesis of SAPHO and provide the basis for improved diagnosis and treatment.
Collapse
Affiliation(s)
- Changlong Guo
- From the National Research Institute for Family Planning, Beijing; The No. 1 Hospital of Shijiazhuang, Shijiazhuang; Shijiazhuang Maternity Hospital, Shijiazhuang; and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,C. Guo, MD, PhD, National Research Institute for Family Planning; X. Tian, BS, The No. 1 Hospital of Shijiazhuang, Shijiazhuang Maternity Hospital; F. Han, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; L. Liu, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; J. Gao, MD, PhD, National Research Institute for Family Planning; X. Ma, MD, PhD, National Research Institute for Family Planning
| | - Xin Tian
- From the National Research Institute for Family Planning, Beijing; The No. 1 Hospital of Shijiazhuang, Shijiazhuang; Shijiazhuang Maternity Hospital, Shijiazhuang; and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,C. Guo, MD, PhD, National Research Institute for Family Planning; X. Tian, BS, The No. 1 Hospital of Shijiazhuang, Shijiazhuang Maternity Hospital; F. Han, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; L. Liu, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; J. Gao, MD, PhD, National Research Institute for Family Planning; X. Ma, MD, PhD, National Research Institute for Family Planning
| | - Feifei Han
- From the National Research Institute for Family Planning, Beijing; The No. 1 Hospital of Shijiazhuang, Shijiazhuang; Shijiazhuang Maternity Hospital, Shijiazhuang; and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,C. Guo, MD, PhD, National Research Institute for Family Planning; X. Tian, BS, The No. 1 Hospital of Shijiazhuang, Shijiazhuang Maternity Hospital; F. Han, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; L. Liu, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; J. Gao, MD, PhD, National Research Institute for Family Planning; X. Ma, MD, PhD, National Research Institute for Family Planning
| | - Lihong Liu
- From the National Research Institute for Family Planning, Beijing; The No. 1 Hospital of Shijiazhuang, Shijiazhuang; Shijiazhuang Maternity Hospital, Shijiazhuang; and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,C. Guo, MD, PhD, National Research Institute for Family Planning; X. Tian, BS, The No. 1 Hospital of Shijiazhuang, Shijiazhuang Maternity Hospital; F. Han, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; L. Liu, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; J. Gao, MD, PhD, National Research Institute for Family Planning; X. Ma, MD, PhD, National Research Institute for Family Planning
| | - Jianen Gao
- From the National Research Institute for Family Planning, Beijing; The No. 1 Hospital of Shijiazhuang, Shijiazhuang; Shijiazhuang Maternity Hospital, Shijiazhuang; and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. .,C. Guo, MD, PhD, National Research Institute for Family Planning; X. Tian, BS, The No. 1 Hospital of Shijiazhuang, Shijiazhuang Maternity Hospital; F. Han, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; L. Liu, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; J. Gao, MD, PhD, National Research Institute for Family Planning; X. Ma, MD, PhD, National Research Institute for Family Planning.
| | - Xu Ma
- From the National Research Institute for Family Planning, Beijing; The No. 1 Hospital of Shijiazhuang, Shijiazhuang; Shijiazhuang Maternity Hospital, Shijiazhuang; and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,C. Guo, MD, PhD, National Research Institute for Family Planning; X. Tian, BS, The No. 1 Hospital of Shijiazhuang, Shijiazhuang Maternity Hospital; F. Han, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; L. Liu, MD, PhD, Beijing Chao-Yang Hospital, Capital Medical University; J. Gao, MD, PhD, National Research Institute for Family Planning; X. Ma, MD, PhD, National Research Institute for Family Planning
| |
Collapse
|
8
|
Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome with Purely Osteolytic, Not Osteosclerotic, Lesions Mimicking a Malignant Tumor. Case Rep Rheumatol 2020; 2020:6316921. [PMID: 32280553 PMCID: PMC7142334 DOI: 10.1155/2020/6316921] [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: 06/12/2019] [Accepted: 03/14/2020] [Indexed: 11/24/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare inflammatory disorder with multiple phenotypes. The syndrome has identifiable radiologic characteristics that are the most important when making a diagnosis. X-rays of cases diagnosed with SAPHO syndrome reveal sclerotic lesions or mixed lytic and sclerotic lesions. Pure osteolytic lesions in SAPHO syndrome are rare, and to the best of our knowledge, no study has reported the radiologic change of purely osteolytic lesions to osteosclerotic lesions over time. Herein, we report on the case of a woman experiencing severe left thigh acute pain and having a medical history of palmoplantar pustulosis. Although SAPHO syndrome was suspected because of palmoplantar pustulosis, based on radiologic findings, bone metastasis of a malignant tumor or chronic bacterial osteomyelitis owing to a purely osteolytic lesion was suspected. However, needle biopsy revealed no malignancy and bacterial culture was negative, thus suggesting SAPHO syndrome. Nonsteroidal anti-inflammatory drugs, bisphosphonates, and corticosteroids were administered, which improved the left thigh pain. Furthermore, the radiologic change of osteolytic lesions to osteosclerotic lesions over time was confirmed, leading to the diagnosis of SAPHO syndrome. Our case demonstrates that knowledge of atypical radiologic findings is necessary to diagnose initial SAPHO syndrome.
Collapse
|
9
|
Singh AK, Ranjan RS. SAPHO syndrome: A radiological case report. Indian J Radiol Imaging 2020; 30:84-88. [PMID: 32476756 PMCID: PMC7240896 DOI: 10.4103/ijri.ijri_203_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/28/2018] [Accepted: 11/30/2019] [Indexed: 11/05/2022] Open
Abstract
The SAPHO syndrome (synovitis–acne–pustulosis–hyperostosis–osteitis syndrome) is a rare chronic inflammatory disease of unknown etiology. Herein, we present a case of incidentally detected SAPHO syndrome in a middle-aged male patient who visited the hospital for pulmonary complaints.
Collapse
Affiliation(s)
| | - Rahul S Ranjan
- Department of Radiodiagnosis, Rama Medical College, Mandhana, Kanpur, Uttar Pradesh, India
| |
Collapse
|
10
|
Hu WR, Yao ZL, Yu B, Jiang N. Clinical characteristics and treatment of clavicular osteomyelitis: a systematic review with pooled analysis of 294 reported cases. J Shoulder Elbow Surg 2019; 28:1411-1421. [PMID: 30826202 DOI: 10.1016/j.jse.2018.11.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is usually difficult to diagnose clavicular osteomyelitis (OM), and treatment is delayed because of its rarity. This study aimed to summarize clinical characteristics and treatment of this disease. METHODS We searched the PubMed and Embase databases to identify English studies that reported on clavicular OM from January 1980 through December 2016. Effective data were pooled for analysis. RESULTS In total, 111 studies comprising 294 cases (bacterial OM, 146; nonbacterial OM, 148) were included, with a sex ratio of 1.89:1 indicating female predilection. Overall, the median age at diagnosis was 16 years. The acute to chronic phase ratio was 0.30, with a median symptom duration of 4 months. The most frequently reported symptom was pain (192 cases), followed by swelling (151 cases) and fever (52 cases). Altogether, 86.94% cases of single-site involvement were reported, with the medial side being the most common site (69.95%). The erythrocyte sedimentation rate achieved the highest positive rate (74.44%) before treatment. The total positive rate of culture for bacterial OM was 81.82%, with Staphylococcus aureus being the most frequently detected pathogen (44.70%). The average cure rate was 83.52%, with no significant difference between surgical (89.70%) and nonsurgical (79.63%) cases (P = .079). CONCLUSIONS Clavicular OM, predominant in female patients and young people, usually occurred at a chronic stage. Pain was the most frequent symptom, with the medial side being the most involved site. The erythrocyte sedimentation rate may be a helpful indicator for diagnosis. Regardless of surgery or nonsurgery, most patients achieved a favorable prognosis.
Collapse
Affiliation(s)
- Wei-Ran Hu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zi-Long Yao
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| |
Collapse
|
11
|
Abstract
Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome was first described as chronic recurrent multifocal osteomyelitis. Because of its rarity, a thorough description of its clinical manifestations is lacking. Herein, we describe the clinical manifestations and imaging features, especially the enthesopathy in bilateral Achilles tendons, of a middle-aged Asian woman with SAPHO syndrome, who improved after diclofenac treatment.
Collapse
Affiliation(s)
- Chin-Fang Su
- Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chuan Shen
- Division of Rheumatology, Tao-Yuan General Hospital, Ministry of Health & Welfare, Tao-Yuan, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
12
|
Berkowitz YJ, Greenwood SJ, Cribb G, Davies K, Cassar-Pullicino VN. Complete resolution and remodeling of chronic recurrent multifocal osteomyelitis on MRI and radiographs. Skeletal Radiol 2018; 47:563-568. [PMID: 29124297 DOI: 10.1007/s00256-017-2812-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/11/2017] [Accepted: 10/24/2017] [Indexed: 02/02/2023]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition thought to be under-diagnosed, with a true prevalence of more than the 1 in 10,000 estimated. It is a condition that is classically described as polyostotic with a relapsing and remitting course, preferentially affecting the metaphyses of tubular bones in the pediatric population. Lesions have characteristic appearances of cortical hyperostosis and mixed lytic/sclerotic medullary appearances radiographically, with active osteitis and periostitis best seen with fluid-sensitive sequences on magnetic resonance imaging (MRI). There are reports of lesions resolving on follow-up radiographs and MRI scans, but no supporting images. In particular, although the marrow appearances and degree of osteitis have been shown to improve on MRI, complete resolution and remodeling back to normal has never been demonstrated. We present a case of a lesion that has completely healed and remodeled back to normal appearances on both radiographs and MRI, and consider this the standard for the often loosely used terms "normalization" and "resolution". We discuss the implications of this for our understanding of the natural history of CRMO, and how this adds weight to the condition being significantly under-diagnosed. It provides a "gold standard" to be aimed for when assessing treatments for CRMO, and the optimal outcomes that are possible. It also provides further insight into the potential of pediatric bone to recover and remodel when affected by inflammatory conditions.
Collapse
Affiliation(s)
- Y J Berkowitz
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, SY10 7AG, UK
| | - S J Greenwood
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, SY10 7AG, UK
| | - G Cribb
- Department of Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, SY10 7AG, UK
| | - K Davies
- Department of Medicine, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, SY10 7AG, UK
| | - V N Cassar-Pullicino
- Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, SY10 7AG, UK.
| |
Collapse
|
13
|
Greenwood S, Leone A, Cassar-Pullicino VN. SAPHO and Recurrent Multifocal Osteomyelitis. Radiol Clin North Am 2017; 55:1035-1053. [DOI: 10.1016/j.rcl.2017.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
14
|
Zhao Y, Laxer RM, Ferguson PJ. Treatment Advances in Chronic Non-Bacterial Osteomyelitis and Other Autoinflammatory Bone Conditions. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017. [DOI: 10.1007/s40674-017-0058-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
15
|
Carmo M, Pereira M, Mastella M, Pereira I. SÍNDROME DE SAPHO ASSOCIADO A HIDRADENITE SUPURATIVA. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
16
|
Gorecki P, Stockmann P, Distler JH, Wuest W, Schmidt D, Neukam FW, Nkenke E, Wehrhan F. Implication of bisphosphonate use in the treatment of SAPHO syndrome: Case report and discussion of current literature. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2015. [DOI: 10.1016/j.jmhi.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
17
|
Murakami M, Masuda K, Utsunomiya R, Oda F, Namba C, Sayama K. Cefcapene Pivoxil Hydrochloride Is a Potentially New Treatment for Palmoplantar Pustulosis with Pustulotic Arthro-Osteitis. Dermatology 2015; 231:304-11. [PMID: 26440444 DOI: 10.1159/000439401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
Pustulosis palmaris et plantaris or palmoplantar pustulosis (PPP) is a refractory pustular eruption of the palms and soles with unknown etiology. In addition to skin lesions, PPP patients may present with severe joint pain and pustulotic arthro-osteitis (PAO), especially of the sternoclavicular joint. PAO is sometimes regarded as a variant of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Hence, macrolide and tetracycline antibiotics are used for the treatment of PPP with PAO. We report 3 cases of PPP with PAO that did not improve upon administration of macrolide antibiotics with NSAIDs. After administration of cefcapene pivoxil hydrochloride (CFPN-PI), a third-generation cephalosporin, the swelling and sternoclavicular joint pain were promptly reduced and dramatically improved in all 3 cases. We review the conventional antibiotic treatments used currently and propose CFPN-PI as a potentially new therapy for PPP or PPP + PAO.
Collapse
Affiliation(s)
- Masamoto Murakami
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, Japan
| | | | | | | | | | | |
Collapse
|
18
|
A Case of SAPHO Syndrome with Endodontic Implications and Treatment with Biologic Drugs. J Endod 2015; 41:1565-70. [DOI: 10.1016/j.joen.2015.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/06/2015] [Accepted: 04/09/2015] [Indexed: 11/21/2022]
|
19
|
Abstract
The SAPHO syndrome, an acronym for synovitis, acne, pustulosis, hyperostosis and osteitis, is a rare disease which affects bones, joints and the skin. The main osteoarticular features are hyperostosis and osteitis. Osteoarticular symptoms predominantly occur on the anterior chest wall but the spine and the peripheral skeleton can also be involved. The most important skin affections are palmoplantar pustulosis and severe acne. The etiology of this syndrome remains unclear but infectious, immunological and genetic factors are involved. The diagnostic features of SAPHO syndrome are clinical and radiological. The most important diagnostic procedure is Tc-99 m bone scintigraphy but conventional x-rays as well as computed tomography (CT) and magnetic resonance imaging (MRI) can also contribute to the final diagnosis. Bone histology and positron emission tomography CT (PET-CT) may help to differentiate SAPHO syndrome from malignancies and infectious osteomyelitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of treatment. The results obtained using antibiotics and disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine and methotrexate are inconsistent. Bisphosphonates and anti-tumor necrosis factor (anti-TNF) drugs have shown promising results in small studies but further research is still necessary.
Collapse
|
20
|
Abstract
INTRODUCTION Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) is an acronym for various osteoarticular and dermatological manifestations that can appear in the same patient. It is a rare syndrome, but since its awareness has increased, there have been more and more such reports in the literature. AIMS The objectives of this review are to summarize the current state of knowledge on pediatric and adult-onset SAPHO syndrome, and to discuss treatment strategies that should be considered. RESULTS The SAPHO syndrome can affect patients of any age, and its etiology is still not known. The syndrome has its cognizable radiological characteristics that are most important in making the diagnosis. There are several diagnostic criteria as well, but they need further validation. No standard treatment protocols are available and current treatment options are not evidenced-based due to the rarity of the syndrome. Therapy is empirical and aimed at easing pain and modifying the inflammatory process. It includes nonsteroidal anti-inflammatory drugs (NSAIDs) as the first-line agents. Antibiotics, corticosteroids, disease-modifying anti-rheumatic drugs, biologicals targeting tumor necrosis factor alpha or interleukin-1, and bisphosphonates have all been used with variable success. Surgery is reserved to treat complications. Even though it is a disease with good long-term prognosis, its treatment remains a challenge and the results are known to be disappointing, especially with the skin component of the disease. CONCLUSION It is expected that these patients present at the time of diagnosis and the treatment should be as early, effective, and safe as possible in order to prevent osteoarticular progression and to limit the adverse events associated with pharmacological drugs.
Collapse
Affiliation(s)
- Iva Rukavina
- Department of Paediatrics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
| |
Collapse
|
21
|
Song X, Sun W, Meng Z, Gong L, Tan J, Jia Q, Yu C, Yu T. Diagnosis and treatment of SAPHO syndrome: A case report. Exp Ther Med 2014; 8:419-422. [PMID: 25009594 PMCID: PMC4079404 DOI: 10.3892/etm.2014.1758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/20/2014] [Indexed: 11/11/2022] Open
Abstract
The present study reports a rare case of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome in an adult male. The 42-year-old man complained of skin lesions, chest pain and lumbago. Laboratory evaluations demonstrated an elevated erythrocyte sedimentation rate and increased levels of C-reactive protein. Computerized tomography, bone scintigraphy and magnetic resonance imaging revealed multiple bone lesions. A diagnosis of SAPHO syndrome was made. Non-steroidal anti-inflammatory drugs, alendronate sodium and steroids were administered, which resulted in clinical improvement. The current case study demonstrates that skin manifestation and multiple imaging modalities are important in generating a definite diagnosis of SAPHO syndrome, and that early treatment is vital for a positive outcome.
Collapse
Affiliation(s)
- Xinghua Song
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Wenwen Sun
- Department of Rheumatology and Immunological Diseases, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Lu Gong
- Department of Rheumatology and Immunological Diseases, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Chunshui Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| | - Tielian Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R.China
| |
Collapse
|
22
|
Treatment of Pain in SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis) Syndrome. PM R 2014; 6:92-5. [DOI: 10.1016/j.pmrj.2013.08.610] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 08/24/2013] [Accepted: 08/27/2013] [Indexed: 11/24/2022]
|
23
|
A case report of extended neurogenic muscular atrophy related to SAPHO syndrome. Neurol Sci 2013; 35:479-81. [PMID: 24158656 DOI: 10.1007/s10072-013-1564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
|
24
|
Nguyen TV, Cowen EW, Leslie KS. Autoinflammation: From monogenic syndromes to common skin diseases. J Am Acad Dermatol 2013; 68:834-53. [PMID: 23453357 DOI: 10.1016/j.jaad.2012.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 10/05/2012] [Accepted: 11/01/2012] [Indexed: 11/26/2022]
Abstract
Autoinflammation is characterized by aberrant regulation of the innate immune system and often manifests as periodic fevers and systemic inflammation involving multiple organs, including the skin. Mutations leading to abnormal behavior or activity of the interleukin 1 beta (IL-1ß)-processing inflammasome complex have been found in several rare autoinflammatory syndromes, for which anticytokine therapy such as IL-1 or tumor necrosis factor-alfa inhibition may be effective. It is becoming clear that features of autoinflammation also affect common dermatoses, some of which were previously thought to be solely autoimmune in origin (eg, vitiligo, systemic lupus erythematosus). Recognizing the pathogenetic role of autoinflammation can open up new avenues for the targeted treatment of complex, inflammatory dermatoses.
Collapse
Affiliation(s)
- Tien V Nguyen
- Department of Dermatology, University of California, San Francisco, California 94143, USA
| | | | | |
Collapse
|
25
|
Sterile Osteitis and Suppurative Arthritis Associated with Pannus Responding to Colchicine. Case Rep Rheumatol 2013; 2013:249471. [PMID: 23984159 PMCID: PMC3741952 DOI: 10.1155/2013/249471] [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: 05/23/2013] [Accepted: 07/08/2013] [Indexed: 11/17/2022] Open
Abstract
Sterile suppurative arthritis is characterized by neutrophilic infiltration of joints without any causative pathogen. Here, we present a 32-year-old man with refractory osteitis and erosive suppurative oligoarthritis with pannus. Treatments with multiple disease modifying antirheumatic drugs were all unsuccessful. However, he had clinical response to colchicine and the synovial hypertrophy and the pannus in the MRI of his left shoulder resolved. In this case, the effects of colchicine on neutrophils might have played a role in treating neutrophilic sterile suppurative arthritis, which, in adults, might be a distinct oligoarticular disease.
Collapse
|
26
|
Sweeney SA, Kumar VA, Tayar J, Weber DM, Safdar A, Alonso C, Hymes S. Case 181: synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome. Radiology 2012; 263:613-7. [PMID: 22517965 DOI: 10.1148/radiol.12101436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
27
|
Weerasuriya T, Nashi S, Morgan A, Ebizie A. A dilemma of fibrous dysplasia versus chronic osteomyelitis of the clavicle. BMJ Case Rep 2012; 2012:bcr.12.2011.5319. [PMID: 22669928 DOI: 10.1136/bcr.12.2011.5319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 11-year-old child presented to the emergency department in 2005 with episodes of pain in his right clavicle. No history of trauma was noted and he was systemically well with no clinical signs of acute inflammation. He was extensively investigated and a diagnosis of fibrous dysplasia of the right clavicle was reached on histology. He developed periodic relapses of pain in the clavicle. He has been followed up since 2005, his most recent follow-up being in November 2011. The clinical dilemma of fibrous dysplasia versus chronic osteomyelitis is illustrated by highlighting this case.
Collapse
Affiliation(s)
- Thisara Weerasuriya
- Department of Orthopaedics, Tameside Hospital, Ashton-under-Lyne, Lancashire, UK.
| | | | | | | |
Collapse
|
28
|
Macrolides in chronic inflammatory skin disorders. Mediators Inflamm 2012; 2012:159354. [PMID: 22685371 PMCID: PMC3362991 DOI: 10.1155/2012/159354] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 03/10/2012] [Accepted: 03/15/2012] [Indexed: 12/30/2022] Open
Abstract
Long-term therapy with the macrolide antibiotic erythromycin was shown to alter the clinical course of diffuse panbronchiolitis in the late 1980s. Since that time, macrolides have been found to have a large number of anti-inflammatory properties in addition to being antimicrobials. These observations provided the rationale for many studies performed to assess the usefulness of macrolides in other inflammatory diseases including skin and hair disorders, such as rosacea, psoriasis, pityriasis rosea, alopecia areata, bullous pemphigoid, and pityriasis lichenoides. This paper summarizes a collection of clinical studies and case reports dealing with the potential benefits of macrolides antibiotics in the treatment of selected dermatoses which have primarily been classified as noninfectious and demonstrating their potential for being disease-modifying agents.
Collapse
|
29
|
Dellatorre G, Castro CCSD. Do you know this syndrome? An Bras Dermatol 2012; 87:155-6. [DOI: 10.1590/s0365-05962012000100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 08/20/2011] [Indexed: 11/21/2022] Open
Abstract
The SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) includes a group of findings characterized by bone lesions usually located on the anterior chest wall, often associated with skin lesions. We report the case of a 47 years old patient, with osteochondritis at costoesternal and manubrium-sternal joints, besides of palmar-plantar pustulosis. The diagnosis is predominantly clinical and there are several treatment options described in the literature.
Collapse
|
30
|
Kim YJ, Bae SI, Choi SJ, Lee YH, Ji JD, Song GG. A Case of Refractory SAPHO Syndrome Treated with Etanercept. JOURNAL OF RHEUMATIC DISEASES 2012. [DOI: 10.4078/jrd.2012.19.1.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ye Ji Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Song I Bae
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jong Dae Ji
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| |
Collapse
|
31
|
Depasquale R, Kumar N, Lalam RK, Tins BJ, Tyrrell PNM, Singh J, Cassar-Pullicino VN. SAPHO: What radiologists should know. Clin Radiol 2011; 67:195-206. [PMID: 21939963 DOI: 10.1016/j.crad.2011.08.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 08/09/2011] [Accepted: 08/10/2011] [Indexed: 11/17/2022]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is an umbrella acronym for inflammatory clinical conditions whose common denominator is aseptic osteoarticular involvement with characteristic skin lesions. It involves all ages, can involve any skeletal site, and has variable imaging appearances depending on the stage/age of the lesion and imaging method. It mimics important differentials including infection and neoplasia. Awareness of the imaging features, especially in the spine, facilitates early diagnosis, prevents repeated biopsies, and avoids unnecessary surgery, while initiating appropriate treatment.
Collapse
Affiliation(s)
- R Depasquale
- Radiology Department, Robert Jones and Agnes Hunt Orthopaedic and District Hospitals NHS Trust, Gobowen, Oswestry, Shropshire, UK
| | | | | | | | | | | | | |
Collapse
|
32
|
Mann B, Shaerf DA, Sheeraz A, Skinner JA, Saifuddin A. SAPHO syndrome presenting as widespread bony metastatic disease of unknown origin. Rheumatol Int 2011; 32:505-7. [DOI: 10.1007/s00296-010-1742-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/30/2010] [Indexed: 11/28/2022]
|
33
|
Abstract
Musculoskeletal chest pain is the most common identifiable cause of chest pain in children and adolescents. A lesion or irritation of any layer of the anterior chest wall may lead to pain. Causes range from the common, such as costochondritis, to the rare, such as chronic recurrent multifocal osteomyelitis. Regardless of the cause, chest pain raises concern of cardiac abnormalities, and may rapidly lead to significant anxiety and lifestyle alterations. Thus, efficient and accurate identification of the cause of pediatric chest pain by a thorough history and physical examination is important to minimize the disruption it may cause.
Collapse
Affiliation(s)
- Mary Beth F Son
- Division of Immunology, Harvard Medical School, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
| | | |
Collapse
|
34
|
Blasberg JD, Donington JS. Infections and Radiation Injuries Involving the Chest Wall. Thorac Surg Clin 2010; 20:487-94. [DOI: 10.1016/j.thorsurg.2010.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
35
|
Sultana S. Poster Board Number: 70: SAPHO Syndrome Affecting TMJ With Different Bone Change of Condylar Head—Report of 2 Cases Demonstrates the Bone Absorptive or Hypertrophic Change. J Oral Maxillofac Surg 2010. [DOI: 10.1016/j.joms.2010.06.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Intracranial manifestations in SAPHO syndrome: the first case report in literature. Rheumatol Int 2010; 32:1797-9. [DOI: 10.1007/s00296-010-1464-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 03/12/2010] [Indexed: 11/26/2022]
|