SAPHO syndrome is a disorder involving the skin, bone and joints. The underlying causes of SAPHO are poorly understood, and treatment is, therefore, directed towards the individual symptoms. However, many patients are refractory to treatment, and new treatment options are needed. Herein, we describe a 28-year-old patient with SAPHO syndrome and palmoplantar pustulosis seen at our hospital. Treatment was initiated with non-steroidal anti-inflammatory drugs, but clinical improvement was poor. The addition of sulfasalazine and oral alendronate also failed to alleviate symptoms. We subsequently commenced treatment with adalimumab 40 mg every 15 days and suspended bisphosphonates. Following 4 weeks' treatment with adalimumab, there was clear articular improvement and disappearance of palmoplantar pustulous lesions. Nocturnal inflammatory lumbar pain and global disease assessment were also improved. To our knowledge, this is the first report on the use of adalimumab for SAPHO. More studies are required to confirm our findings.
Letter to the Editor
Belimumab in subacute cutaneous lupus erythematosusSir,We read with interest the article published in Lupus by Vashisht et al. 1 describing a series of patients with recalcitrant cutaneous lupus erythematosus (CLE). In this prospective observation of 5 recalcitrant CLE patients with systemic lupus erythematosus (SLE) satisfactory treated with belimumab in whom previous medium-high steroid dose, immunosupressants and anti-malarials were insufficient. This series included acute CLE, subacute CLE and chronic CLE patients with median CLE duration of 4 months, in whom a rapid (<2 months) and clinically significant improvement with belimumab treatment was observed. Moreover, CLE Disease Area and Severity Index (CLASI) score decreased and no changes on damage score were observed, leading to an important steroids sparing effect.Belimumab has shown overt efficacy in both mucocutaneous and musculoskeletal domains of SLE and also improving SLE activity markers, as observed in clinical trials. This data enhances the possibility to consider belimumab as an effective long-term disease modifying drug in SLE patients with mucocutaneous activity (rash, mucosal ulcers and alopecia), although limited data is available on its efficacy on each specific CLE involvement. 2 Salle et al. described a CLASI-50 response in 8/16 intravenously belimumab treated CLE patients (including 3 patients with isolated CLE) who failed to a median of 6.5 systemic therapies, at 6-month follow-up. 3 As response predictors, the presence of a Fitzpatrick phototype IV-VI and lower baseline CLASI score were suggested. Fruchter et al. found substantial response in 6 out of 16 CLE patients treated with intravenous belimumab in whom antimalarials were inneffective, mainly in those who showed isolated CLE, with no SLE diagnosis. 4 Husein-ElAhmed et al. presented a case of subacute CLE with SLE who responded well to belimumab after failure of multiple systemic treatments, including rituximab. 5
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