New Insights in the Treatment of SAPHO Syndrome and Medication Recommendations

Abstract

Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare autoinflammatory disease characterized by dermatological disorders and osteoarticular inflammatory lesions. This article reviews the application of biologics and other treatments based on the therapeutic target and the size of molecules in SAPHO syndrome. We found that drugs, especially biologics, have different effects on bone, joint, and skin damage. This may relate to the different inflammatory pathways involved in the osteoarticular and cutaneous symptoms in SAPHO patients. In this study, we provide stratified medication recommendations for SAPHO syndrome. Patients with osteoarticular symptoms can consider tumor necrosis factor blockers, JAK inhibitor, interleukin (IL)-1 inhibitor, and IL-17 inhibitor. Patients with cutaneous symptoms should consider IL-17 and JAK inhibitors. Apremilast, Tripterygium wilfordii Hook F, and bisphosphonates are other effective treatments.

Successful Treatment of SAPHO Syndrome Complicated with Ankylosing Spondylitis by Secukinumab: A Case Report

“…The primary purpose for SAPHO syndrome management is to relieve the symptoms, including alleviating pain and ameliorating skin lesions [ 3 , 21 ]. Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line drugs for relieving pain but not for preventing progress in SAPHO syndrome [ 3 , 21 ].…”

“…The primary purpose for SAPHO syndrome management is to relieve the symptoms, including alleviating pain and ameliorating skin lesions [ 3 , 21 ]. Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line drugs for relieving pain but not for preventing progress in SAPHO syndrome [ 3 , 21 ]. However, a variety of regimens, including glucocorticoids, bisphosphonates, some traditional antirheumatic drugs (such as methotrexate and leflunomide), and traditional Chinese medicines, have been reported to be effective in curbing disease deterioration and improving symptoms in SAPHO patients [ 21 ].…”

“…Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line drugs for relieving pain but not for preventing progress in SAPHO syndrome [ 3 , 21 ]. However, a variety of regimens, including glucocorticoids, bisphosphonates, some traditional antirheumatic drugs (such as methotrexate and leflunomide), and traditional Chinese medicines, have been reported to be effective in curbing disease deterioration and improving symptoms in SAPHO patients [ 21 ]. Both biological agents and JAK inhibitors have also achieved satisfactory remission, especially in patients with significantly elevated inflammatory levels after ineffective conventional drug treatment [ 6 , 7 , 11 ].…”

Hyperostosis of the Clavicle as a Cardinal Symptom for Sapho Syndrome – Presentation and Discussion of a Clinical Case

“…Possibly due to different inflammatory pathways involved, biologics in particular show different effects on bone, joint and skin lesions in SAPHO [20,32], whereby the exact extent of their effect is uncertain [33]. The tumour necrosis factor blockers, JAK inhibitors, and interleukin-1 and -17 inhibitors, which are selected and adapted according to the clinical picture, are of greatest importance [32].…”

Osteoarthropathy of the front thorax

“…Успешные результаты также получены в результате использования ингибиторов ИЛ-17/23 (секукинумаб). Тоцилизумаб (ингибитор ИЛ-6) оказался неэффективен [47]. Опубликованы положительные результаты применения при синдроме SAPHO ингибитора янус-киназ тофацитиниба [48].…”