Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO): A Case Report

Abstract

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is an uncommon adulthood disorder that presents as focal swellings and pain accompanied by abnormal changes in bone and surrounding soft tissues. X-rays of the involved region are usually insignificant; however, CT and MRI show excellent visualization of the affected structures. Typical radiological images show cortical thickening leading to decreased marrow cavity, bony erosion, and ligament ossifications. Other associated findings are synovitis and joint effusions. It is usually diagnosed on the basis of clinical as well as radiological findings. The treatment initially relies on non-steroidal anti-inflammatory drugs (NSAIDs). Patients showing poor response are started on corticosteroids and disease-modifying antirheumatic drugs (DMARDs). We report two patients who presented with joint swellings. Their workup unmasked the underlying SAPHO, which was managed well with NSAIDs.

Clinical and imaging features of six Han patients with SAPHO syndrome

“…Bisphosphate can significantly and rapidly alleviate the symptoms of bone pain by inhibiting bone resorption and its anti-inflammatory effects, and has a long-term effect on the control of inflammation (47). For refractory SAPHO, biological agents such as TNF-α antagonists can be considered (35). The long-term application of TNF-α antagonists can significantly improve bone and joint lesions, but some patients have abnormal skin lesions (psoriasiform scaly plaques or pustular lesions) (48).…”

“…PPP is characterized by aseptic pustules, erythema, and palm and plantar scales, and is more common in women, while SA is more common in men. In addition to inflammatory papules, pustules, and nodules, SA can also have systemic symptoms such as fever and joint pain (11,35). Skin involvement usually occurs earlier than bone lesions, but it can also occur at any time during the course of the disease or not appear, with no fixed regularity of intervals (24).…”