The importance of bone scintigraphy in the diagnosis of sapho syndrome

Rodríguez, M. Vázquez; Tormo, I. Casáns; Peña, M.C. Redal; Castillo, V. Lopez

doi:10.1016/s1578-200x(10)70020-6

Cited by 8 publications

(8 citation statements)

References 13 publications

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“…ACW and sternocostoclavicular joints were the main regions affected in the present cases. It has been shown that the lesions of SAPHO syndrome may be age dependent (25). In children, SAPHO syndrome often affects long bones, followed by the clavicle and spine (15).…”

Section: Discussionmentioning

confidence: 99%

Multimodal imaging findings of SAPHO syndrome with no skin lesions: A report of three cases and review of the literature

Duan

Chen

Liu

et al. 2016

Experimental and Therapeutic Medicine

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Synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis syndrome (SAPHO) is a rare syndrome that affects the skin, bones and joints. Diagnosis of SAPHO syndrome is established on clinical appearance and imaging features. The present case report described the imaging features of three cases of SAPHO with sternoclavicular joint arthritis but without skin manifestations using multiple imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and bone scintigraphy. The first case was a 52-year-old male who suffered from progressive sternoclavicular arthritis for 2 years. The second case was a 62-year-old female with arthritis in the larger joints for 5 years, particularly on the right thoracic area. The third case was a 44-year-old male who exhibited a slight bulge accompanied by pain in the upper anterior chest wall for 4 years. All of them lacked cutaneous lesions. CT demonstrated sclerosis and hyperostosis with subchondral erosions in the sternocostoclavicular joints. MRI revealed bone marrow edema that was slightly hypointense on T1-weighted imaging, and hyperintense on T2-weighted imaging. Typical 'bull head' signs were observed in bone scintigraphy images. The present case study demonstrated that SAPHO syndrome should be suspected in patients with multifocal osteitis or arthritis affecting the chest wall that lack skin manifestations. Multimodal imaging modalities in combination are helpful for SAPHO diagnosis.

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Section: Discussionmentioning

confidence: 99%

Multimodal imaging findings of SAPHO syndrome with no skin lesions: A report of three cases and review of the literature

Duan

Chen

Liu

et al. 2016

Experimental and Therapeutic Medicine

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“…Symmetric uptake in the sternoclavicular region with a typical “bull‘s head” appearance shown in bone scintigraphy is characteristic of the SAPHO syndrome (Fig. 3) [46]. It was first described by Freyschmidt and Sternberg [47] but, even though it is considered to be pathognomonic, it is not a very sensitive indicator of SAPHO.…”

Section: Radiological Featuresmentioning

confidence: 99%

“…When only one site is involved in the absence of skin lesions, making the diagnosis can be difficult and biopsy may be needed. Sterile osteitis (little or no medullary change) is one of the major characteristics of this syndrome, but the diagnosis can never be done by histological results alone, and the advantage of biopsy is just to exclude other diagnoses [24, 46].…”

Section: Diagnosis and Differential Diagnosismentioning

confidence: 99%

SAPHO syndrome: A review

Rukavina

2015

Journal of Children's Orthopaedics

175

167

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IntroductionSynovitis–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.AimsThe 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.ResultsThe 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.ConclusionIt 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.

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“…MRI is the most sensitive imaging technique in evaluating soft tissue swelling, synovial reaction, and intra-articular effusion and synovial reaction in SAPHO syndrome [ 15 ]. Bone scintigraphy can be very useful because it not only shows increased uptake in the affected sites but also reveals silent lesions [ 16 ]. The most frequent localization is the anterior chest wall, especially the characteristic appearance of the bull's head sign, as seen in the first case.…”

Section: Discussionmentioning

confidence: 99%

SAPHO Syndrome Mimicking Infectious Spondylodiscitis and Bone Metastasis

Biuden

Maatallah

Riahi

et al. 2021

Case Reports in Rheumatology

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The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) includes diseases with similar osteoarticular manifestations and skin conditions. Making this diagnosis is not always obvious, especially when the clinical presentation does not fit the typical pattern of the disease or it occurs in a particular field. We described three cases where the diagnosis was difficult. A 46 year-old woman presented with cervical pain. The cervical X-ray showed the aspect of an ivory C5 vertebra. The patient had, however, preserved general condition, no signs of underlying neoplasia, nor other joint complaints. Blood analysis was normal. Tomography did not find any suspect lesion but showed sclerosis and hyperostosis of the manubrium. Scintigraphy showed the characteristic “bullhead” appearance. A 61-year-old woman had thoracic and lumbar pain. MRI showed spondylodiscitis in D3-D4, D4-D5, D5-D6, D6-D7, and L1-L2 with paraspinal soft tissue involvement, simulating infectious spondylodiscitis. Infectious investigations and discovertebral biopsy performed twice were negative. SAPHO syndrome was then suspected. Bone scintigraphy showed uptake in the chondrosternal articulations and D4 to D7 vertebrae. The diagnosis of SAPHO was established. The third case was a 46-year-old man with a lung adenocarcinoma. Staging for metastatic disease, a TAP tomography was performed and showed osteosclerosis of D8 to D12 and intra-articular bridges in the sacroiliac joints. MRI and scintigraphy eliminated malignancy and confirmed the diagnosis of SAPHO. In our cases, imaging findings could facilitate differentiating SAPHO syndrome from other diseases.

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The importance of bone scintigraphy in the diagnosis of sapho syndrome

Cited by 8 publications

References 13 publications

Multimodal imaging findings of SAPHO syndrome with no skin lesions: A report of three cases and review of the literature

Multimodal imaging findings of SAPHO syndrome with no skin lesions: A report of three cases and review of the literature

SAPHO syndrome: A review

SAPHO Syndrome Mimicking Infectious Spondylodiscitis and Bone Metastasis

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