1
|
Sarikaya Solak S, Yelgen Ilyas H. Tofacitinib: a successful treatment option for SAPHO syndrome. Int J Dermatol 2024; 63:671-674. [PMID: 38357788 DOI: 10.1111/ijd.17075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/10/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Sezgi Sarikaya Solak
- Faculty of Medicine, Department of Dermatology, Trakya University, Edirne, Turkey
| | - Hande Yelgen Ilyas
- Faculty of Medicine, Department of Dermatology, Trakya University, Edirne, Turkey
| |
Collapse
|
2
|
Shi XJ, Wang L, Ding YH, Hou XJ, Li C. Precision management in SAPHO syndrome: Stratified care based on various skin manifestations. Semin Arthritis Rheum 2024; 65:152374. [PMID: 38237232 DOI: 10.1016/j.semarthrit.2024.152374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Xiao-Jun Shi
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Luying Wang
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yi-Hang Ding
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiu-Juan Hou
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China.
| |
Collapse
|
3
|
Matucci-Cerinic C, Viglizzo G, Gattorno M. SAPHO syndrome: Patient stratification and the new horizon of precision medicine. Semin Arthritis Rheum 2024; 65:152373. [PMID: 38290373 DOI: 10.1016/j.semarthrit.2024.152373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Caterina Matucci-Cerinic
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Rheumatology and Autoinflammatory Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | | | - Marco Gattorno
- Rheumatology and Autoinflammatory Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| |
Collapse
|
4
|
Zhang Y, Zheng Z, Gu M, Wu Y, Li C. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome may present with extra-articular and cutaneous manifestations. Int J Rheum Dis 2024; 27:e15093. [PMID: 38443985 DOI: 10.1111/1756-185x.15093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/07/2024]
Affiliation(s)
- YuRu Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - ZiXiang Zheng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - MengJiao Gu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - YuanHao Wu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chen Li
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
5
|
Dierckx S, Nisolle JF, Boutsen Y. Dramatic response of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome to tofacitinib monotherapy: a case report. J Med Case Rep 2024; 18:57. [PMID: 38360816 PMCID: PMC10870493 DOI: 10.1186/s13256-024-04366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/05/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare condition. Its treatment remains a challenge for clinicians, and often yields mixed results. CASE We report the case of a 51-year-old Caucasian woman who presented with SAPHO syndrome with mainly axial involvement. She had been treated with sulfasalazine and anti-inflammatory drugs for many years without any success. A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved. Imaging also showed considerable regression of the vertebral and pelvic lesions. However, tofacitinib had to be discontinued due to the occurrence of pulmonary embolism. Consequently, recurrence of bone pain and biologic inflammation was rapidly observed. CONCLUSIONS Anti-JAKs are an interesting treatment option in the management of SAPHO syndrome that need further clinical trials and assessment for validating response.
Collapse
Affiliation(s)
- Stéphanie Dierckx
- Department of Rheumatology, CHU UCL Namur, Mont-Godinne, 1 Avenue Gaston Therasse, 5530, Yvoir, Belgium.
| | - Jean-François Nisolle
- Department of Radiology, CHU UCL Namur, Mont-Godinne, 1 Avenue Gaston Therasse, 5530, Yvoir, Belgium
| | - Yves Boutsen
- Department of Rheumatology, CHU UCL Namur, Mont-Godinne, 1 Avenue Gaston Therasse, 5530, Yvoir, Belgium
| |
Collapse
|
6
|
Wang T, Gong X, Xia C, Kong W, Geng S, Jiang H, Xiao E, Wang H, Yu Y, Li C, Yuan K. An integrated transcriptomics and network pharmacology approach to explore the mechanism of Wang-Bi tablet against SAPHO syndrome. Int J Rheum Dis 2024; 27:e15077. [PMID: 38402418 DOI: 10.1111/1756-185x.15077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND SAPHO syndrome is recognized as a rare entity with damage to skin and bones due to inflammation. Currently, the treatment for SAPHO syndrome is still a challenge in clinical practice. In this study, an integrated transcriptomics and network pharmacology approach was applied to explore the therapeutic effect and mechanism of Wang-Bi tablet (WBT) on SAPHO syndrome. METHODS The main components of WBT and their targets, as well as the targets of SAPHO syndrome, were collected from databases. Network visualization was performed using Cytoscape software. The GO and KEGG enrichment analysis was executed by David dataset. Then, the molecular mechanism of WBT improving SAPHO syndrome was validated by transcriptomics of peripheral blood neutrophils in SAPHO syndrome. Finally, the above results were validated by molecular docking. RESULTS The Network Pharmacology results showed there are 152 core targets for WBT treatment on SAPHO syndrome. RNA-seq data showed 442 differentially expressed genes (DEGs) in peripheral blood neutrophils of SAPHO patients. Intriguingly, NIK/NF-kappaB-, MyD88-dependent toll-like receptor-, and MAPK pathway were included in the enrichment results of network pharmacology and RNA-seq. Moreover, we verified that the core components of WBT have good affinity with the core targets of NIK/NF-kappaB-, MyD88-dependent toll-like receptor-, and MAPK pathway by molecular docking. CONCLUSIONS This study illustrated that the possible mechanisms of WBT against SAPHO syndrome may be related to NIK/NF-kappaB-, MyD88-dependent toll-like receptor-, and MAPK pathway, and further experiments are needed to prove these predictions.
Collapse
Affiliation(s)
- Ting Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Xun Gong
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Congmin Xia
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weijia Kong
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Shaohui Geng
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Haixu Jiang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Enfan Xiao
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Hesong Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Yingcai Yu
- Department of Biochemistry, College of Life Sciences, Jiangxi University of Chinese Medicine, Nanchang, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kai Yuan
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
7
|
Ben Nessib D, Ferjani HL, Majdoub F, Ben Aissa R, Gzam Y, Kaffel D, Maatallah K, Hamdi W. Anterior Chest Wall Non-traumatic Arthropathies: A Crucial but Often Overlooked Site. Curr Rheumatol Rev 2024; 20:88-96. [PMID: 37670695 DOI: 10.2174/1573397119666230905122525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/16/2023] [Accepted: 07/20/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the distribution of Anterior Chest Wall (ACW) arthropathies in a tertiary care center and identify clinical, biological and imaging findings to differentiate osteoarthritis (OA) from non-osteoarthritis (N-OA) etiologies. METHODS Search from medical records from January 2009 to April 2022, including patients with manubriosternal and/or sternoclavicular and/or sternocostal joint changes confirmed by ultrasonography, computed tomography or magnetic resonance imaging. The final study group was divided into OA and N-OA subgroups. RESULTS A total of 108 patients (34 males and 74 females, mean age: 47.3 ± 13 years) were included. Twenty patients had findings of OA, while 88 were diagnosed with N-OA pathologies. SpA was the most common etiology in the N-OA group (n = 75). The other N-OA etiologies were less common: rheumatoid arthritis (n = 4), Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome (n = 3), infectious arthritis (n = 3) and microcrystalline arthropathies (n = 3). Regarding the distinctive features, ACW pain was the inaugural manifestation in 50% of patients in OA group and 18.2% of patients in N-OA group (p = 0.003); high inflammatory biomarkers were more common in N-OA group (p = 0.033). Imaging findings significantly associated with OA included subchondral bone cysts (p < 0.001) and intra-articular vacuum phenomenon (p < 0.001), while the presence of erosions was significantly associated with N-OA arthropathies (p = 0.019). OA was independently predicted by the presence of subchondral bone cysts (p = 0.026). CONCLUSION ACW pain is a common but often underestimated complaint. Knowledge of the different non-traumatic pathologies and differentiation between OA and N-OA etiologies is fundamental for appropriate therapeutic management.
Collapse
Affiliation(s)
- Dorra Ben Nessib
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Hanene Lassoued Ferjani
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Fatma Majdoub
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Rania Ben Aissa
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Yosra Gzam
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Dhia Kaffel
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Kaouther Maatallah
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| | - Wafa Hamdi
- Department of Rheumatology, Kassab Orthopedics Institute, Ksar Saïd, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia
| |
Collapse
|
8
|
Colina M, Khodeir M. Antibiotics in SAPHO syndrome: Comment on the article by Terui et al. J Dermatol 2024; 51:e25. [PMID: 37641478 DOI: 10.1111/1346-8138.16937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Matteo Colina
- Rheumatology Service, Section of Internal Medicine, Department of Medicine and Oncology, Ospedale "Santa Maria della Scaletta", Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Micheline Khodeir
- Hospital Pharmacy. Ospedale "Santa Maria della Scaletta", Bologna, Italy
| |
Collapse
|
9
|
Duan H, Gao S, Zhang L, Song L, Zhai J, Deng X. The clinical characteristics and prognosis of patients with SAPHO syndrome--a real-world cohort study. Clin Rheumatol 2024; 43:561-568. [PMID: 37755548 DOI: 10.1007/s10067-023-06782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/22/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES We aimed to analyze the clinical characteristics and outcomes of patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. METHODS The clinical records of 64 patients with SAPHO syndrome were collected, and the treatment and outcomes of 27 patients were followed up. The patients were divided into three groups according to the site of bone lesions: only anterior chest wall (ACW) involvement, only spinal involvement, and bone lesion involvement at both sites. The clinical characteristics and outcomes were compared. The clinical characteristics of the patients with and without peripheral joint involvement were compared. RESULTS Among all patients, 31.25% (20/64) had only ACW involvement, 15.63% (10/64) had only spinal involvement, and 53.12% (34/64) had both ACW and spinal involvement. Peripheral joint involvement was observed in 25.00% (16/64) of the patients. Patients with only spinal involvement were older than those with only ACW involvement (p = 0.006). Patients with both ACW and spinal involvement were older than those with only ACW involvement (p = 0.002) and had a longer diagnosis delay (p = 0.015). Patients with peripheral joint involvement were younger than those without peripheral joint involvement (p = 0.028). During follow-up, 88.89% (24/27) of patients had good outcomes. Twenty-two patients were treated with non-steroidal anti-inflammatory drugs + Iguratimod (IGU), and the outcomes of 90.91% (20/22) improved. CONCLUSIONS A relationship may exist between the sites of bone lesions and clinical characteristics of patients with SAPHO syndrome. The clinical outcomes of these patients may be good, and IGU may be effective in treating SAPHO syndrome. Key Points • This study is the first long-term follow-up on the effectiveness of iguratimod in treating patients with SAPHO. • This study revealed that patients with SAPHO and different bone lesion sites may present with different clinical characteristics.
Collapse
Affiliation(s)
- Hongji Duan
- Department of Orthopedic Medicine, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East St, Xicheng District, Beijing, 100035, China
| | - Shuang Gao
- Department of Hematology, Lymphoma Center, Peking University Third Hospital, Beijing, China
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
| | - Jiayu Zhai
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Xiaoli Deng
- Department of Orthopedic Medicine, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East St, Xicheng District, Beijing, 100035, China.
| |
Collapse
|
10
|
Huang H, Shi X, Jin Y, Wu Y, Li C. Infection in SAPHO syndrome: Is it a reactive osteitis? Int J Rheum Dis 2024; 27:e14977. [PMID: 37964684 DOI: 10.1111/1756-185x.14977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/21/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Hanjing Huang
- Department of Rheumatology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xiaojun Shi
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Jin
- Department of Rheumatology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuanhao Wu
- Department of Rheumatology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
11
|
Awadh NI, Gorial FI, Al-Obaidi AD, Hashim HT, Al-Obaidi MN, Hammadi RA. Unusual cause of inflammatory backache: SAPHO syndrome. Int J Rheum Dis 2024; 27:e14878. [PMID: 37592395 DOI: 10.1111/1756-185x.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) is a rare chronic inflammatory disease that develops in adults. We present a case of SAPHO syndrome in a 37-year-old male presenting with gradually worsening back and neck pain for a 7-year period. The episodes were preceded by a history of pustular skin eruptions, which first appeared on the upper trunk and then involved his face and were pustular and scarring. The purpose of presenting this case report from Iraq is to raise awareness about this rare condition, which is frequently misdiagnosed and under-recognized.
Collapse
Affiliation(s)
- Nabaa Ihsan Awadh
- Rheumatology Unit, Department of Internal Medicine, Baghdad Teaching Hospital, Baghdad, Iraq
| | - Faiq I Gorial
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | | | | | - Reem Abbas Hammadi
- Rheumatology Unit, Department of Internal Medicine, Baghdad Teaching Hospital, Baghdad, Iraq
| |
Collapse
|
12
|
Li L, Du M, Xu H, Hou X, Li C. SAPHO syndrome complicated by multiple venous thrombosis of left lower limb: A case report and literature review. Int J Rheum Dis 2024; 27:e14880. [PMID: 37694521 DOI: 10.1111/1756-185x.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/28/2023] [Accepted: 08/05/2023] [Indexed: 09/12/2023]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an uncommon clinical syndrome with the signs of skin problems and osteoarthropathy as its main features. The pathogenesis of SAPHO syndrome has not been fully elucidated, and multiple complications may be present, including thrombosis. A 39-year-old male patient was diagnosed with SAPHO syndrome, complicated by multiple venous thrombosis of the left lower limb. We conducted a brief review of the current available literature on thrombosis in patients with SAPHO syndrome and speculated that the presence of lower extremity thrombosis in this patient with SAPHO syndrome may be related to physiological structure or antiphospholipid syndrome. Whether positive lupus anticoagulant has an effect on thrombosis in patients with SAPHO syndrome remains to be investigated.
Collapse
Affiliation(s)
- Leqing Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Mengmeng Du
- Beijing University of Chinese Medicine, Beijing, China
| | - Heng Xu
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
13
|
Liu S, Yin D, Lin Z, Wei S, Li C. Short-term efficacy of zoledronic acid in the treatment of 30 cases of SAPHO syndrome. Clin Exp Rheumatol 2024; 42:205-206. [PMID: 37470228 DOI: 10.55563/clinexprheumatol/zpgyz9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/27/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Shengyan Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, and Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dan Yin
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Zhimin Lin
- Beijing University of Chinese Medicine, Beijing, China
| | - Shufeng Wei
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China.
| |
Collapse
|
14
|
Mori Y, Izumiyama T, Kanabuchi R, Aizawa T. SAPHO syndrome complicated by hypertrophic pachymeningitis. Int J Rheum Dis 2024; 27:e14937. [PMID: 37803941 DOI: 10.1111/1756-185x.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuya Izumiyama
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuichi Kanabuchi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
15
|
Yue Q, Ma M, Liu S, Wu Y, Li C. JAKi: Can it be used to treat SAPHO syndrome? Int J Rheum Dis 2024; 27:e14930. [PMID: 37786240 DOI: 10.1111/1756-185x.14930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Qingyun Yue
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Mingwei Ma
- Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Shengyan Liu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yuanhao Wu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chen Li
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
16
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
17
|
Wang G, Liu Z. Inflammatory bowel diseases complicating SAPHO syndrome: A literature-based study. Asian J Surg 2023; 46:5948-5949. [PMID: 37690894 DOI: 10.1016/j.asjsur.2023.08.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Gang Wang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
| |
Collapse
|
18
|
Du H, Zhao Y, Zhu J, Li C. Spinal involvement in SAPHO syndrome mimics metastatic hematogenous lesions. Int J Rheum Dis 2023; 26:2581-2582. [PMID: 37681760 DOI: 10.1111/1756-185x.14885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Hongjia Du
- Department of Fifth Internal Medicine, Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, China
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Zhao
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Jing Zhu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
19
|
Li Y, Hou X, Liu S, Lu S, Du M, Dong X, Liu X, Li C. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome with cranial bone involvement: Case report and literature review. Int J Rheum Dis 2023; 26:2304-2309. [PMID: 37218535 DOI: 10.1111/1756-185x.14740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoimmune inflammatory disease characterized by osteoarticular and dermatological manifestations. The most common osteoarticular manifestations involve the anterior chest wall, axial skeleton, and long bones. Cranial bone involvement is less reported in SAPHO syndrome. We herein present three cases of SAPHO syndrome with cranial bone involvement, and review the previous literature on similar manifestations. It was revealed that SAPHO syndrome could lead to cranial bone involvement, which could involve the dura mater, leading to hypertrophic pachymeningitis, but the outcome is usually good. Janus kinase inhibitors may be a potential treatment option.
Collapse
Affiliation(s)
- Yuan Li
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Shengyan Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, China
| | - Siyi Lu
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Mengmeng Du
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xia Dong
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoping Liu
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
20
|
Ma M, Lu S, Hou X, Li C. Novel JAK-1 inhibitor upadacitinib as a possible treatment for refractory SAPHO syndrome: A case report. Int J Rheum Dis 2023; 26:2335-2337. [PMID: 37287393 DOI: 10.1111/1756-185x.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Mingwei Ma
- School of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyi Lu
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
21
|
Cao F, Hou X, Kang T, Shi X, Ma W, Zhang Y, Li C. SAPHO syndrome complicated with relapsing polychondritis: A case report. Int J Rheum Dis 2023; 26:2060-2063. [PMID: 37021927 DOI: 10.1111/1756-185x.14693] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic inflammatory disease. The main clinical manifestation of SAPHO syndrome is an osteoarthropathy with cutaneous involvement. Relapsing polychondritis (RP) characterized by chronic inflammation and cartilage degeneration is a rare systematic autoimmune disease. Here we report a RP case in a SAPHO syndrome patient, in which auricularitis happened 10 years after the diagnosed as SAPHO syndrome. Tofacitinib treatment can alleviate the symptoms.
Collapse
Affiliation(s)
- Fengjiao Cao
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiujuan Hou
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Tianlun Kang
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Xiaojun Shi
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Weiguo Ma
- Department of Rheumatology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Yuan Zhang
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
22
|
Liu S, Yu Y, Liu Y, Ma M, Li C. Efficacy of baricitinib in synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: A case series. Joint Bone Spine 2023; 90:105587. [PMID: 37127258 DOI: 10.1016/j.jbspin.2023.105587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/25/2023] [Accepted: 04/25/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Shengyan Liu
- School of Clinical Medicine, Peking Union Medical College, 100730 Beijing, China; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Yanying Yu
- School of Clinical Medicine, Peking Union Medical College, 100730 Beijing, China; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Yuchen Liu
- School of Clinical Medicine, Peking Union Medical College, 100730 Beijing, China; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Mingwei Ma
- School of Clinical Medicine, Peking Union Medical College, 100730 Beijing, China; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Chen Li
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, 102401 Beijing, China.
| |
Collapse
|
23
|
Hu N, Liu J, Cui W, Wang J, Wang Z, Chen X. Extracutaneous/osteoarticular manifestations in patients with SAPHO syndrome. Int J Rheum Dis 2023; 26:1649-1652. [PMID: 37664960 DOI: 10.1111/1756-185x.14779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Nandong Hu
- Department of Radiology, The Affiliated Hospital of Nanjing, University of Chinese Medicine, Nanjing, China
| | - Jingjing Liu
- Department of Radiology, The Affiliated Hospital of Nanjing, University of Chinese Medicine, Nanjing, China
- The First Clinical Institute, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenjing Cui
- Department of Radiology, The Affiliated Hospital of Nanjing, University of Chinese Medicine, Nanjing, China
| | - Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Nanjing, University of Chinese Medicine, Nanjing, China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing, University of Chinese Medicine, Nanjing, China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing, University of Chinese Medicine, Nanjing, China
| |
Collapse
|
24
|
Affiliation(s)
- Haixu Jiang
- School of Chinese Materia, Beijing University of Chinese Medicine, Beijing, China
| | - Liu Lv
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhimin Lin
- Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Li
- Department of Rheumatology, Beijing University of Chinese Medicine, Beijing, China
- Department of Traditional Chinese Medicine, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
25
|
Liu Y, Wu X, Cao Y, Liu S, Ma M, Li C. Synovitis, acne, pustulosis, hyperostosis and osteitis syndrome with mandibular involvement: Would surgical operation help? Int J Rheum Dis 2023; 26:563-567. [PMID: 36537363 DOI: 10.1111/1756-185x.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/02/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a rare autoinflammatory disease; its primary manifestation includes osteoarthropathy with skin involvement. Janus kinase (JAK) inhibitors, such as tofacitinib, were used for rheumatoid arthritis; however, due to its downregulation of immune cytokines including interleukin (IL)-6 and IL-8, it might be effective for SAPHO patients. CASE SUMMARY We report the 1st case of mandibular-related SAPHO syndrome treated with tofacitinib. The patient underwent mandibular resection surgery twice and postoperative pathology showed "osteomyelitis". The patient developed sclerosing osteomyelitis in the left wrist 9 months after surgery and SAPHO syndrome was diagnosed. The patient was administered nonsteroidal anti-inflammatory drugs and corticosteroids therapy without much remission. A 3-month tofacitinib therapy provided remission from both systemic inflammation status and peripheral osteoarticular symptoms and no significant recurrence was observed during follow-up in this case. CONCLUSION Mandibular involvement in SAPHO syndrome is easily misdiagnosed due to its rarity. Mandibular resection surgery should be applied carefully; after systemic treatment with tofacitinib, the patient had remission. We provide a successful experience for the treatment of mandibular-related SAPHO syndrome.
Collapse
Affiliation(s)
- Yuchen Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, China
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xia Wu
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shengyan Liu
- School of Clinical Medicine, Peking Union Medical College, Beijing, China
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingwei Ma
- School of Clinical Medicine, Peking Union Medical College, Beijing, China
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chen Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Rheumatology, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
26
|
Adam Z, Šedivá A, Zeman D, Fojtík Z, Petrášová H, Diatková J, Tomíška M, Král Z, Treglerová J, Peřina V, Kamaradová K, Adamová Z, Pour L. Successful treatment of SAPHO syndrome (chronic nonbacterial osteomyelitis and acne) with anakinra and denosumab. Case report and review of therapy. Vnitr Lek 2023; 69:4-14. [PMID: 37827817 DOI: 10.36290/vnl.2023.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
SAPHO is an acronym derived from capital letters of Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO). SAPHO syndrome is an umbrella term covering a constellation of bone lesions and skin manifestations. A 40-year-old male complained about his jaw and back pain, swelling of multiple joints and weight loss accompanied by physical deterioration and acne type skin lesions. Laboratory tests revealed abnormal elevation of inflammatory markers. Imaging studies illustrated multiple osteolytic bone lesions and paraosseal infiltrates. According to the set of criteria diagnosis of SAPHO syndrome was stated. The patient was treated with glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs), but only high dose dexamethasone and prednisone were effective. Daily subcutaneous administration of anakinra at the dose of 100 mg was initiated due to limited response to more classical therapies. Because of planned mandibular osteosynthesis initiation of denosumab was preferred before bisphosphonates. Therapeutic response was confirmed by FDG-PET/MR after 5 months of anakinra and denosumab therapy, showing decreased accumulation of FDG in periosteal and paraosseal infiltrates. Inflammatory markers significantly decreased, bone pain deferred but skin manifestation receded only partially. Therefore the response was evaluated as partial remission.
Collapse
|
27
|
Adachi-Katayama M, Kondo Y, Okamoto S, Sato R, Morinaka S, Nishiyama T, Terasaki M, Terasaki T, Toko H, Yagishita M, Takahashi H, Hagiwara S, Tsuboi H, Sumida T, Matsumoto I. Synovitis-acne-pustulosis-hyperostosis-osteitis Syndrome with Bilateral Pleural Effusion. Intern Med 2022; 61:2671-2675. [PMID: 35135914 PMCID: PMC9492480 DOI: 10.2169/internalmedicine.8473-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pleural effusion is a rare manifestation in synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome, which is characterized by the presence of osteoarticular lesions and dermatological involvement. We herein report a 71-year-old man with pleural effusion resulting from SAPHO syndrome. He was successfully treated using corticosteroids and has experienced no recurrence for one year. We should consider SAPHO syndrome when encountering cases of anterior chest pain and pleural fluid.
Collapse
Affiliation(s)
- Maho Adachi-Katayama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
- Department of General Medicine, Mito Kyodo General Hospital, University of Tsukuba, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Shota Okamoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Ryota Sato
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Satoshi Morinaka
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Taihei Nishiyama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Mayu Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Toshihiko Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hirofumi Toko
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Mizuki Yagishita
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroyuki Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Shinya Hagiwara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| |
Collapse
|
28
|
Ji Q, Wang Q, Pan W, Hou Y, Wang X, Bian L, Wang Z. Exceptional response of skin symptoms to secukinumab treatment in a patient with SAPHO syndrome: Case report and literature review. Medicine (Baltimore) 2022; 101:e30065. [PMID: 35984163 PMCID: PMC9388011 DOI: 10.1097/md.0000000000030065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE SAPHO syndrome is a rare clinical entity characterized by a wide range of dermatological and musculoskeletal manifestations. Treatment strategies are not standardized. Palmoplantar pustulosis (PPP) is the most common rash in patients with SAPHO syndrome. PATIENT CONCERNS A 24-year-old Chinese woman with no relevant medical or familial history had a 1-year history of cutaneous lesions with PPP and pain in the sternoclavicular joint. DIAGNOSIS Based on the diagnostic criteria for SAPHO syndrome proposed by Nguyen et al in 2012, we diagnosed SAPHO syndrome with severe PPP as the predominant manifestation. INTERVENTIONS Due to the limited therapeutic efficacy of methotrexate and cyclosporin, we started therapy with subcutaneous secukinumab 150 mg weekly for the first month, then 150 mg monthly thereafter. OUTCOMES After 4 weeks of secukinumab administration, the patient showed significant remission of pustular skin lesions, with almost no joint pain and no adverse reaction. Complete remission of skin symptoms was achieved after 3 months. Joint pain and adverse events have not reoccurred in follow-up thus far. CONCLUSIONS In patients with SAPHO syndrome, we recommend personalized treatment, which may have excellent therapeutic efficacy in those with PPP or severe skin symptoms. Although data related to the use of IL-17 blockers for SAPHO syndrome are very limited, secukinumab provides a novel therapeutic option, especially for patients with PPP and severe skin lesions. Further prospective studies are needed to support our findings.
Collapse
Affiliation(s)
- Qiang Ji
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Rheumatology and Autoimmunology, Shandong Provincial Qianfoshan Hospital, First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong medicine and Health Key Laboratory of Rheumatism
| | - Qing Wang
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong medicine and Health Key Laboratory of Rheumatism
| | - Wenping Pan
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong medicine and Health Key Laboratory of Rheumatism
| | - Yanfeng Hou
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong medicine and Health Key Laboratory of Rheumatism
| | - Xiuhua Wang
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong medicine and Health Key Laboratory of Rheumatism
| | - Lin Bian
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong medicine and Health Key Laboratory of Rheumatism
| | - Zhankui Wang
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong medicine and Health Key Laboratory of Rheumatism
- *Correspondence: Zhankui Wang, Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong medicine and Health Key Laboratory of Rheumatism (e-mail: )
| |
Collapse
|
29
|
Furer V, Kishimoto M, Tomita T, Elkayam O, Helliwell PS. Pro and contra: is synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) a spondyloarthritis variant? Curr Opin Rheumatol 2022; 34:209-217. [PMID: 35699334 DOI: 10.1097/bor.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to present the up-to-date evidence on the epidemiology, pathogenesis, musculoskeletal manifestations, and imaging of the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and to discuss its relationship with spondyloarthritis (SpA). RECENT FINDINGS SAPHO is a rare inflammatory disorder of bone, joints, and skin, with a worldwide distribution that predominantly affects the middle-age adults. The hallmark of the syndrome is a constellation of sterile inflammatory osteitis, hyperostosis, and synovitis involving the anterior chest wall, associated with acneiform and neutrophilic dermatoses, such as palmoplantar pustulosis and severe acne. The axial skeleton, sacroiliac, and peripheral joints can be involved in a similar fashion to SpA. The pathogenesis of the syndrome is multifactorial. The diagnosis is mainly based on the clinical and typical radiological features. The treatment approach is based on the off-label use of antibiotics, bisphosphonates, disease-modifying antirheumatic drugs, and anticytokine biologics. SUMMARY The SAPHO syndrome shares common features with SpA-related diseases, yet also shows some unique pathogenetic and clinical features. The nosology of SAPHO remains a subject of controversy, awaiting further research into the pathogenetic and clinical aspects of this syndrome. A better understanding of these aspects will improve the diagnostics and clinical care of patients with SAPHO.
Collapse
Affiliation(s)
- Victoria Furer
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ori Elkayam
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
30
|
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] [What about the content of this article? (0)] [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
|
31
|
Horino T, Ogasawara M, Matsumoto T, Ichii O, Terada Y. Monoclonal Gammopathy of Undetermined Significance in a Patient With Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) Syndrome: Coincidence or Association? J Clin Rheumatol 2021; 27:S557-S558. [PMID: 30870251 DOI: 10.1097/rhu.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Wang Y, Xiang Y, Cao Y, Zhang W, Li C. Tonsillectomy Leads to Remission of Bone Marrow Edema and Palmoplantar Pustulosis in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome. J Clin Rheumatol 2021; 27:S719-S720. [PMID: 32897988 DOI: 10.1097/rhu.0000000000001546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yutong Wang
- From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Yirong Xiang
- From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Yihan Cao
- From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Wen Zhang
- From the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Chen Li
- Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
33
|
贾 慧, 李 勇, 刘 增, 郭 玉. [SAPHO syndrome with chronic tonsillitis: a case report and literature review]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:944-947. [PMID: 34628822 PMCID: PMC10127713 DOI: 10.13201/j.issn.2096-7993.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 04/30/2023]
Abstract
SAPHO syndrome is a rare disease which affects the bones, joints, and skin. It is often misdiagnosed and treated mistakenly because of various clinical manifestations and general lack of awareness about the disease. The pathogenesis is inadequately understood, as a result, current therapy is empirical and aimed to control inflammatory process and alleviate pain. This paper summarizes the clinical manifestations and diagnosis and treatment scheme of SAPHO syndrome, and presents a case of patient with SAPHO syndrome who was treated in our department for bilateral tonsillectomy due to repeated pharyngalgia and fever for 10 years. Interestingly, the patient is getting better after the operation. The case is reported so as to provide reference for the diagnosis and treatment of SAPHO syndrome.
Collapse
Affiliation(s)
- 慧 贾
- 兰州大学第二医院耳鼻咽喉头颈外科(兰州,730030)
| | - 勇 李
- 兰州大学第二医院耳鼻咽喉头颈外科(兰州,730030)
| | - 增平 刘
- 兰州大学第二医院耳鼻咽喉头颈外科(兰州,730030)
| | - 玉芬 郭
- 兰州大学第二医院耳鼻咽喉头颈外科(兰州,730030)
- 郭玉芬,
| |
Collapse
|
34
|
Sehgal R, Virata AR, Bansal P, Hart M. Metastatic Carcinoma of Prostate as a Mimicker of SAPHO Syndrome. Clin Med Res 2021; 19:141-147. [PMID: 33985979 PMCID: PMC8445665 DOI: 10.3121/cmr.2021.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 03/02/2021] [Accepted: 03/24/2020] [Indexed: 11/18/2022]
Abstract
Paraneoplastic arthritides are a group of immune-mediated inflammatory arthropathies associated with occult or manifest malignancy. Musculoskeletal spread of an underlying malignancy may also mimic many rheumatologic conditions. Distinguishing primary rheumatologic condition from paraneoplastic arthritides versus direct musculoskeletal spread of malignancy can be challenging especially in individuals with prior history of cancer and new musculoskeletal complaints. SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome is an uncommon, although under recognized autoimmune disorder. Two musculoskeletal manifestations, namely inflammatory osteitis and hyperostosis of anterior chest wall with or without dermatologic manifestations, constitute a unifying feature of SAPHO syndrome. However, diagnosis of SAPHO syndrome is one of exclusion, and a wide variety of disorders including infections, malignancy (chondrosarcoma/osteosarcoma/metastasis), metabolic bone disorders (Paget's disease), osteoarthritis, seronegative spondyloarthropathy (spA) and osteonecrosis form part of a broad differential diagnosis. We present the case of a man, aged 72 years, with signs and symptoms of SAPHO syndrome and skin findings. Detailed history, radiological imaging, dermatology appearance, and role of immunohistochemical markers, especially staining for NKX3.1 protein with a novel antibody, led to a diagnosis of metastatic prostate adenocarcinoma. To our knowledge, this is the first case of metastatic adenocarcinoma of the prostate manifesting as SAPHO syndrome and cutaneous metastasis.
Collapse
Affiliation(s)
- Rahul Sehgal
- Department of Rheumatology, Mayo Clinic Health System, Eau Claire, WI 54702
| | - Andrew R Virata
- Department of Laboratory medicine and Pathology, Mayo Clinic Health System, Eau Claire, WI 54702
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, Eau Claire, WI 54702
| | - Melissa Hart
- Department of Laboratory medicine and Hemato-pathology, Mayo Clinic Health System, Eau Claire, WI 54702
| |
Collapse
|
35
|
You H, Dang G, Lu B, Zhang S, Li C, Wang L, Hu Y, Chen H, Zhang J, He W. Serum Sp17 Autoantibody Serves as a Potential Specific Biomarker in Patients with SAPHO Syndrome. J Clin Immunol 2021; 41:565-575. [PMID: 33392854 PMCID: PMC7921076 DOI: 10.1007/s10875-020-00937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome shows a wide variability in musculoskeletal and cutaneous manifestations, and it is therefore underrecognized and misdiagnosed in the clinic due to a lack of specific markers. In this study, we aimed to identify specific biomarkers by screening serum autoantibodies in SAPHO patients with a 17K human whole-proteome microarray. The serum anti-Sp17 autoantibody was identified and verified to be a specific biomarker in patients with SAPHO syndrome. Indeed, the level of the anti-Sp17 autoantibody was significantly increased in patients with active SAPHO compared to patients with an inactive disease and healthy controls (P < 0.05). Additionally, serum anti-Sp17 autoantibody levels correlated with those of serum hypersensitive C-reactive protein (hsCRP), the erythrocyte sedimentation rate (ESR), and β-crosslaps (β-CTx) in patients with active SAPHO disease. Moreover, anti-Sp17 autoantibody levels were markedly decreased after anti-inflammatory treatment with pamidronate disodium, which downregulated levels of hsCRP and ESR in patients with active SAPHO. Thus, serum levels of the anti-Sp17 autoantibody might serve as a specific biomarker for the diagnosis of SAPHO syndrome or for monitoring the disease status.
Collapse
Affiliation(s)
- Hongqin You
- Department of Immunology, Key Laboratory of T Cell Mediated Cancer Immunotherapy, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, State Key Laboratory of Medical Molecular Biology, Peking Union Medical College, Beijing, China
- Department of Immunotherapy, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Guanglei Dang
- Department of Immunology, Key Laboratory of T Cell Mediated Cancer Immunotherapy, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, State Key Laboratory of Medical Molecular Biology, Peking Union Medical College, Beijing, China
| | - Bichao Lu
- Department of Immunology, Key Laboratory of T Cell Mediated Cancer Immunotherapy, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, State Key Laboratory of Medical Molecular Biology, Peking Union Medical College, Beijing, China
| | - Siya Zhang
- Department of Immunology, Key Laboratory of T Cell Mediated Cancer Immunotherapy, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, State Key Laboratory of Medical Molecular Biology, Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lun Wang
- Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Hu
- Department of Immunology, Key Laboratory of T Cell Mediated Cancer Immunotherapy, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, State Key Laboratory of Medical Molecular Biology, Peking Union Medical College, Beijing, China
| | - Hui Chen
- Department of Immunology, Key Laboratory of T Cell Mediated Cancer Immunotherapy, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, State Key Laboratory of Medical Molecular Biology, Peking Union Medical College, Beijing, China.
| | - Jianmin Zhang
- Department of Immunology, Key Laboratory of T Cell Mediated Cancer Immunotherapy, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, State Key Laboratory of Medical Molecular Biology, Peking Union Medical College, Beijing, China.
| | - Wei He
- Department of Immunology, Key Laboratory of T Cell Mediated Cancer Immunotherapy, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, State Key Laboratory of Medical Molecular Biology, Peking Union Medical College, Beijing, China.
| |
Collapse
|
36
|
Yazawa Y, Itabashi R. Hypertrophic Pachymeningitis Related Brain Infarction in Synovitis-Acne-Pustulosis-Hyperostosis Osteomyelitis Syndrome. J Stroke Cerebrovasc Dis 2020; 30:105522. [PMID: 33307288 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/14/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022] Open
Abstract
A 50-year-old woman with a history of synovitis-acne-pustulosis-hyperostosis osteomyelitis (SAPHO) syndrome was admitted for left unilateral neglect, dysarthria, and left hemiparesis. Brain MRI showed multiple infarctions in the territory of the right middle cerebral artery and gadolinium enhancement of the thickened frontotemporal dura mater on the right side. MR angiography showed significant narrowing of the cavernous segment of the right internal carotid artery. The right internal carotid artery stenosis was thought to originate from hypertrophic pachymeningitis associated with SAPHO syndrome. This is the first report of brain infarction due to internal carotid artery stenosis caused by hypertrophic pachymeningitis associated with SAPHO syndrome.
Collapse
Affiliation(s)
- Yukako Yazawa
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan.
| | - Ryo Itabashi
- Stroke Center, Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 2-1-1, Yahaba, Shiwa, Iwate, 028-3695, Japan
| |
Collapse
|
37
|
Briede K, Valiukeviciene S, Kucinskiene V, Gollnick HPM. Biologic Therapy for Hidradenitis Suppurativa Plus Conglobate Acne Associated with SAPHO Syndrome: A Case Report. Acta Derm Venereol 2020; 100:adv00311. [PMID: 33074337 PMCID: PMC9309827 DOI: 10.2340/00015555-3672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
is missing (Short Communication).
Collapse
Affiliation(s)
- Kamilija Briede
- Skin and Venereal Diseases, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania. E-mail:
| | | | | | | |
Collapse
|
38
|
Wu N, Zhao Y, Tao W, Wu Z, Li C, Li L. A single cohort, open-label study of the efficacy of pamidronate for palmoplantar pustulosis in synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Clin Exp Rheumatol 2020; 38:1263-1264. [PMID: 32573425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Nan Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing; Medical Research Center of Orthopaedics, Chinese Academy of Medical Sciences, Beijing; and Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China
| | - Yanxue Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing; Medical Research Center of Orthopaedics, Chinese Academy of Medical Sciences, Beijing; and Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China
| | - Weilan Tao
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihong Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing; Medical Research Center of Orthopaedics, Chinese Academy of Medical Sciences, Beijing; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, and Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Li Li
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
39
|
Xiang Y, Jiao R, Cao Y, Liang D, Zhang W, Yu Y, Zhang W, Li C. Fibromyalgia in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome: prevalence and screening. Clin Rheumatol 2020; 40:1559-1565. [PMID: 32949312 DOI: 10.1007/s10067-020-05394-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/21/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore the prevalence, clinical characteristics, and screening strategy for fibromyalgia (FM) in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. METHODS A total of 313 patients from a cohort of 354 SAPHO patients volunteered to participate in this study. Demographic, clinical and laboratory data were collected at baseline. Acute-phase reactants during the last 3 months were obtained. Patient-reported outcomes (PROs) and FM evaluation were recorded by questionnaires. RESULTS A total of 57 (18.2%) patients met the 2016 research criteria for FM. Compared to those without FM, these patients had significantly higher visual analog scale (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores (all p < 0.001). However, no differences in the erythrocyte sedimentation rate (ESR) or hypersensitive C-reactive protein (hs-CRP) levels were identified between the two groups. Patients with FM were also markedly older [odds ratio (OR) 1.072, p = 0.032] and had higher Fibromyalgia Rapid Screening Tool (FiRST) scores (OR 1.607, p = 0.016). The FiRST score showed a sensitivity of 50.9% and a specificity of 89.8%, and with a cutoff of 3, the FiRST score presented a high sensitivity of 84.2%. CONCLUSION The prevalence of FM among SAPHO patients was similar to that among patients with other rheumatic diseases. Concomitant FM in SAPHO syndrome was associated with older age and worse PROs. Different cutoff values for FiRST screening should be used in patients with SAPHO syndrome. Key Points • The prevalence of FM among SAPHO patients was similar to that among patients with other rheumatic diseases. • Concomitant FM in SAPHO syndrome was associated with older age, widespread pain, and worse PROs. • Different cutoff values for FiRST screening should be used in patients with SAPHO syndrome.
Collapse
Affiliation(s)
- Yirong Xiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Jiao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yihan Cao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dongfeng Liang
- Department of Rheumatology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Weihong Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yanying Yu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
40
|
Godot A, Fakih O, Prati C, Wendling D, Verhoeven F. SAPHO syndrome and subclavian thrombosis: Simple fortuitous association? Eur J Intern Med 2020; 72:103-105. [PMID: 31796244 DOI: 10.1016/j.ejim.2019.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Amélie Godot
- Rheumatology Department, CHRU de BESANCON, 25000 Besancon, France
| | - Olivier Fakih
- Rheumatology Department, CHRU de BESANCON, 25000 Besancon, France
| | - Clément Prati
- Rheumatology Department, CHRU de BESANCON, 25000 Besancon, France; EA 4267 "PEPITE", University of Bourgogne Franche-Comté, 25000 Besancon, France
| | - Daniel Wendling
- Rheumatology Department, CHRU de BESANCON, 25000 Besancon, France; EA4266 "EPILAB" University of Bourgogne Franche-Comté, 25000 Besancon, France
| | - Frank Verhoeven
- Rheumatology Department, CHRU de BESANCON, 25000 Besancon, France; EA 4267 "PEPITE", University of Bourgogne Franche-Comté, 25000 Besancon, France.
| |
Collapse
|
41
|
Li Y, Li C, Wu N, Li F, Wu Z, Sun X, Li Q, Li L. Demographic, clinical, and scintigraphic comparison of patients affected by palmoplantar pustulosis and severe acne: a retrospective study. Clin Rheumatol 2020; 39:1989-1996. [PMID: 31953569 DOI: 10.1007/s10067-019-04904-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 12/02/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome encompasses heterogeneous dermatological manifestations, mainly palmoplantar pustulosis (PPP) and severe acne (SA). This study aims to explore the necessity of stratified management according to skin lesions. METHODS In a cohort of SAPHO patients, we compared the demographic, clinical, and scintigraphic characteristics of the SAPHO patients whose skin lesion was PPP or SA. RESULTS A total of 249 patients were included (227 affected by PPP and 22 affected by SA). Patients with SA were younger at onset (20, interquartile ranges (IQR) 15-30 vs. 37, IQR 30-46 years old; p < 0.001) and enrollment (35, IQR 25-38 vs. 41, IQR 33-50 years old; p = 0.001), and they had a prolonged disease duration (88.5 months, IQR 18.7-216.0 vs. 16.0, IQR 7.0-48.0 months; p < 0.001) and time needed for diagnosis (7.5, IQR 2.0-19.0 vs. 1.0, IQR 1.0-4.0 years; p < 0.001). Adjusted by age, sex, and disease duration, SA was significantly associated with more disease-modifying anti-rheumatic drug (DMARD) use (adjusted odds ratio (OR) 3.72; 95% confidence interval (CI) 1.23, 12.62; p = 0.019) and more sternoclavicular joint involvement (adjusted OR 5.91; 95% CI 1.17, 61.3; p = 0.030) in two separate Firth's logistic regression models. CONCLUSION SAPHO patients affected by PPP or SA as the only skin lesion may have different epidemiologic features, osteoarticular manifestations, and treatment history.Key Points• SAPHO patients with PPP or SA were heterogenous in both demographic, clinical, and imaging features.• SAPHO patients with SA were mainly male and had a significantly younger age and longer duration of symptoms before diagnosis.• SA in SAPHO patients was significantly associated with more sternoclavicular involvement and more DMARD use history.
Collapse
Affiliation(s)
- Yueting Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Nan Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China
- Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Li
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhihong Wu
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China
- Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, China
- Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaochuan Sun
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Qiyi Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Li Li
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| |
Collapse
|
42
|
Li C, Xiang Y, Wu X, Cao Y, Zhao Y, Sun X, Wu N, Zhang W. Serum IgG4 elevation in SAPHO syndrome: does it unmask a disease activity marker? Clin Exp Rheumatol 2020; 38:35-41. [PMID: 31025928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES SAPHO syndrome is a rare inflammatory disorder with multiple phenotypes, including synovitis, acne, pustulosis, hyperostosis, and osteitis. IgG4 is a subclass of immunoglobulin G, and the elevation of IgG4 has been found in different autoimmune diseases. In the present study, we explored the clinical significance of serum IgG4 levels in patients with SAPHO syndrome. METHODS Fifty-two patients who met the classification criteria of SAPHO syndrome were included in this study. Clinical data and disease activity markers were collected including erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hsCRP), pain visual analogue scale (VAS), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Serum immunoglobin (IgA, IgM, and IgG) and IgG subclass (IgG1, IgG2, IgG3, and IgG4) levels were determined using the immunonephelometric assay. RESULTS Raised serum IgG4 levels (>1400 mg/dL) were detected in 23% (12/52) of patients. Patients with elevated sIgG4 levels had significantly higher pain VAS (5.42±2.76 vs. 3.08±1.78, p=0.02), BASMI (1.80±1.64 vs. 0.38±0.94, p=0.03) and ASDAS (3.20±0.65 vs. 1.74±0.58, p<0.001) levels compared with patients with normal sIgG4 levels. This difference was also observed for ESR (38.2 vs. 22.2 mm/h, p=0.01) and serum CRP (21.0 vs. 2.2 mg/L, p=0.04) levels, which also positively correlated with sIgG4 levels. We also included 4 patients whose IgG4 levels decreased and correlated with the decrease in hsCRP and ESR levels after treatment. CONCLUSIONS Elevated sIgG4 levels are common in patients with SAPHO syndrome and are associated with high disease activity. Further investigations are needed for this phenomenon.
Collapse
Affiliation(s)
- Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yirong Xiang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xia Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yihan Cao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yanxue Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaochuan Sun
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Nan Wu
- Dept.Orthopaedic Surgery, Peking Union Med.College Hosp., Peking Union Med.College & Chinese Academy of Med. Sciences, Beijing; Med. Res. Ctr of Orthopaedics, Chinese Academy of Medical Sciences; Beijing Key Lab. Genetic Res.Skeletal Deformity, China
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
43
|
Abstract
Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) syndrome refers to a rare entity expressed by a combination of dermatological and osteoarticular manifestations. We report a case of this unique syndrome initially diagnosed as "Sweet's syndrome" due to more or less similar features. The patient is also a diagnosed case of ulcerative colitis, a rare association with SAPHO syndrome. The clinical picture, laboratory findings and most of all radiological features, ultimately directed us towards the final diagnosis. The purpose of this case report is to raise awareness regarding this unusual syndrome, its clinical manifestations, laboratory and radiological findings, so that proper management can be carried out in time.
Collapse
Affiliation(s)
- Sana Sayeed
- Department of Radiology, Shifa International Hospital, Islamabad, Pakistan
| | - Areeba Imtiaz
- Department of Radiology, Shifa International Hospital, Islamabad, Pakistan
| | - Faiza Naz
- Department of Radiology, Shifa International Hospital, Islamabad, Pakistan
| |
Collapse
|
44
|
Jelušić M, Čekada N, Frković M, Potočki K, Skerlev M, Murat-Sušić S, Husar K, Đapić T, Šmigovec I, Bajramović D. Chronic Recurrent Multifocal Osteomyelitis (CRMO) and Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) Syndrome - Two Presentations of the Same Disease? Acta Dermatovenerol Croat 2018; 26:212-219. [PMID: 30390722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The two most common entities among generally rare but under-diagnosed autoinflammatory bone disorders are chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Due to their similarities, many authors consider CRMO to be a subtype of SAPHO syndrome. The aim of this study was to compare clinical, laboratory, and imaging features and outcomes of patients with CRMO and SAPHO. The analysis of the data from 6 children with CRMO (four girls and two boys, age 3.5-14 years) and of 6 children (6 boys, age 13.5-17.5 years) with SAPHO syndrome was performed. The initiating symptoms in all patients with CRMO were bone pain with multifocal bone lesions. There were no skin manifestations. Five out of six patients achieved control with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, while one patient required disease-modifying antirheumatic drugs (DMARDs). The initiating symptom in five patients with SAPHO syndrome were severe acne, while in one patient acne occurred two years after the disease onset. Two patients typically developed inflamed sternoclavicular joints and sternum, while the others showed changes affecting other skeletal regions. Three patients achieved control with NSAIDs and corticosteroids, the others required DMARDs and TNFα inhibitors. In comparison with patients with CRMO, patients with SAPHO suffered more frequent and longer lasting exacerbations. In conclusion, CRMO and SAPHO syndrome have an array of common characteristics, but also a number of differences. Nevertheless, further investigation into the etiopathogenesis is required to establish a definite relationship between CRMO and SAPHO.
Collapse
Affiliation(s)
- Marija Jelušić
- Assoc. Prof. Marija Jelušić, MD, PhD Department of Paediatrics Division of Rheumatology and Immunology Referral Centre for Paediatric and Adolescent Rheumatology Republic of Croatia, University Hospital Centre Zagreb University of Zagreb, School of Medicine Kišpatićeva 12, 10000 Zagreb, Croatia;
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Asano T, Furuya MY, Fujita Y, Matsuoka N, Sato S, Kobayashi H, Watanabe H, Honda A, Migita K. Diagnostic value of ultrasonography in synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome: A case report. Medicine (Baltimore) 2018; 97:e12725. [PMID: 30313072 PMCID: PMC6203473 DOI: 10.1097/md.0000000000012725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is a rare condition that affects the skin, bones, and joints. Diagnosis of SAPHO syndrome is established based on clinical manifestations and imaging features on radiography or magnetic resonance imaging. PATIENT CONCERNS We report a 44-year-old male with a 20-year history of pustulosis who presented with pain in the lower extremities. Plain radiography demonstrated hyperostosis with subperiosteal erosions in the right tibia. Magnetic resonance imaging and computed tomography showed inflammatory accumulation, whereas musculoskeletal ultrasonography clearly depicted a periosteal reaction, osteitis, and enthesitis with abnormal blood flow in the surface of the right tibia. DIAGNOSES A diagnosis of SAPHO syndrome was made. INTERVENTIONS The patient was treated with combination therapy comprising prednisolone, methotrexate, and infliximab, which resulted in clinical improvement. OUTCOMES The elevated levels of C-reactive protein and matrix metalloproteinase-3 normalized, and the abnormal ultrasonographic findings disappeared. LESSONS The present case report demonstrates that multiple imaging modalities are important for the definitive diagnosis of SAPHO syndrome. Ultrasonography might be a useful tool for evaluating local musculoskeletal inflammation in patients with SAPHO syndrome.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Aki Honda
- Department of Dermatology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | | |
Collapse
|
46
|
Przepiera-Będzak H, Brzosko M. Clinical symptoms, imaging, and treatment of SAPHO syndrome: a single‑center study of 52 cases. Pol Arch Intern Med 2018; 128:396-399. [PMID: 29726848 DOI: 10.20452/pamw.4261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
47
|
Abstract
INTRODUCTION Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an autoinflammatory disorder without standardized treatment. Janus kinase (JAK) inhibitors can block a range of cytokines and might possess significant anti-inflammatory activity. Here, we report the first case of efficacious treatment of refractory SAPHO syndrome with the JAK inhibitor tofacitinib. CASE PRESENTATION A 44-year-old woman presented with arthralgia in the right wrist and complained of having difficulty in doing housework. Symptoms were unresponsiveness to nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and tumor necrosis factor inhibitors. A diagnosis of SAPHO syndrome was made based on previous dermatological and osteoarticular manifestations and bone scintigraphy findings. Oral treatment with tofacitinib at 5 mg twice daily in combination with the basic methotrexate treatment was initiated. After 4 weeks of using tofacitinib, the patient reported marked improvement of symptoms and also reported being competent in completing housework. CONCLUSIONS The efficacy of JAK inhibitors in treating refractory SAPHO syndrome should be noted.
Collapse
Affiliation(s)
- Qiao Yang
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital
- Peking Union Medical College
| | - Yumo Zhao
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital
- Peking Union Medical College
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital
| | - Yaping Luo
- Department of Nuclear Medicine, Peking Union Medical College Hospital
| | - Weixin Hao
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| |
Collapse
|
48
|
Borok S, Flusser G, Elkayam O. Clinical Images: Marked Inflammation in a Patient with Cervical Vertebral SAPHO Complicated by Vertebral Body Collapse and Severe Kyphosis. Isr Med Assoc J 2017; 19:725-726. [PMID: 29185291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Sara Borok
- Department of Rheumatology, Tel Aviv Sourasky Medical Center
| | - Gideon Flusser
- Department of Rheumatology, Tel Aviv Sourasky Medical Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
49
|
Abstract
Neutrophilic dermatoses are a group of inflammatory skin disorders characterized by an overactive innate immune system with dysregulation of neutrophils without underlying infectious etiology. The major representative conditions discussed are Sweet syndrome; pyoderma gangrenosum; neutrophilic eccrine hidradenitis; palmoplantar eccrine hidradenitis; subcorneal pustular dermatoses; bowel-associated dermatosis arthritis syndrome; and synovitis, acne, pustulosis, hyperostosis, and osteitis. We will also discuss other neutrophilic conditions present almost exclusively in the pediatric population, including congenital erosive and vesicular dermatosis with reticulated supple scarring and the recently described group of autoinflammatory diseases. The clinical characteristics, diagnostic approach, and treatment management in the pediatric and adult population are discussed.
Collapse
Affiliation(s)
- Grace L Lee
- Department of Pediatrics and Dermatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Amy Y-Y Chen
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT.
| |
Collapse
|
50
|
Abstract
RATIONAL SAPHO (Synovitis-Acne-Pustulosis-Hyperstosis-Osteitis) syndrome is a rare disease featured by its dermatological and osteoarthritic disorders, the latter of which mainly affecting the anterior chest wall, spine, and sacroiliac joint. However, rheumatoid arthritis (RA) is a chronic autoimmune disease, mainly affecting the synovial tissue of small joints in hands and feet. Here, we present an extremely rare case diagnosed with both SAPHO syndrome and RA, with an onset interval of 10 years. So far, only 1 similar case has been reported in the English literature. PATIENT CONCERNS In Sep 2015, a 59-year-old female patient presented to our hospital, complaining of refractory low back pain, left sternoclavicular joint pain, and palmoplanar pustulosis (PPP). In addition, RA had been diagnosed 10 years earlier in the patient, manifested as pain and swelling in bilateral hands and wrists, accompanied by morning stiffness, as well as positive serologic tests. INTERVENTIONS In our hospital, laboratory tests revealed elevated inflammatory markers, and imaging examinations of relevant sites showed specific osteoarthritic lesions for SAPHO syndrome. DIAGNOSES These findings lead us to make an easy diagnosis of the coexistence of SAPHO syndrome and RA in this petient. OUTCOMES Treatment with tripterygium wilfordii polyglycosidium and prednisone was introduced. Both dermatological and osteoarthritic symptoms improved during a 3-month follow-up. Symptoms of RA were successfully controlled with prednisone and leflunomide since 2005. LESSONS We present an extremely rare case diagnosed with both SAPHO syndrome and RA, with an onset interval of 10 years. With this case report, we want to draw attention to the diverse features of SAPHO syndrome.
Collapse
Affiliation(s)
| | - Chen Li
- Department of Traditional Chinese Medicine,Peking Union Medical College Hospital (PUMCH),Peking Union Medical College and Chinese Academy of Medical Sciences (PUMC&CAMS), Beijing, People's Republic of China
| | | |
Collapse
|