1
|
Li Y, Meng F, Jiang H, Peng Q, Fu J, Yin D, Hou X, Li C. Paradoxical skin lesions induced by IL-17 inhibitors in SAPHO syndrome. J DERMATOL TREAT 2024; 35:2295239. [PMID: 38153122 DOI: 10.1080/09546634.2023.2295239] [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: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Yuan Li
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fanzhang Meng
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Haixu Jiang
- School of Chinese Materia, Beijing University of Chinese Medicine, Beijing, China
| | - Qiuwei Peng
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingyuan Fu
- School of Chinese Materia, Beijing University of Chinese Medicine, Beijing, China
| | - Dan Yin
- Department of Endocrinology, Dongzhimen 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
|
2
|
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
|
3
|
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
|
4
|
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
|
5
|
Abstract
RATIONALE Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare disease without standard treatments. Tripterygium wilfordii hook f (TwHF) is a traditional Chinese herb with anti-inflammatory effect, and 1.0 mg/(kg·d) dose of Tripterygium glycosides has been reported to significantly improve the disease activity of a SAPHO patient in a case report. However, the optimal dose of TwHF is still unclear. Here, we report the first case of SAPHO patient who achieved rapid remission in clinical symptoms after receiving 1.5 mg/(kg·d) dose of Tripterygium glycosides treatment. PATIENT CONCERNS A 67-year-old woman noted palmoplantar pustulosis and pain in the anterior chest wall and waist. Bone scintigraphy demonstrated the typical tracer accumulation feature and magnetic resonance images showed bone marrow edema in lumbosacral vertebra. DIAGNOSES The diagnosis was made by dermatological and osteoarticular manifestations and classical signs in bone scintigraphy in accordance with the diagnostic criteria proposed in 2012. INTERVENTIONS Tripterygium glycosides was given with a primary dose of 1.5 mg/(kg·d) for 1 month and then reduced at a rate of 10 mg every 2 weeks until 1.0 mg/(kg·d) for a long-term maintenance. OUTCOMES Fast-induced remission on clinical manifestations was achieved and magnetic resonance imaging abnormality was improved significantly. Additionally, no apparent side effects were observed. LESSONS 1.5 mg/(kg·d) dose of Tripterygium glycosides seems to have fast-induced remission than 1.0 mg/(kg·d) with reliable safety. Besides, Tripterygium glycosides may also have a pharmacological effect of inhibiting osteolysis and enhancing bone strength.
Collapse
Affiliation(s)
| | | | | | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, China
| |
Collapse
|
6
|
Affiliation(s)
- S-Z Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - X Zhou
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - A Song
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Y-P Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Y Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
7
|
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
|
8
|
Valiallah N, Denny J, Worsnop F, Natkunarajah J. Images of the month 3: The 'bull's head' sign of SAPHO syndrome. Clin Med (Lond) 2019; 19:342-343. [PMID: 31308121 PMCID: PMC6752253 DOI: 10.7861/clinmedicine.19-4-342] [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] [Indexed: 11/27/2022]
Abstract
Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a rare, chronic, inflammatory disorder with cutaneous and osteoarticular manifestations.1 The aetiology of SAPHO syndrome is unknown and therefore treatment is tailored towards the individual. Non-steroidal anti-inflammatory drugs, bisphosphonates, corticosteriods, antibiotics, disease modifying anti-rheumatic drugs and biologics have all been used with variable success.
Collapse
Affiliation(s)
| | - James Denny
- Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK
| | - Fiona Worsnop
- Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK
| | | |
Collapse
|
9
|
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]
|
10
|
McGauvran AM, Kotsenas AL, Diehn FE, Wald JT, Carr CM, Morris JM. SAPHO Syndrome: Imaging Findings of Vertebral Involvement. AJNR Am J Neuroradiol 2016; 37:1567-72. [PMID: 27012293 DOI: 10.3174/ajnr.a4736] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/14/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging findings in patients with a combination of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) are often misinterpreted as discitis/osteomyelitis or metastases, resulting in multiple biopsies and delayed diagnosis. We have incidentally noted a semicircular morphology in vertebral body imaging in several cases of SAPHO syndrome with vertebral involvement. Our goal was to evaluate the prevalence of this distinctive morphology in these patients. MATERIALS AND METHODS A retrospective review of patients with SAPHO syndrome diagnosed between July 1998 and August 2013 was conducted. A descriptive analysis of MR imaging, CT, radiography, bone scanning, and PET imaging was performed for the presence and distribution of vertebral body signal intensity or attenuation changes and/or enhancement; contiguous vertebral body involvement; vertebral body collapse; endplate irregularity; disc space, facet, and spinous process involvement; subligamentous thickening; and paraspinal soft-tissue involvement. RESULTS Eighteen patients (16 women [89%]; mean age, 52.9 years) with SAPHO and spine involvement were included. Contiguous involvement of ≥2 vertebral bodies was found in 16 patients (89%), with a curvilinear or "semicircular" pattern involving portions of adjacent vertebral bodies in 10 (63%, P = .14). Most intervertebral discs demonstrated absence of abnormal T2 hyperintensity (73%) and enhancement (89%). Subligamentous thickening was present in 12 (67%). Paraspinal soft-tissue involvement was present in 6 (33%). CONCLUSIONS SAPHO syndrome should be included in the differential diagnosis in a patient with a curvilinear or semicircular pattern of vertebral involvement, contiguous vertebral body involvement, and absence of intervertebral disc edema and enhancement.
Collapse
Affiliation(s)
- A M McGauvran
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - A L Kotsenas
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
| | - F E Diehn
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J T Wald
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - C M Carr
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J M Morris
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
11
|
Liao HJ, Chyuan IT, Wu CS, Lin SW, Chen KH, Tsai HF, Hsu PN. Increased neutrophil infiltration, IL-1 production and a SAPHO syndrome-like phenotype in PSTPIP2-deficient mice. Rheumatology (Oxford) 2015; 54:1317-26. [PMID: 25602062 DOI: 10.1093/rheumatology/keu481] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 05/04/2014] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Proline-serine-threonine-phosphatase-interacting protein 2 (PSTPIP2) is involved in macrophage activation, neutrophil motility and osteoclast differentiation. However, the role of PSTPIP2 in inflammation and autoinflammatory diseases is still not clear. In this study, we generated PSTPIP2 knockout (Pstpip2(-/-)) mice to investigate its phenotype and role in autoinflammatory diseases. METHODS We constructed a Pstpip2-targeting vector and generated Pstpip2(-/-) mice. The phenotype and immunopathology of Pstpip2(-/-) mice were analysed. RESULTS All Pstpip2(-/-) mice developed paw swelling, synovitis, hyperostosis and osteitis, resembling SAPHO syndrome, an inflammatory disorder of the bone, skin and joints. Multifocal osteomyelitis was found in inflamed paws, with increased macrophage and marked neutrophil infiltrations in the bone, joint and skin. Profound osteolytic lesions with markedly decreased bone volume density developed in paws and limbs. Neutrophil-attracting chemokines and IL-1β were markedly elevated in inflamed tissues. CONCLUSION Our study suggests that PSTPIP2 could play a role in innate immunity and development of autoinflammatory bone disorders, and may be associated with the pathogenesis of human SAPHO syndrome.
Collapse
Affiliation(s)
- Hsiu-Jung Liao
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, Division of Rheumatology, Department of Internal Medicine, Cathay General Hospital, Division of Rheumatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Tsu Chyuan
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, Division of Rheumatology, Department of Internal Medicine, Cathay General Hospital, Division of Rheumatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Sheng Wu
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, Division of Rheumatology, Department of Internal Medicine, Cathay General Hospital, Division of Rheumatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Wha Lin
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, Division of Rheumatology, Department of Internal Medicine, Cathay General Hospital, Division of Rheumatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kun-Hung Chen
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, Division of Rheumatology, Department of Internal Medicine, Cathay General Hospital, Division of Rheumatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hwei-Fang Tsai
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, Division of Rheumatology, Department of Internal Medicine, Cathay General Hospital, Division of Rheumatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Immunology, College of Medicine, National Taiwan University, Division of Rheumatology, Department of Internal Medicine, Cathay General Hospital, Division of Rheumatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Ning Hsu
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, Division of Rheumatology, Department of Internal Medicine, Cathay General Hospital, Division of Rheumatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Immunology, College of Medicine, National Taiwan University, Division of Rheumatology, Department of Internal Medicine, Cathay General Hospital, Division of Rheumatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
12
|
Zuo RC, Schwartz DM, Lee CCR, Anadkat MJ, Cowen EW, Naik HB. Palmoplantar pustules and osteoarticular pain in a 42-year-old woman. J Am Acad Dermatol 2014; 72:550-3. [PMID: 25127881 DOI: 10.1016/j.jaad.2014.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 11/18/2022]
Abstract
Key teaching points • Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is characterized by distinctive osteoarticular manifestations and a spectrum of neutrophilic dermatoses. • The most common dermatologic manifestations include palmoplantar pustulosis, acne conglobata, and acne fulminans. • SAPHO syndrome should be considered in patients presenting osteoarticular pain, particularly involving the anterior chest wall and/or spine, and neutrophilic skin lesions.
Collapse
Affiliation(s)
- Rena C Zuo
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniella M Schwartz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Chyi-Chia Richard Lee
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Milan J Anadkat
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri
| | - Edward W Cowen
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Haley B Naik
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| |
Collapse
|
13
|
Colina M, Bettoli V, Pretolani S, Zauli S, Govoni M, Arienti V. "Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome": comment on the article by Zhao et al. J Dermatol 2012; 39:659-60. [PMID: 22211732 DOI: 10.1111/j.1346-8138.2011.01463.x] [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: 11/29/2022]
|
14
|
Uematsu M, Tobisawa S, Nagao M, Matsubara S, Mizutani T, Shibuya M. [Headache as a manifestation of SAPHO syndrome with a lesion extending to the dura mater, parietal bone, and temporal muscle]. Rinsho Shinkeigaku 2012; 52:106-110. [PMID: 22354235 DOI: 10.5692/clinicalneurol.52.106] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 50-year-old woman with a history of palmoplantar pustulosis, femur osteomyelitis, and sterno-costo-clavicular hyperostosis presented with a chronic severe left temporal headache that had progressed during the previous year. Her CRP level was elevated. Cranial images showed Gadolinium-enhancement of the left temporal muscle, left parietal bone and dura mater. (99m)Tc-HMDP scintigram showed increased uptake in the left parietal bone, left sterno-costo-clavicular joint, right femoral head and intervertebral joints. Biopsy of the lesion demonstrated 1) proliferation of connective tissue in both perimysium and endomysium of the temporal muscle with mild inflammatory cell infiltration within the interstitium, 2) marked infiltration of granulocytes to the bone marrow of the parietal bone, 3) necrosis and moderate fibrosis in the interstitium with inflammatory cell infiltration in the parietal bone, and 4) moderate fibrosis and slight infiltration of inflammatory cells in the dura mater. The patient was diagnosed with a cranial lesion of synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome. There was a moderate response to treatment with intravenous steroid pulse therapy and subsequent methotrexate. In a case of headache accompanied by inflammatory response, palmoplantar pustulosis and joint lesions such as hyperostosis, the possibility of a rare cranial manifestation of SAPHO syndrome should be considered.
Collapse
Affiliation(s)
- Miho Uematsu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | | | | | | | | | | |
Collapse
|
15
|
Vilar-Alejo J, Dehesa L, de la Rosa-del Rey P, Novoa-Medina J, Valerón Almazán P, Santana Medina N, Bastida J. SAPHO syndrome with unusual cutaneous manifestations treated successfully with etanercept. Acta Derm Venereol 2010; 90:531-2. [PMID: 20814638 DOI: 10.2340/00015555-0895] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
16
|
Karadag-Saygi E, Gunduz OH, Gumrukcu G, Akyuz G. SAPHO syndrome: misdiagnosed and operated. Acta Reumatol Port 2008; 33:460-463. [PMID: 19078862] [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: 05/27/2023]
Abstract
SAPHO is a rare disorder that results in synovitis, acne, pustulosis, hyperostosis and osteitis. Patients with this syndrome typically present with musculoskeletal complaints, frequently localized to the anterior chest wall. However, diagnosis can be difficult in case of involvement of only one symptomatic bone without skin lesions. Awareness of SAPHO syndrome is necessary for accurate diagnosis and to prevent inappropriate and unnecessary treatment.
Collapse
Affiliation(s)
- Evrim Karadag-Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul-TURKEY.
| | | | | | | |
Collapse
|
17
|
Yabe H, Takano Y, Nomura E, Nakayama M, Kihara M, Miyakawa SI, Horiuchi Y. Two cases of SAPHO syndrome accompanied by classic features of Behcet's disease and review of the literature. Clin Rheumatol 2007; 27:133-5. [PMID: 17717714 DOI: 10.1007/s10067-007-0697-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 06/23/2007] [Accepted: 06/25/2007] [Indexed: 11/29/2022]
Abstract
We describe two patients with SAPHO (synovitis-acne-pustulosis-hyperostosis-ostitis) syndrome who presented some of the classic features of Behcet's disease. The first case is a man diagnosed as SAPHO at 74 years old. His major complaint is pain and swelling of the bilateral sterno-clavicular region for more than 14 years. Another conspicuous complication was bilateral glaucoma and episodes of iritis were recognized during the follow-up period. The second case is a 65-year-old woman, who first consulted us with right knee pain. As she had a past history of palmoplantar pustulosis and anterior chest pain, her sterile knee arthritis was diagnosed as SAPHO. She also had been suffering from recurrent oral aphthous ulceration since 6 months before visiting our hospital. Considering the clinical courses of our two cases and a review of five previously reported cases, these conditions may imply that classic features of Behcet's disease are minor complications of SAPHO syndrome. Human leukocyte antigen typing and frequent association of sacroiliitis in our cases and in the review of the literature for SAPHO syndrome with some of the classic features of Behcet's disease may indicate this condition to be a closely related disease with seronegative spondylo-arthritis.
Collapse
Affiliation(s)
- Hiroki Yabe
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Higashigaoka 2-5-1, Meguro-ku, Tokyo, 152-8902, Japan.
| | | | | | | | | | | | | |
Collapse
|
18
|
Colina M, Lo Monaco A, Khodeir M, Trotta F. Propionibacterium acnes and SAPHO syndrome: a case report and literature review. Clin Exp Rheumatol 2007; 25:457-60. [PMID: 17631745] [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] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To describe the presence of Propionibacterium acnes (P. acnes) in a series of patients with SAPHO syndrome in which a bone biopsy has been carried out and to discuss the results comparing them to the data described in the literature. METHODS In 6 out of 56 patients with SAPHO syndrome, a bone biopsy from osteitic lesion was carried out. This invasive investigation was performed only in those cases in which it was necessary to clarify the diagnosis. RESULTS Of the 6 biopsies processed, P. acnes was isolated in only one case. No other infectious agents were identified. CONCLUSION P. acnes is not often found in bone lesions of SAPHO syndrome. A bone biopsy may represent a procedure useful for corroborating the diagnosis or for excluding other diseases only in specific cases.
Collapse
Affiliation(s)
- M Colina
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Ferrara, and Dipartimento di Patologia ed Oncologia, Azienda Ospedaliera/Universitaria Arcispedale Sant'Anna, Ferrara, Italy.
| | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE To retrospectively evaluate the magnetic resonance (MR) imaging findings of vertebral involvement in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. MATERIALS AND METHODS Ethics committee approval and informed patient consent were not required for this retrospective study. MR images obtained in 12 patients (seven female, five male; mean age, 42 years; range, 16-65 years) with SAPHO syndrome involving the spine were reviewed. One vertebral lesion separated by one or more normal vertebrae was analyzed as a distinct lesion. For each lesion, the number of associated vertebrae with abnormal signal intensity (SI) (ie, single vertebra, two adjacent vertebrae, or more than two adjacent vertebrae) was noted. The following MR imaging findings were evaluated: cortical bone erosion, abnormal vertebral body SI compared with normal vertebral body SI, increased anteroposterior diameter of the vertebral body, soft-tissue involvement, vertebral body height loss of more than 30%, and abnormal SI of the adjacent intervertebral disk compared with the SI of the other disks. RESULTS Of 24 vertebral lesions found, 17 involved a single vertebra, four involved two adjacent vertebrae, and three involved three or four adjacent vertebrae. Vertebral corner cortical erosion was present in all lesions, and 23 (96%) lesions had anterior vertebral corner involvement. The erosion was confined to a vertebral corner in five (21%) lesions and included the adjacent endplate and/or the anterior cortex of the vertebral body in the remaining 19 (79%) lesions. In four (17%) lesions, involvement of two adjacent vertebral corners on either side of an intervertebral disk mimicked to some extent early disk space infection. An adjacent disk space was narrowed in six (25%) lesions and exhibited abnormal SI in two (8%). Prevertebral tissue thickening was observed in eight (33%) lesions. CONCLUSION Erosion of a vertebral body corner is consistently seen on MR images of SAPHO vertebral lesions and may support the diagnosis of SAPHO syndrome in the appropriate clinical context.
Collapse
Affiliation(s)
- Jean-Denis Laredo
- Department of Osteoarticular Radiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75475 Paris CEDEX, France.
| | | | | | | | | |
Collapse
|
20
|
Przepiera-Bedzak H, Brzosko I, Fliciński J, Samborski W, Brzosko M. [SAPHO syndrome--clinical features]. Pol Arch Med Wewn 2006; 116:1172-1177. [PMID: 18634527] [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: 05/26/2023]
Abstract
OBJECTIVE Presentation of clinical features of the SAPHO syndrome. MATERIALS AND METHODS Seventeen patients (15 women and 2 men) with confirmed diagnosis of the SAPHO syndrome was presented. The culture of biopsy of pustulotic skin lesions was performed in 11 patients. ESR, C-reactive protein level and Waaler-Rose test were determined in all patients, and antinuclear antibodies and bone scintigraphy were performed in 16 patients. X-ray of the sterno-clavicular joints was performed in 15 patients. RESULTS The age of patients was 22-59 yr. (mean: 47.1 yr). The duration of joint symptoms was 0.1-25 yr. (mean: 4.4 years). Pustulosis was presented in 16 patients, only 1 patient had acne. All patients suffered from pain localized on the anterior chest wall. Tenderness of the peripheral joints: wrist (in 7 patients), shoulder (in 7 patients), knee (in 4 patients) was shown. In 6 patients, skin changes preceded joint symptoms, in 2 patients skin changes followed joint symptoms after 5 and 10 yr., respectively. All patients had negative the Waaler-Rose test. Active inflammatory process characterized by an increased ESR and C-reactive protein level was present in 12 patients. Abnormalities in x-ray of the sterno-clavicular joints were present in 4 patients. Characteristic alternations for the SAPHO syndrome in scintigraphic picture of the skeleton were observed in 14 patients. All patients were treated with non-steroidal anti-inflammatory drugs. In 8 patients, treatment with antibiotics, in 11 patients--with sulfasalazine, in 3 patients--with methotrexate and low doses of glucocorticosteroids, in 1 patient--with colchicines was performed. CONCLUSIONS Association of typical skin changes with pain of the anterior chest wall is the key for diagnosis of the SAPHO syndrome. It seems that this syndrome is more common in Poland than it has been previously estimated.
Collapse
|
21
|
Docquier PL, Malghem J, Mousny M, Rombouts JJ. Chronic osteomyelitis of clavicle as primary manifestation of SAPHO syndrome in adolescents: report of four cases and long-term evolution. Joint Bone Spine 2006; 73:756-9. [PMID: 17011808 DOI: 10.1016/j.jbspin.2006.01.020] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
Four cases of chronic osteomyelitis of clavicle as primary manifestation of synovitis, acne, pustulosis, hyperostosis, osteomyelitis (SAPHO) are reported in adolescents. In all cases a typical radiographical evolution had been observed with progressive slow migration of sclerotic area from medial to lateral side of clavicle. Long-term evolution was alternation of remission and exacerbation but none of the patients healed.
Collapse
Affiliation(s)
- Pierre-Louis Docquier
- Department of Orthopaedic Surgery, Saint-Luc University Hospital, Cliniques Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium.
| | | | | | | |
Collapse
|
22
|
Ozyemisci-Taskiran O, Bölükbasi N, Gögüs F. A hidradenitis suppurativa related SAPHO case associated with features resembling spondylarthropathy and proteinuria. Clin Rheumatol 2006; 26:789-91. [PMID: 16680392 DOI: 10.1007/s10067-005-0199-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Accepted: 05/21/2005] [Indexed: 10/24/2022]
Abstract
We present a 53-year-old man with synovitis-acne-palmoplantar pustulosis-hyperosteosis-osteitis (SAPHO) syndrome who is HLA-B27 positive with a history of uveitis and complicated by proteinuria and osteoporosis. Interesting, yet unreported features of SAPHO syndrome and the etiology of proteinuria are further discussed.
Collapse
Affiliation(s)
- Ozden Ozyemisci-Taskiran
- Physical Medicine and Rehabilitation, Gazi University, 9. Sokak 27/6, Besevler, 06490 Ankara, Turkey.
| | | | | |
Collapse
|
23
|
Abstract
SAPHO syndrome is a group of bone and joint abnormalities associated with skin lesions. A 29-year-old male presented with severe acne on his trunk and anterior chest wall, right knee and foot pain. Radiographs and magnetic resonance images showed hyperostosis in the sternocostoclavicular region, sclerosis of one-third of the right distal 5th metatarsal bone and bony outgrowth from the medial condyle of the right femur. The histological findings of the biopsy specimen were consistent with-those of old osteomyelitis. All fungal and microbacterial cultures were negative. Pain and swelling of the right knee and foot repeated remission and aggravation. There were no radiological changes of the above-mentioned lesions noted within 4-years follow-up.
Collapse
Affiliation(s)
- Munenori Watanuki
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | | | | |
Collapse
|
24
|
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome are characterized by peculiar bone lesions that commonly involve the anterior chest wall. Osteitis typically is the most prominent skeletal lesion seen in synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome. We present a patient with aseptic femoral osteitis and sternocostal hyperostosis. The classic clinical, radiographic, and histologic features of this syndrome are described. Diagnosis is difficult in patients with only one symptomatic bone. The lesion often is confused with suppurative osteomyelitis because of similar clinicopathologic findings. Although the optimal treatment is unclear, it is important to consider synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome in the differential diagnosis of any lytic, sclerotic, or hyperostotic bone lesion to avoid unnecessary long-term antibiotic therapy.
Collapse
Affiliation(s)
- Torsten Franz
- Department of Orthopaedic Surgery, University of Berne, Inselspital, Berne, Switzerland.
| | | | | |
Collapse
|
25
|
Asano T, Abe M, Asai M, Imai T, Kamisago M, Kuwabara K, Nakajima M, Ohaki Y, Sugizaki Y, Itoh Y, Fujino O. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome in a 14-year-old boy: an immunohistochemical study of infiltrating lymphocytes in acneous skin regions. Eur J Pediatr 2005; 164:466-8. [PMID: 15906088 DOI: 10.1007/s00431-005-1697-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/07/2004] [Accepted: 04/07/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Takeshi Asano
- Department of Paediatrics, Nippon Medical School, Chiba-Hokusoh Hospital, 1715 Kamakari, Inba-gun, Inba-mura, 2701694 Chiba, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Acne fulminans is a syndrome of sudden onset hemorrhagic and ulcerative acne involving the back, chest, and face combined with systemic symptoms. It can be the dermatologic manifestation of the synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome. Current therapy for acne fulminans consists of wound care, topical and systemic corticosteroids, isotretinoin, and nonsteroidal anti-inflammatory drugs (NSAIDs). Infliximab, a recently developed monoclonal antibody against tumor necrosis factor-alfa, has shown efficacy in the treatment of psoriatic arthritis and ankylosing spondylitis both of which share clinical similarities to the SAPHO syndrome. We report the case of a patient with the SAPHO syndrome and acne fulminans who was treated with infliximab. Ten months after initiating therapy with infliximab, the area of the patient's ulcerative lesions was reduced by 70%. Infliximab might be considered as a treatment option for patients with acne fulminans unresponsive to conventional therapies.
Collapse
Affiliation(s)
- Marvi Iqbal
- Department of Medicine, Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance 90502, USA
| | | |
Collapse
|
27
|
Court C, Charlez C, Molina V, Clerc D, Miquel A, Nordin JY. Isolated thoracic spine lesion: is this the presentation of a SAPHO syndrome? A case report. Eur Spine J 2004; 14:711-5. [PMID: 15480825 PMCID: PMC3489227 DOI: 10.1007/s00586-004-0791-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Revised: 05/27/2004] [Accepted: 07/20/2004] [Indexed: 11/30/2022]
Abstract
A case of an isolated lesion of the thoracic spine attributed to SAPHO syndrome is presented. A 51-year-old man was referred for inflammatory pain in the thoracic spine. The general examination was normal (especially cutaneous and rheumatologic examinations). Laboratory analysis showed only a mild inflammatory reaction. Standard radiographs showed partial condensation of T8. Computed tomography showed osteolysis of the anterior corner of T8, and MRI revealed an abnormal signal of T8, with enlargement of the prevertebral soft tissue. Percutaneous and thoracoscopic biopsies showed a nonspecific inflammatory process, and cultures were sterile. Initially, several diagnoses were advanced: infectious spondylitis, malignant tumor, lymphomas, Paget disease, seronegative spondyloarthropathies and finally atypical SAPHO syndrome. Three months later, the patient experienced more pain. General examination was still normal. The radiological findings worsened, while the inflammatory blood tests were normal. A new thoracoscopic biopsy revealed a nonspecific inflammatory process. A diagnosis of SAPHO syndrome was made, despite the lack of typical lesions. Dramatically improving with anti-inflammatory therapy, the patient's condition was favorable at 3-year follow-up. This atypical presentation of an isolated lesion in the spine makes the diagnosis of a SAPHO syndrome difficult but possible. Spine surgeons must be aware of this rare entity, to avoid misdiagnosis and unnecessary repeated surgical biopsies.
Collapse
Affiliation(s)
- Charles Court
- Department of Orthopedic and Traumatologic Surgery, University Paris-Sud Hospital of Bicêtre, Le Kremlin Bicêtre, France
- Orthopedic and Traumatology Surgery Service of Bicêtre, 78, rue du général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Céline Charlez
- Department of Orthopedic and Traumatologic Surgery, University Paris-Sud Hospital of Bicêtre, Le Kremlin Bicêtre, France
| | - Véronique Molina
- Department of Orthopedic and Traumatologic Surgery, University Paris-Sud Hospital of Bicêtre, Le Kremlin Bicêtre, France
| | - Didier Clerc
- Department of Rheumatology, University Paris-Sud, Hospital of Bicêtre, Le Kremlin Bicêtre, France
| | - Anne Miquel
- Department of Radiology, University Paris-Sud Hospital of Bicêtre, Le Kremlin Bicêtre, France
| | - Jacques Yves Nordin
- Department of Orthopedic and Traumatologic Surgery, University Paris-Sud Hospital of Bicêtre, Le Kremlin Bicêtre, France
| |
Collapse
|
28
|
Przepiera-Bedzak H, Brzosko M, Brzosko I. [SAPHO syndrome]. Pol Arch Med Wewn 2004; 111:265-8. [PMID: 15230242] [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: 04/30/2023]
|
29
|
Schilling F, Märker-Hermann E. Die chronische rekurrierende multifokale Osteomyelitis in Assoziation mit chronisch entz�ndlichen Darmerkrankungen: Die enteropathische CRMO. Z Rheumatol 2003; 62:527-38. [PMID: 14685714 DOI: 10.1007/s00393-003-0526-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2003] [Accepted: 04/23/2003] [Indexed: 11/28/2022]
Abstract
The enterogenic reactive arthritides and entheropathic spondyloarthropathies are well-known entities. The so-called gut iteropathy concept offers an interesting working hypothesis to link the gut inflammation and the lymphocytic infiltration of the synovium. However, the association of rheumatic diseases belonging to the entity of the SAPHO syndrome with inflammatory bowel diseases (IBD) has only been rarely described in the literature. Among 138 cases of our (heterogenic) SAPHO cohort, we detected 5 patients (1 male, 4 females) with a proven association of SAPHO syndrome with IBD (in 4 cases Crohn's disease, in 1 case ulcerative colitis). Two patients belonged to the juvenileadolescent form and 3 to the adult form of SAPHO syndrome. In all cases the underlying osteoarticluar disease was classified as chronic recurrent multifocal osteomyelitis (CRMO), 2 of them presenting as inflammatory anterior chest wall syndrome. There was a strong association with psoriatic pustular dermatitis. Thus, we present 5 cases of "enteropathic CRMO" demonstrating several analogies to the enteropathic spondyloarthropathies. Both disease entities have in common i) metachronic development with osteoarticluar manifestations often preceding the gastrointestinal disease; ii) Crohn's like lesions that may develop from the stomach to the colon; iii) concomittent or intermittent skin pustulosis which mostly resolves; iiii) the gastrointestinal disease that often dominates the whole syndrome namely in the longterm follow-up. We suggest to transfer the hypothesis of the gut-synovium axis of enteropathic spondyloarthropathies to the entity of CRMO. This concept offers an opportunity to link the target organs gut mucosa, bone marrow and the skin via homing of antigen specific lymphocytes. This concept may help to better understand the pathogenesis of the "Skibo" (i. e., skin-bone) disease CRMO.
Collapse
Affiliation(s)
- F Schilling
- Klinikum der Johannes-Gutenberg-Universität Mainz, Klinische und radiologische Rheumatologie, Hebbelstr. 20, 55127 Mainz, Germany
| | | |
Collapse
|
30
|
Abstract
The SAPHO syndrome was a term coined to include a variety of musculoskeletal disorders associated with skin conditions, mainly palmoplantar pustulosis and acne conglobata. It is more correctly a spectrum which includes the following: skin lesions, osteoarticular manifestations of synovitis hyperostosis and osteitis affecting particular target sites, and.a clinical course marked by relapses and remissions. The major sites of involvement are the anterior chest wall, the spine, long bones, flat bones, and large and small joints. The distribution and severity of involvement varies from the adult to the pediatric form of chronic recurrent multifocal osteomyelitis (CRMO). The diagnosis of SAPHO syndrome is not difficult when the typical osteoarticular lesions are located in characteristic target sites. The diagnosis is more difficult if atypical sites are involved and there is no skin disease.
Collapse
Affiliation(s)
- J W S Earwaker
- Department of Medical Imaging, Holy Spirit Hospital, Brisbane, Australia.
| | | |
Collapse
|
31
|
Tohme-Noun C, Feydy A, Belmatoug N, Krainik A, Fantin B, Menu Y. Cervical involvement in SAPHO syndrome: imaging findings with a 10-year follow-up. Skeletal Radiol 2003; 32:103-6. [PMID: 12589491 DOI: 10.1007/s00256-002-0608-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2002] [Revised: 11/04/2002] [Accepted: 11/05/2002] [Indexed: 02/02/2023]
Abstract
Osteoarticular manifestations of SAPHO syndrome include vertebral lesions, typically in the thoracic segment. Chronic inflammatory changes are well depicted by MRI. We report the imaging findings with a 10-year follow-up in a case of SAPHO syndrome with marked cervical lesions.
Collapse
Affiliation(s)
- C Tohme-Noun
- Department of Radiology, Hôpital Beaujon, AP HP, Université Paris 7, Faculté de médecine Bichat-Beaujon, Paris, France
| | | | | | | | | | | |
Collapse
|
32
|
Wohl Y, Bergman R, Sprecher E, Brenner S. Stress in a case of SAPHO syndrome. Cutis 2003; 71:63-7. [PMID: 12553632] [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] [Indexed: 02/28/2023]
Abstract
In this article, we describe a case of seemingly stress-induced SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome in a man who exhibited the central features of palmoplantar psoriasis and anterior chest involvement. We also review the etiology, pathogenesis, and treatment of SAPHO syndrome and emphasize the important differences between this syndrome and psoriatic arthritis.
Collapse
Affiliation(s)
- Yonit Wohl
- Department of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | | |
Collapse
|
33
|
Schilling F, Uhl M. SAPHO syndrome and transient hemiparesis in a child: coincidence or new association? J Rheumatol 2002; 29:2019-21; author reply 2021. [PMID: 12233904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
|
34
|
Abstract
A young woman presented with deteriorated visual acuity due to acute retinal vasculitis. The diagnosis of Behçet's disease was made on the basis of the ophthalmologic findings and recurrent oral and genital aphthous ulcerations. In the past, this young woman had been operated on several times because of progressive aseptic osteitis of the right clavicle. The actual examination revealed chronic osteitis, osteosclerosis and hyperostosis of the anterior chest wall, as well as severe acne papulopustulosa et conglobata. These findings resulted in an additional diagnosis of SAPHO syndrome. This report is the first description of Behçet's disease occurring in association with SAPHO syndrome, both fulfilling the diagnostic criteria.
Collapse
Affiliation(s)
- M Caravatti
- University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
35
|
|
36
|
Károlyi Z, Harhai I, Erós N. [Dermatologic aspects of SAPHO-syndrome]. Orv Hetil 2001; 142:1801-4. [PMID: 11573450] [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] [Indexed: 02/21/2023]
Abstract
SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) as a new disease entity was first described in 1987. The syndrome is characterized by the presence of pustular dermatoses together with aseptic osteoarticular lesions. The bone involvement includes hyperostosis, aseptic osteomyelitis or arthritis of the anterior chest wall, sacroiliac joints or long bones. Skin diseases include acne conglobata or acne fulminans, palmoplantar pustulosis and hidradenitis suppurativa. Authors describe the dermatological relationship of SAPHO syndrome reporting their 7 cases (3 acne fulminans, 4 palmoplantar pustulosis). Authors draw attention to the isotretinoin therapy as a possible provoking factor of the articular symptoms, and they emphasize the diagnostic role of bone scintigraphy.
Collapse
Affiliation(s)
- Z Károlyi
- Miskolc Város Onkormányzat Semmelweis Kórház, Bórgyógyászati Osztály
| | | | | |
Collapse
|
37
|
Abstract
OBJECTIVE To determine the clinical presentation and outcomes of chronic recurrent multifocal osteomyelitis (CRMO) in pediatric patients. PATIENTS AND METHODS Ten girls and four boys were followed up between 1993 and 1999 for CRMO diagnosed on the basis of radiographic bone lesions with, at the same sites, increased radionuclide uptake, negative microbiological specimens, and histological evidence of nonspecific osteomyelitis. RESULTS Mean age at CRMO was 9.6+/-3.4 years, mean disease duration was 5.3+/-2.5 years, and mean number of flares per patient was 5.9+/-3.7. Thirty-four percent of lesions were in the metaphyses of the lower limb bones, 14% in the pelvis, and 13% in the chest wall (with clavicular lesions in four patients). Three patients had skin lesions (psoriasis in two and palmoplantar pustulosis in one). Eight patients received antibiotic therapy, for 2 months at the most, to no advantage in the short term. Nonsteroidal anti-inflammatory drugs were used in all 14 patients and glucocorticoid therapy in four. Sulfasalazine was used in five patients, to good effect in four. Mean follow-up was 5.3+/-2.5 years. At last follow-up, eight patients had active disease, including one with synovitis and one with Takayashu's disease. CONCLUSION As compared to SAPHO syndrome, skin lesions and chest wall involvement are less common in CRMO. The long-term prognosis is guarded: in our study only six of 14 patients were in remission at last follow-up.
Collapse
|
38
|
Roldán JC, Terheyden H, Dunsche A, Kampen WU, Schroeder JO. Acne with chronic recurrent multifocal osteomyelitis involving the mandible as part of the SAPHO syndrome: case report. Br J Oral Maxillofac Surg 2001; 39:141-4. [PMID: 11286450 DOI: 10.1054/bjom.2000.0591] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 11/18/2022]
Abstract
For 12 years, a 26-year-old man had acne conglobata and a non-suppurative diffuse sclerosing osteomyelitis of the mandible as part of a chronic recurrent multifocal osteomyelitis of the sternum, the pelvic bones, and the femoral head, and aseptic arthritis of the knee, the fibulotalar, and the sternoclavicular joints. This fulfills the formal criteria of the SAPHO syndrome. Repeated surgical and antibiotic treatment combined with hyperbaric oxygen caused partial improvement. Complete relief and partial disappearance of the scintigraphic lesions was achieved with long-term corticosteroids, non-steroidal anti-inflammatory drugs, minocycline, and isotretinoin.
Collapse
Affiliation(s)
- J C Roldán
- Department of Oral and Maxillofacial Surgery, Christian-Albrechts-Universität, Kiel, Germany.
| | | | | | | | | |
Collapse
|
39
|
Legoupil N, Révelon G, Allain J, Voisin MC, Rahmouni A, Chevalier X, Claudepierr P. Iliac vein thrombosis complicating SAPHO syndrome: MRI and histologic features of soft tissue lesions. Joint Bone Spine 2001; 68:79-83. [PMID: 11235788 DOI: 10.1016/s1297-319x(00)00229-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [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: 11/29/2022]
Abstract
Subclavian and superior vena cava obstruction complicating SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) syndrome has been described. We report the first case to our knowledge of iliac vein thrombosis complicating lumbar vertebral osteitis due to SAPHO syndrome. Lumbar MRI demonstrated a large tissue mass anterior to the involved vertebras and surrounding the right iliac vein. Histology of the mass showed aseptic inflammation.
Collapse
Affiliation(s)
- N Legoupil
- Department of Rheumatology, H pital Henri Mondor, Créteil, France
| | | | | | | | | | | | | |
Collapse
|
40
|
DiMeco F, Clatterbuck RE, Li KW, McCarthy EF, Olivi A. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome presenting as a primary calvarial lesion. Case report and review of the literature. J Neurosurg 2000; 93:693-7. [PMID: 11014551 DOI: 10.3171/jns.2000.93.4.0693] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 11/06/2022]
Abstract
The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a recently described, currently evolving clinical entity that groups together several idiopathic disorders of bone and skin formerly described under a variety of names. Among the spectrum of possible locations for the bone lesions, there is no previous report in the literature of primary involvement of the skull vault. A patient with primary involvement of the calvaria in the setting of SAPHO syndrome is described here, which, to the authors' knowledge, is the first report of such localization. The clinically and radiologically benign evolution of the different stages of the bone lesions is presented. The authors suggest that the SAPHO syndrome should be considered in the differential diagnosis of lytic, sclerotic, or hyperostotic lesions of the skull, particularly before considering invasive diagnostic procedures.
Collapse
Affiliation(s)
- F DiMeco
- Department of Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
| | | | | | | | | |
Collapse
|
41
|
Abstract
A 46-year-old man who had been suffering from palmoplantar pustulosis (PPP) for 3 years had anterior chest pain and left temporal pain from six months after the onset of his disease. A bone scan revealed abnormal uptake at the sternoclavicular joint and left temporal region. The head CT and MRI gave the diagnosis of temporal osteomyelitis with meningitis and myositis. His headache continued even after tonsillectomy and was effectively treated with cyclosporine A (3 mg/kg/day). Oral cyclosporine A was beneficial for the osteomyelitis and skin lesions. Sterile lytic bone lesions occurring most often at the sternocostoclavicular joint have been associated with PPP. However, there have been no reports of a PPP patient with temporal osteomyelytic involvement.
Collapse
Affiliation(s)
- A Seno
- Department of Dermatology, Mitoyo General Hospital, Kagawa, Japan
| | | | | | | |
Collapse
|
42
|
Abstract
Synovitis (inflammatory arthritis), acne (pustulosa), pustulosis (psoriasis, palmoplantar pustulosis), hyperostosis (acquired), and ostitis (bland osteomyelitis) are symptoms forming the acronym SAPHO, which is a syndrome of nosologic heterogeneity. All entities forming the SAPHO syndrome are connected by a non-obligate dermatoskeletal association with an aseptic pustulous character. 86 cases were analyzed clinically, radiologically and by histology/histopathology. 31 adult patients showed the typical triad of pustulosis palmo-plantaris (psoriatica, PPP), sterno-costo-clavicular hyperostosis (SCCH), and "productive" spondylopathy, which we define as entity I. spondarthritis hyperostotica pustulopsoriatica (Spond.hyp.pp). Twelve adolescent and 13 adult patients showed entity no. II: chronic recurrent multifocal osteomyelitis (CRMO), being characterized by non-purulent osteomyelitis of plasma-cell sclerotic type, potentially being a reactive inflammatory process. 50% of the adult patients with CRMO showed PPP. Differentiation between these two entities is possible by detection of ossifying enthesiopathy in cases of Spond. hyp.pp and primarily chronic osteomyelitis in cases of CRMO. Two more entities or abortive forms of group I and II are III: the inflammatory syndrome of the anterior chest-wall (ACW syndrome) and IV: the more productive form of isolated sterno-costoclavicular hyperostosis (SCCH). Both are connected quite frequently to HLA-B-27-independent forms of spondarthritis and to pustulous dermatosis. More rarely we find osteo-articular symptoms in cases of acne pustulosa, which form group V: acne-associated spondarthritis and CRMO in the case of acne. Adult forms of CRMO with different forms of appearance (lumosacro-iliac hyperostosis with retroperitobeal fibrosis, pelvic type with affection of the hip-joint) are described. The immunologic theory of a "reactive osteomyelitis" potentially triggered by saprophytes is described. The inverse acne triad is brought in a context of skin symptoms. A case of intercurrent postpartum symptoms together with ulcerative colitis is described. Three cases of patients with Crohn's disease are described. Clinical features, radiological findings, and histopathological elements are brought together to determine the connections between the different entities and the possibilities of differentiation. With these elements together with bone-scan, it is often not necessary to obtain a bone specimen. Therapeutical possibilities, especially concerning CRMO, are discussed. "SAPHO syndrome" is more a sign-post on the way to a more subtle diagnosis when it comes to hyperostotic, skin-associated diseases, and it needs interdisciplinary work to clear the situation.
Collapse
Affiliation(s)
- F Schilling
- Rheinland-Pfälzisches Rheumazentrum Mainz-Bad Kreuznach, Mainz-Lerchenberg, Germany
| |
Collapse
|
43
|
Eyrich GK, Harder C, Sailer HF, Langenegger T, Bruder E, Michel BA. Primary chronic osteomyelitis associated with synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO syndrome). J Oral Pathol Med 1999; 28:456-64. [PMID: 10551743 DOI: 10.1111/j.1600-0714.1999.tb02106.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [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: 11/29/2022]
Abstract
Diffuse sclerosing osteomyelitis may indicate the mandibular localisation of the SAPHO syndrome. Twelve patients with diffuse sclerosis of the mandible were examined for symptoms of the SAPHO syndrome. Nine patients were found to have primary chronic osteomyelitis and eight of these represented a SAPHO syndrome. Results in this series support the hypothesis of an association between primary chronic osteomyelitis and the SAPHO syndrome.
Collapse
Affiliation(s)
- G K Eyrich
- Department of Cranio-Maxillofacial Surgery, University Hospital, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
OBJECTIVE To discuss the relationships between SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome and the group of spondylarthropathies. METHODS Few reports of familial SAPHO have been published. We describe three children, two sisters and one brother, whose clinical and radiological presentation was in accordance with SAPHO syndrome. RESULTS Two children developed psoriasis, and one child palmoplantar pustulosis. Both sacroiliac and sternoclavicular joints were involved in these three cases. Some features in our observations are also common to psoriatic arthritis. No association was found with HLA antigens, but a history of trauma preceding the onset of symptoms was present in all three children. CONCLUSIONS We can consider that SAPHO is nosologically related to spondylarthropathies. Psoriatic arthritis could be the missing link between SAPHO and spondylarthropathies. It is likely that both genetic and environmental factors are involved.
Collapse
Affiliation(s)
- A Dumolard
- Department of Rheumatology, CHU, Grenoble, France
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
Cervical spinal fracture and pseudarthrosis are previously described causes of spinal cord injury (SCI) in patients with spondylarthropathy. SAPHO (Synovitis Acne Pustulosis Hyperostosis Osteitis) syndrome is a recently recognized rheumatic condition characterized by hyperostosis and arthro-osteitis of the upper anterior chest wall, spinal involvement similar to spondylarthropathies and skin manifestations including palmoplantar pustulosis and pustular psoriasis. We report the first case of SAPHO syndrome disclosed by SCI related to cervical spine ankylosis.
Collapse
Affiliation(s)
- T Deltombe
- Department of Physical Medicine and Rehabilitation, Mont-Godinne University Hospital UCL, Yvoir, Belgium
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
HISTORY AND ADMISSION FINDINGS A 57-year-old man had for the past 18 months complained of recurrent, recently worsening, belt-like backache radiating ventrally. On admission a skin rash consisting of blister and pustules was noted on the palms of both hands. He had pain on pressure over the right upper abdomen, an enlarged prostate and definite pain on percussing the vertebral column with restricted movement of the thoracic vertebral column, but no other physical signs. INVESTIGATIONS Radiology revealed clearly increased sclerosis of several thoracic vertebrae with osteolytic destruction and a paravertebral soft tissue tumor. Search for a primary tumor was unsuccessful. Bone scintigraphy demonstrated nuclide enrichment of the thoracic vertebrae and of the sternoclavicular joints without increase in the LeukoScan. These findings indicated the diagnosis of SAPHO syndrome (synovitis-acne-pustulosis-hyperostosis-osteomyelitis). TREATMENT AND COURSE Rapid subjective and objective improvement followed the administration of clindamycin and ibuprofen. CONCLUSION In case of bone pain of uncertain aetiology, especially when associated with skin rash, the rare SAPHO syndrome should be considered in the differential diagnosis, avoiding lengthy diagnostic steps and allowing early treatment.
Collapse
Affiliation(s)
- D Hagemann
- Medizinische Klinik I, Ruhr-Universität, St. Josef-Hospital, Bochum.
| | | | | | | |
Collapse
|
47
|
Girschick HJ, Huppertz HI, Harmsen D, Krauspe R, Müller-Hermelink HK, Papadopoulos T. Chronic recurrent multifocal osteomyelitis in children: diagnostic value of histopathology and microbial testing. Hum Pathol 1999; 30:59-65. [PMID: 9923928 DOI: 10.1016/s0046-8177(99)90301-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic recurrent, unifocal or multifocal osteomyelitis (CRMO), an inflammatory disorder of unknown origin, involves different osseous sites and may be associated with palmoplantar pustulosis. Bacterial cultures of affected tissue were reported negative in nearly all cases. Radiological and magnetic resonance imaging features of CRMO have been described, but differential diagnosis remains difficult, including rheumatic diseases, bacterial osteomyelitis, and malignancy. Although definite diagnosis relies on histopathologic confirmation by biopsy, histopathologic criteria have not been defined. Because CRMO may be treated with nonsteroidal antiinflammatory drugs, but not antibiotics, distinguishing CRMO from bacterial osteomyelitis is of major importance. Histopathologic analysis of 12 patients with CRMO indicated a wide variation of reparative changes of bone, but chronic inflammation could not be found at all sites in the same biopsy. The inflammatory infiltrate was mostly scattered, consisting mainly of lymphocytes, plasma cells, histiocytes, and also few neutrophil granulocytes. Immunohistochemistry showed a predominance of CD3(+), CD45RO(+) T-cells, which were mainly CD8(+). In addition, CD20(+) B cells and CD68(+) macrophages were abundant in each biopsy specimen. Mild lymphocytic and granulocytic infiltrates were also detected in three synovial biopsy specimens obtained from adjacent joints. All bacterial and fungal cultures from native biopsy tissues were negative. Amplification of partial-length 16S ribosomal DNA by polymerase chain reaction (PCR) using broad-range eubacterial primers was below the detection limit in all patients. Because histopathologic features alone may not provide conclusive evidence, CRMO should be included in the differential diagnosis of chronic inflammatory bone lesions in children, and the definite diagnosis should be made by the clinical picture, x-ray studies, bone scan, bacterial culture, and histopathologic analysis in a multidisciplinary approach.
Collapse
Affiliation(s)
- H J Girschick
- Universitäts-Kinderklinik und Poliklinik, the Institut für Hygiene und Mikrobiologie, Universität Würzburg, Germany
| | | | | | | | | | | |
Collapse
|