"S: synovitis"
"A: acne"
"P: pustulosis"
"H: hyperostosis"
"O: osteitis"
"The SAPHO syndrome is a rare osteoarticular and cutaneous condition that is manifested by a combined occurrence of 2:"
"SAPHO has a reported prevalence of 1 in 10,000 adults 15. It classically presents in young to middle-aged adults 15. Presentation in the paediatric population is not uncommon. There may be a slightly higher female predilection in younger ("
"The aetiology of SAPHO syndrome is unknown, with an autoinflammatory disease pathogenesis favoured 13. Cutibacterium acnes (previously known as Propionibacterium acnes), an anaerobic skin commensal, has been reported as a causative agent or environmental trigger but is not thought to be a major aetiological factor 8,11-13."
"Plain radiograph is non-specific, but SAPHO syndrome can be suspected if present with the other clinical findings:"
"SAPHO has a waxing and waning course 13. Evidence for treatment options for SAPHO syndrome is limited, with no standardised treatment regimen 13,15. NSAIDs are first-line for pain, and bisphosphonates (usually intravenous pamidronate) are the most consistently effective for bone disease but not for skin disease 6,13. Methotrexate and TNF inhibitors are used for refractory disease and help both bone and, to a lesser extent, skin, while tofacitinib shows early promise for refractory skin and nail involvement 13."
"SAPHO has a waxing and waning course 13. Evidence for treatment options for SAPHO syndrome is limited, with no standardised treatment regimen 13,15. NSAIDs are first-line for pain, and bisphosphonates (usually intravenous pamidronate) are the most consistently effective for bone disease but not for skin disease 6,13. Methotrexate and TNF inhibitors are used for refractory disease and help both bone and, to a lesser extent, skin, while tofacitinib shows early promise for refractory skin and nail involvement 13."
"SAPHO has a waxing and waning course 13. Evidence for treatment options for SAPHO syndrome is limited, with no standardised treatment regimen 13,15. NSAIDs are first-line for pain, and bisphosphonates (usually intravenous pamidronate) are the most consistently effective for bone disease but not for skin disease 6,13. Methotrexate and TNF inhibitors are used for refractory disease and help both bone and, to a lesser extent, skin, while tofacitinib shows early promise for refractory skin and nail involvement 13."
"For bony features in children, consider chronic recurrent multifocal osteomyelitis (CRMO), although there is controversy over whether CRMO and SAPHO are the same condition presenting at different ages 13,14."
"S: synovitis"
"A: acne"
"P: pustulosis"
"H: hyperostosis"
"O: osteitis"
"The aetiology of SAPHO syndrome is unknown, with an autoinflammatory disease pathogenesis favoured 13. Cutibacterium acnes (previously known as Propionibacterium acnes), an anaerobic skin commensal, has been reported as a causative agent or environmental trigger but is not thought to be a major aetiological factor 8,11-13."
Expected headings
"Associations"
"joint pain, swelling and tenderness affecting the anterior chest wall (~90%), sacroiliac joints, spine, and less commonly (~30%) peripheral large joints 13,14"
"osteitis, hyperostosis and hypertrophy of the medial ends of the clavicles, sternum and upper ribs and ultimately ankylosis"
"osteitis, hyperostosis and hypertrophy of the medial ends of the clavicles, sternum and upper ribs and ultimately ankylosis"