SAPHO Syndrome Diagnosis and Treatment: Report of Five Cases and Review of the Literature



Ch Matzaroglou1, D Velissaris2, A Karageorgos1, M Marangos3, E Panagiotopoulos1, M Karanikolas*, 2
1 Department of Orthopaedic Surgery, University of Patras Medical School, Patras, Greece
2 Department of Anaesthesiology and Intensive Care Medicine, University of Patras Medical School, Patras, Greece
3 Department of Internal Medicine, University of Patras Medical School, Patras, Greece


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© Matzaroglou et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Anaesthesiology and Intensive Care Medicine, University of Patras Medical School, Patras, Greece; E-mail: kmenelaos@yahoo.com


Abstract

Background:

The term “SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) syndrome” includes a variety of musculoskeletal disorders associated with skin conditions; Osteitis is the most prominent skeletal lesion, whereas palmoplantar pustulosis and acne are the main skin lesions. Diagnosing SAPHO syndrome is difficult, because this syndrome is often confused with suppurative osteomyelitis, which has similar clinical and pathologic findings. SAPHO diagnosis is even more difficult when atypical sites are involved and there are no skin lesions.

Patients and Methods:

This case series presents five patients (3 women, 2 men), ages 27 to 44 years, who came to the Orthopaedic Department outpatient clinic for evaluation of pain in the humerus, clavicle, sacroiliac joints, and/or distal radius, and were diagnosed with SAPHO syndrome. Clinical and radiologic findings, treatment and outcome data, with up to 4 years of follow-up are presented. An extensive discussion of the clinical presentation, published literature, treatment options and outcome of SAPHO syndrome is also included.

Results:

Once the diagnosis of SAPHO syndrome was established, treatment with antibiotics (clindamycin) and non steroid anti-inflammatory drugs (lornoxicam) was remarkably effective. All patients did well and remained symptom free for up to four years, after a 3-8 month course of treatment.

Interpretation:

SAPHO syndrome should be included in the differential diagnosis when evaluating patients with lytic, sclerotic, or hyperostotic bone lesions and pain. Prompt SAPHO syndrome recognition, followed by appropriate therapy with antibiotics and NSAIDs can produce rapid symptom resolution, while avoiding unnecessary procedures and longterm antibiotic therapy.

Keywords: SAPHO, synovitis, acne, pustulosis, hyperostosis, osteitis, pain, lornoxicam, clindamycin.