SAPHO: Rare or just not recognized?

Objective: The SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome describes an association between musculoskeletal disorders, in par ticular hyperostosis involving the bones and joints of the anterior chest w all, and various dermatologic conditions. It has been reported in Europe an d Japan, but no Australian series have been published. We describe the clin ical, laboratory, and radiographic features of a group of patients with the SAPHO syndrome and compare this with the literature. Methods: We performed a retrospective review of patients seen in our depart ment between 1990 and 1998 who met the proposed diagnostic criteria for SAP HO. Information regarding age, sex, disease duration, skeletal site(s) of d isease, presence of skin disease, previous treatment, and response to treat ment was collected. Laboratory tests were reviewed, as was all available ra diology and bone scintigraphy. Results: Six women with a mean age of 40 years fulfilled the criteria for S APHO. The skeletal manifestations were similar to those reported in the lit erature, with hyperostosis of the anterior chest wall being the central fea ture. Cervical spine and pubic bone were other sites of involvement, wherea s sacroiliitis and peripheral joint synovitis were not seen. Skin disease w as less frequent in our population than has been reported in other series. Nonsteroidal anti-inflammatory drugs were frequently prescribed as first-li ne treatment but had limited efficacy. Intravenous pamidronate was administ ered to two patients, resulting in complete resolution of pain in one patie nt and 50% reduction in pain in the other. Conclusions: The SAPHO syndrome may be underrecognized as the skin manifest ations in our patients were mild or absent. Although optimal treatment for these patients remains unclear, it is important to make the diagnosis of SA PHO to avoid unnecessary investigations and treatment. Copyright (C) 2000 b y W.B. Saunders Company.