The sternoclavicular syndrome: experience from a district general hospitaland results of a national postal survey

Objective. To report our local experience of the sternoclavicular syndrome and sample the experience of other rheumatologists in the UK. Methods. We studied case records of 23 patients referred to the Southend rh eumatology clinic and data obtained from a postal questionnaire survey of B ritish rheumatologists. Results. We describe 58 cases (20 males and 38 females, mean age 47.2 yr). The disease was unilateral in 40 patients. Shoulder and/or arm pain (38 cas es) with limitation of shoulder movements was an important presenting featu re; other presenting features were anterior chest wall pain (14 cases) and neck pain (15 cases). Peripheral joint involvement was seen in 12 cases. Sk in rash was reported in 12 cases (psoriasis, 6; acne, 2; none had pustulosi s). No patients had symptoms or signs of sacroiliitis, and HLA-B27 was nega tive in 22 out of 23 patients. (99)Technetium scintiscanning showed increas ed uptake in the sternoclavicular region in 31/34 patients (91.1%), but not in the sacroiliac areas. Plain radiographs were abnormal in 18 cases (scle rosis, 9; erosions, 2; soft tissue swelling, 2; bony expansion, 5). CT and/ or MRI scans (available in 27 cases) showed erosions in 12 and osteitis in 18. Available histology showed a variable picture, including inflammation, bone erosion, sterile osteomyelitis and fibrosis. The majority of patients (45) were treated with non-steroidal anti-inflammatory drugs: 12 received s teroids and 10 received disease-modifying anti-rheumatic drugs (methotrexat e, 4; sulphasalazine, 6). Follow-up information was available for 38 patien ts, of whom 14 became asymptomatic and 24 had chronic disease with intermit tent flares. Conclusion. Sternoclavicular disease is not uncommon in the UK. It can pres ent with pain in the shoulder, neck or anterior chest wall, and may be unde rdiagnosed. Our results do not show a link with acne or pustulosis. Feature s of spondyloarthropathies, such as sacroiliitis and HLA-B27 positivity, we re rare in this survey.