Infliximab can induce a prolonged clinical remission and a decrease in thyroid hormonal requirements in a patient...

Area of Science:

• Rheumatology
• Dermatology
• Endocrinology

Background:

• SAPHO syndrome is a rare autoinflammatory disorder characterized by the triad of synovitis, acne, pustulosis, hyperostosis, and osteitis.
• It often presents with significant skeletal and dermatological manifestations, impacting patient quality of life.
• Treatment of refractory SAPHO syndrome can be challenging, necessitating exploration of novel therapeutic agents.

Observation:

• A 39-year-old male patient with severe, refractory SAPHO syndrome and hypothyroidism secondary to Graves' disease was treated with infliximab.
• The patient experienced invalidating arthritis and associated dermatological conditions.
• Hypothyroidism was managed with levothyroxine after radioiodine treatment for Graves' disease.

Findings:

• Infliximab, a tumor necrosis factor alpha (TNF-alpha) inhibitor, demonstrated a prompt and sustained improvement in both the articular and cutaneous symptoms of SAPHO syndrome.
• The patient required only three doses of infliximab to achieve a prolonged therapeutic response.
• Remarkably, the patient's levothyroxine dosage requirement decreased following the TNF-alpha blockade therapy.

Implications:

• Infliximab is a potential effective treatment for refractory SAPHO syndrome, addressing both skeletal and dermatological manifestations.
• TNF-alpha blockade may influence thyroid hormone metabolism or autoimmune thyroid disease activity, warranting further investigation.
• This case highlights a potential novel therapeutic approach for SAPHO syndrome and suggests an interplay between inflammation and thyroid function.