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SAPHO: Treatment options including bisphosphonates.

Tom Zwaenepoel1, Kurt de Vlam1

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Summary

The syndrome of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) is challenging to diagnose and treat. This case series found bisphosphonates to be a promising treatment option, with most patients achieving remission.

Keywords:
AcneBisphosphonatesHyperostosisOsteitisPustulosisRadiologic imagingSAPHOSyndrome of synovitis

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Area of Science:

  • Rheumatology
  • Dermatology
  • Orthopedics

Background:

  • The syndrome of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) presents diagnostic and therapeutic challenges.
  • Early diagnosis is often hindered by incomplete symptom presentation, sometimes mimicking other conditions like psoriatic arthritis.

Purpose of the Study:

  • To evaluate the response of SAPHO patients to various pharmacological treatments.
  • To identify effective therapeutic strategies for SAPHO syndrome.

Main Methods:

  • A retrospective case series of 21 SAPHO patients diagnosed between 2005 and 2013.
  • Collection of clinical, biochemical, and imaging data, with symptom and inflammatory marker assessment at presentation and follow-up.
  • Categorization of treatment responses into full remission, partial remission, and no disease control.

Main Results:

  • The cohort showed a female predominance with a median age of 32 years and a median follow-up of 45 months.
  • All patients achieved either full or partial remission.
  • 14 patients received bisphosphonates, with 8 achieving full or partial remission, indicating its potential efficacy.

Conclusions:

  • SAPHO diagnosis can be difficult due to variable initial presentations.
  • Bisphosphonates represent a noteworthy treatment option for SAPHO syndrome.
  • Further investigation via a prospective, placebo-controlled trial of bisphosphonates is recommended.