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Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome - A challenging diagnosis not to be missed.
J Infect 2016; 72 Suppl:S106-14JI

Abstract

SAPHO syndrome manifests as chronic inflammation of bones and joints, which may or may not be accompanied by skin changes. The term SAPHO is an acronym that stands for synovitis, acne, pustulosis (usually palmoplantar), hyperostosis and osteitis. The bones most commonly affected are those in the anterior chest wall (mainly the sternum, clavicles and sternocostoclavicular joints), the vertebrae and the sacroiliac joints, but peripheral and flat bones may also be involved, especially in children. There are no validated diagnostic criteria for SAPHO, and diagnosis is based on clinical and radiological findings. One of the main challenges in diagnosis is that the clinical features may occur many years apart. Additionally, patients may not develop all manifestations. Delayed diagnosis, as a result of a lack of awareness of SAPHO, can lead to patients suffering ongoing pain and disfiguring skin manifestations. One theory is that Propionibacterium acnes (isolated from bone biopsies in many SAPHO patients) triggers an auto-immune mediated chronic inflammation in genetically predisposed individuals. Treatment involves the use of nonsteroidal anti-inflammatory drugs, intra-articular steroids, bisphosphonates and biologicals. The course of SAPHO is often prolonged but, despite the challenges in diagnosis and treatment, the long-term prognosis is good.

Authors+Show Affiliations

Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia.Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases & Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Australia. Electronic address: nigel.curtis@rch.org.au.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27263075

Citation

Zimmermann, Petra, and Nigel Curtis. "Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome - a Challenging Diagnosis Not to Be Missed." The Journal of Infection, vol. 72 Suppl, 2016, pp. S106-14.
Zimmermann P, Curtis N. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome - A challenging diagnosis not to be missed. J Infect. 2016;72 Suppl:S106-14.
Zimmermann, P., & Curtis, N. (2016). Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome - A challenging diagnosis not to be missed. The Journal of Infection, 72 Suppl, pp. S106-14. doi:10.1016/j.jinf.2016.04.030.
Zimmermann P, Curtis N. Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome - a Challenging Diagnosis Not to Be Missed. J Infect. 2016 07 5;72 Suppl:S106-14. PubMed PMID: 27263075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome - A challenging diagnosis not to be missed. AU - Zimmermann,Petra, AU - Curtis,Nigel, Y1 - 2016/06/01/ PY - 2016/6/6/entrez PY - 2016/6/6/pubmed PY - 2017/7/29/medline KW - Chronic recurrent multifocal osteomyelitis KW - Hyperostosis KW - Inflammatory bone disorders KW - Osteitis KW - Propionibacterium acnes KW - Pustulosis KW - Spondyloarthropathies KW - Synovitis SP - S106 EP - 14 JF - The Journal of infection JO - J. Infect. VL - 72 Suppl N2 - SAPHO syndrome manifests as chronic inflammation of bones and joints, which may or may not be accompanied by skin changes. The term SAPHO is an acronym that stands for synovitis, acne, pustulosis (usually palmoplantar), hyperostosis and osteitis. The bones most commonly affected are those in the anterior chest wall (mainly the sternum, clavicles and sternocostoclavicular joints), the vertebrae and the sacroiliac joints, but peripheral and flat bones may also be involved, especially in children. There are no validated diagnostic criteria for SAPHO, and diagnosis is based on clinical and radiological findings. One of the main challenges in diagnosis is that the clinical features may occur many years apart. Additionally, patients may not develop all manifestations. Delayed diagnosis, as a result of a lack of awareness of SAPHO, can lead to patients suffering ongoing pain and disfiguring skin manifestations. One theory is that Propionibacterium acnes (isolated from bone biopsies in many SAPHO patients) triggers an auto-immune mediated chronic inflammation in genetically predisposed individuals. Treatment involves the use of nonsteroidal anti-inflammatory drugs, intra-articular steroids, bisphosphonates and biologicals. The course of SAPHO is often prolonged but, despite the challenges in diagnosis and treatment, the long-term prognosis is good. SN - 1532-2742 UR - https://www.unboundmedicine.com/medline/citation/27263075/Synovitis_acne_pustulosis_hyperostosis_and_osteitis__SAPHO__syndrome___A_challenging_diagnosis_not_to_be_missed_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0163-4453(16)30057-3 DB - PRIME DP - Unbound Medicine ER -