Treatment of SAPHO


What is the treatment of a clavicle "SAPHO" if medication management is insufficient?

Submitted by: Peter Batay-Csorba, Richmond Hill, Ontario


Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) syndrome is a rare disease with most available data derived from case reports and few case series. As the initial osteoarticular manifestation in SAPHO syndrome is pain, the first line will often be nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics.  When the patient is refractory to these drugs, however, introduction of disease-modifying antirheumatic drugs (DMARDs) is often indicated. Steroids and conventional DMARDs such as those used in the treatment of chronic inflammatory arthritis (e.g ., methotrexate) have been known to stabilize disease flares. Refractory cases can also be treated with biologic agents such as anti-TNF agents (e.g ., infliximab, adalimumab, etanercept) and anti-IL1 agents (e.g ., anakinra). Isotretinoin, often indicated for the treatment of acne, has also been described for the treatment of SAPHO. Good clinical response was observed with bisphosphonates such as alendronate. Partial or complete remission was observed with intravenous pamidronate in a significant number of patients. Surgery is usually not effective in those patients.

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