The SAPHO syndrome is an acronym that refers to a rare condition that is manifested by a combined occurrence of 2
- S: synovitis
- A: acne
- P: pustulosis
- H: hyperostosis
- O: osteitis
It classically tends to present in young to middle-aged adults. Presentation in the paediatric population is not uncommon.
SAPHO and related conditions have three stages of progression, which are described as :
- Costoclavicular ligament ossification.
- Arthropathy of the sternoclavicular joint, osteitis of the medial end of the clavicle, 1st rib and sternum as well as hypertrophy of the costal cartilages.
- Osteitis, hyperostosis and hypertrophy of the medial ends of the clavicles, sternum and upper ribs and ultimately ankylosis.
Non-specific but can be suspected if present with the other clinical findings:
- sternoclavicular joint: most common location of involvement, with osteitis and hyperostosis
- osteosclerosis of vertebral bodies
- long bones: metaphyseal osteosclerosis and osteolysis 5
Treatment and prognosis
Tends to be benign although patients may have recurrent bouts of attacks. Pamidronate therapy has been successfully trialled for symptom relief (especially in the paediatric population 6).
History and etymology
Chamot et al. initially described it in 1987 3.
- 1. Restrepo CS, Martinez S, Lemos DF et-al. Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 29 (3): 839-59. doi:10.1148/rg.293055136 - Pubmed citation
- 2. Laredo JD, Vuillemin-bodaghi V, Boutry N et-al. SAPHO syndrome: MR appearance of vertebral involvement. Radiology. 2007;242 (3): 825-31. doi:10.1148/radiol.2423051222 - Pubmed citation
- 3. Boutin RD, Resnick D. The SAPHO syndrome: an evolving concept for unifying several idiopathic disorders of bone and skin. AJR Am J Roentgenol. 1998;170 (3): 585-91. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Azouz EM, Jurik AG, Bernard C. Sternocostoclavicular hyperostosis in children: a report of eight cases. AJR Am J Roentgenol. 1998;171 (2): 461-6. AJR Am J Roentgenol (abstract) - Pubmed citation
- 5. Cotten A, Flipo RM, Mentre A et-al. SAPHO syndrome. Radiographics. 1995;15 (5): 1147-54. Radiographics (abstract) - Pubmed citation
- 6. Kerrison C, Davidson JE, Cleary AG et-al. Pamidronate in the treatment of childhood SAPHO syndrome. Rheumatology (Oxford). 2004;43 (10): 1246-51. doi:10.1093/rheumatology/keh295 - Pubmed citation6
- 7. Sweeney SA, Kumar VA, Tayar J et-al. Case 181: Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) Syndrome. Radiology. 2012;263 (2): 613-7. doi:10.1148/radiol.12101436 - Pubmed citation