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Arthritis und Rheuma 2013; 33(04): 213-222
DOI: 10.1055/s-0037-1618188
Seltene Erkrankungen in der Rheumatologie
Schattauer GmbH

SAPHO-Syndrom

Ein aktueller ÜberblickSAPHO-syndromeAn overview
C. Fiehn
1   ACURA-Rheumazentrum Baden-Baden
,
C. Plathow
2   Radiologie Baden-Baden
› Author Affiliations
Further Information

Publication History

Publication Date:
19 December 2017 (online)

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Zusammenfassung

Das SAPHO-Syndrom ist eine Erkrankung, die besondere Herausforderungen an die Differenzialdiagnose durch Rheumatologen und Radiologen stellt. Von anderen entzündlich rheumatischen Erkrankungen unterscheidet sich das SAPHO-Syndrom durch den überwiegenden Befall des Knochens in Form einer Osteitis, während die Arthritis oft eher im Hintergrund steht. Das SAPHO-Syndrom kommt häufig, aber nicht immer, in Assoziation mit der charakteristischen Hauterscheinung der palmaroplantaren Pustulosa-Form der Psoriasis vor, und die nosologische Einteilung dieses Syndroms bereitet immer noch Schwierigkeiten. Der gehäufte Nachweis von Propionibacterium acne, wie auch das zumindest passagere Ansprechen vieler Patienten auf das Antibiotikum Azithromycin, macht eine bakterielle Genese der Erkrankung möglich. In neuerer Zeit wurden mit Erfolg Biologika, vor allem TNF-Inhibitoren, eingesetzt, die in Fallsammlungen in einer großen Anzahl der Patienten ein Ansprechen induzieren konnten.

Summary

SAPHO-syndrome is a disease which has specific challenges for differential diagnosis by rheumatologists and radiologists. In contrast to other inflammatory rheumatic diseases the SAPHO syndrome mainly involves the bone as it induces osteitis, while arthritis of the joints is not regularly found. The SAPHO syndrome often associates with the typical skin manifestation of palmaro-plantaris pustulosa and the nosological classification of the syndrome still is not clear. The frequent detection of Propionibacterium acne and the, although transitory, response to the antibiotic azithromycine makes a bacterial genesis of the disease possible. Currently biologic drugs, in particular TNF-inhibitors, were successfully used in case studies in which in large numbers of the patients a response could be induced.

Schlüsselwörter

SAPHO-Syndrom - Osteitis - Spondylitis - TNF-Inhibitoren - Antibiotika - Bisphosphonate

Keywords

SAPHO-Syndrome - osteitis - spondylitis - TNF-Inhibitors - antibiotics - bisphosphonates
 

  • Literatur

  • 1 Chamot AM, Benhamou CL, Kahn MF. et al. [Acne-pustulosis-hyperostosis-osteitis syndrome. Results of a national survey. 85 cases]. Rev Rhum Mal Osteoartic 1987; 54 (03) 187-196.
    PubMedGoogle Scholar
  • 2 Dihlmann W, Dihlmann SW. Acquired hyperostosis syndrome: spectrum of manifestations at the sternocostoclavicular region. Radiologic evaluation of 34 cases. Clin Rheumatol 1991; 10 (03) 250-263.
    CrossrefPubMedGoogle Scholar
  • 3 Sonozaki H, Mitsui H, Miyanaga Y. et al. Clinical features of 53 cases with pustulotic arthro-osteitis. Ann Rheum Dis 1981; 40 (06) 547-553.
    CrossrefPubMedGoogle Scholar
  • 4 Bjorksten B, Gustavson KH, Eriksson B. et al. Chronic recurrent multifocal osteomyelitis and pustulosis palmoplantaris. J Pediatr 1978; 93 (02) 227-231.
    CrossrefPubMedGoogle Scholar
  • 5 Benhamou CL, Chamot AM, Kahn MF. Synovitisacne-pustulosis hyperostosis-osteomyelitis syndrome (SAPHO). A new syndrome among the spondyloarthropathies?. Clin Exp Rheumatol 1988; 6 (02) 109-112.
    PubMedGoogle Scholar
  • 6 Schilling F. SAPHO-Syndrom. http://www.orpha.net/data/patho/DE/de-sapho.pdf Orphanet Enzyklopädie 1–10–2004.
    Google Scholar
  • 7 Colina M, Govoni M, Orzincolo C, Trotta F. Clinical and radiologic evolution of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: a single center study of a cohort of 71 subjects. Arthritis Rheum 2009; 61 (06) 813-821.
    CrossrefPubMedGoogle Scholar
  • 8 Depasquale R, Kumar N, Lalam RK. et al. SAPHO: What radiologists should know. Clin Radiol 2012; 67 (03) 195-206.
    CrossrefPubMedGoogle Scholar
  • 9 Tlougan BE, Podjasek JO, O’Haver J. et al. Chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with associated neutrophilic dermatoses: a report of seven cases and review of the literature. Pediatr Dermatol 2009; 26 (05) 497-505.
    CrossrefPubMedGoogle Scholar
  • 10 Freyschmidt J, Freyschmidt G. Haut- Schleimhaut- und Skeletterkrankungen – Skibo-Diseases. Heidelberg: Springer; 1996
    Google Scholar
  • 11 Fritz J, Tzaribatchev N, Claussen CD. et al. Chronic recurrent multifocal osteomyelitis: comparison of whole-body MR imaging with radiography and correlation with clinical and laboratory data. Radiology 2009; 252 (03) 842-851.
    CrossrefPubMedGoogle Scholar
  • 12 Inoue K, Yamaguchi T, Ozawa H. et al. Diagnosing active inflammation in the SAPHO syndrome using 18FDG-PET/CT in suspected metastatic vertebral bone tumors. Ann Nucl Med 2007; 21 (08) 477-480.
    CrossrefPubMedGoogle Scholar
  • 13 Takeuchi K, Matsusita M, Takagishi K. A case of SAPHO (synovitis-acne-pustulosis-hyperostosis-osteomyelitis) syndrome in which [18F]fluorodeoxyglucose positron emission tomography was useful for differentiating from multiple metastatic bone tumors. Mod Rheumatol 2007; 17 (01) 67-71.
    CrossrefPubMedGoogle Scholar
  • 14 Hayem G, Bouchaud-Chabot A, Benali K. et al. SAPHO syndrome: a long-term follow-up study of 120 cases. Semin Arthritis Rheum 1999; 29 (03) 159-171.
    CrossrefPubMedGoogle Scholar
  • 15 Scarpato S, Tirri E. Successful treatment of SAPHO syndrome with leflunomide. Report of two cases. Clin Exp Rheumatol 2005; 23 (05) 731.
    PubMedGoogle Scholar
  • 16 Colina M, La CR, Trotta F. Sustained remission of SAPHO syndrome with pamidronate: a follow-up of fourteen cases and a review of the literature. Clin Exp Rheumatol 2009; 27 (01) 112-115.
    PubMedGoogle Scholar
  • 17 Fioravanti A, Cantarini L, Burroni L. et al. Efficacy of alendronate in the treatment of the SAPHO syndrome. J Clin Rheumatol 2008; 14 (03) 183-184.
    CrossrefPubMedGoogle Scholar
  • 18 Assmann G, Kueck O, Kirchhoff T. et al. Efficacy of antibiotic therapy for SAPHO syndrome is lost after its discontinuation: an interventional study. Arthritis Res Ther 2009; 11 (05) R140.
    CrossrefPubMedGoogle Scholar
  • 19 Massara A, Cavazzini PL, Trotta F. In SAPHO syndrome anti-TNF-alpha therapy may induce persistent amelioration of osteoarticular complaints, but may exacerbate cutaneous manifestations. Rheumatology (Oxford) 2006; 45 (06) 730-733.
    CrossrefPubMedGoogle Scholar
  • 20 Ben AK, Dran DG, Gottenberg JE. et al. Tumor necrosis factor-alpha blockers in SAPHO syndrome. J Rheumatol 2010; 37 (08) 1699-1704.
    CrossrefPubMedGoogle Scholar
  • 21 Eleftheriou D, Gerschman T, Sebire N. et al. Biologic therapy in refractory chronic non-bacterial osteomyelitis of childhood. Rheumatology (Oxford) 2010; 49 (08) 1505-1512.
    CrossrefPubMedGoogle Scholar
  • 22 Hayem G, M’Barek RB, Toussirot E. et al. SAPHO Syndrome Treated by TNF alpha-Blocking Agents. Report of 45 Cases. Arthritis Rheum 2010; 62 (10) S954.
    Google Scholar
  • 23 Wendling D, Prati C, Aubin F. Anakinra treatment of SAPHO syndrome: short-term results of an open study. Ann Rheum Dis 2012; 71 (06) 1098-1100.
    CrossrefPubMedGoogle Scholar
  • 24 Schilling F, Kessler S. Das SAPHO-Syndrom: klinisch-rheumatologische und radiologische Differenzierung und Klassifikation eines Krankengutes von 86 Fällen. Z Rheumatol 2000; 59 (01) 1-28.
    CrossrefPubMedGoogle Scholar
  • 25 Schilling F, Kessler S. Spondarthritis hyperostotica pustulo-psoriatica: Nosologische Untersuchung mit klinischer und radiologischer Darstellung innerhalb des SAPHO-Syndroms. Rofo 1998; 169 (06) 576-584.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Legoupil N, Revelon G, Allain J. et al. Iliac vein thrombosis complicating SAPHO syndrome: MRI and histologic features of soft tissue lesions. Joint Bone Spine 2001; 68 (01) 79-83.
    CrossrefPubMedGoogle Scholar
  • 27 Schilling F, Kessler S, Eckhardt A, Stofft E. Die „sympathische Arthritis“ – ein Symptom der chronischen rekurrierenden multifokalen Osteomyelitis (CRMO). Akt Rheumatol 2001; 26: 61-74.
    Article in Thieme ConnectGoogle Scholar