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Successful treatment of primary chronic osteomyelitis in SAPHO syndrome with bisphosphonates
Author(s) -
Just Alexander,
Adams Sabine,
Brinkmeier Thomas,
Barsegian Vahé,
Lorenzen Johannes,
Schilling Fritz,
Frosch Peter
Publication year - 2008
Publication title -
jddg: journal der deutschen dermatologischen gesellschaft
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 60
eISSN - 1610-0387
pISSN - 1610-0379
DOI - 10.1111/j.1610-0387.2008.06588.x
Subject(s) - sapho syndrome , medicine , pustulosis , palmoplantar pustulosis , hyperostosis , sternoclavicular joint , osteitis , bone scintigraphy , osteomyelitis , surgery , synovitis , sternum , dermatology , chronic recurrent multifocal osteomyelitis , prednisolone , arthritis , radiology , psoriasis , clavicle
Summary The treatment of the painful osteomyelitis in patients with SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) is often a problem. A 53‐year‐old woman had experienced palmo‐plantar pustular skin lesions for four years, and in the past two years complained about progressive breath‐and movement‐dependent pain of the sternum. On examination she had extensive palmoplantar pustules and a painful swelling in the area of the right sternoclavicular joint. The three‐phase bone scintigraphy showed a strong focal enrichment in the right sternoclavicular joint and at the transition from the manubrium to the corpus sterni suggesting active osteo‐chondritis. Initially prednisolone and ibuprofen were administered, but only the skin changes regressed. The strong sternal pain decreased only after infusion of 4 mg zoledronic acid over three days. In a follow‐up examination after five months the patient was still free of pain. The bisphosphonates inhibit osteoclastic activity and lead to long‐lasting improvement of osteo‐articular complaints in the SAPHO syndrome.