Diffuse sclerosing osteomyelitis (DSO) of the mandible in SAPHO syndrome: a novel approach with anti-TNF therapy. Systematic review

J Craniomaxillofac Surg. 2014 Dec;42(8):1990-6. doi: 10.1016/j.jcms.2014.09.004. Epub 2014 Sep 23.


Diffuse sclerosing osteomyelitis of the mandible is now considered a local manifestation of SAPHO syndrome. This rare condition is thought to be of auto-inflammatory origin. The myriad of treatments shown in the literature, are basically empirical and reflect its unknown origin. We present a clinical case of refractory DSO treated with an anti-TNF drug (etanercept) with complete clinical remission. We advise against radical surgery and an interdisciplinary approach is recommended. A systematic literature review was also conducted.

Keywords: Anti-TNF; Diffuse sclerosing osteomyelitis; SHAPO syndrome.

Publication types

  • Case Reports
  • Review
  • Systematic Review

MeSH terms

  • Acquired Hyperostosis Syndrome / drug therapy*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Etanercept / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Prosthesis
  • Mandibular Condyle / surgery
  • Mandibular Diseases / drug therapy*
  • Mandibular Diseases / surgery
  • Mandibular Reconstruction / methods
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / surgery
  • Osteosclerosis / drug therapy
  • Osteosclerosis / surgery
  • Recurrence
  • Remission Induction
  • Young Adult


  • Anti-Inflammatory Agents, Non-Steroidal
  • Etanercept