SAPHO syndrome and pustulotic arthro-osteitis

Mod Rheumatol. 2022 Jul 1;32(4):665-674. doi: 10.1093/mr/roab103.


Synovitis-Acne-Pustulosis-Hyperostosis-Osteitis (SAPHO) syndrome is a rare inflammatory osteoarticular disorder, which encompassed many diseases, including pustulotic arthro-osteitis (PAO). Musculoskeletal manifestations, including osteitis, synovitis, and hyperostosis, are the hallmarks of the SAPHO syndrome and affect a variety of regions of the body. Recent survey indicated that more than 80% of cases of SAPHO syndrome in Japan were PAO, originally proposed by Sonozaki et al. in 1981, whereas severe acne was the most commonly reported skin ailment amongst participants with SAPHO syndrome in Israel. Prevalence of SAPHO syndrome remains unavailable, whereas the prevalence of palmoplantar pustulosis (PPP) was reported to be 0.12% in Japan, and 10-30% of patients with PPP had PAO. SAPHO syndrome and PAO are predominantly found in patients in the third through fifth decades of life, and a female predominance is seen in both groups. The diagnosis is typically made by a rheumatologist or dermatologist. Identification of a variety of the clinical, radiological, and laboratory features outlined, as well as diagnostic criteria, are used to make the diagnosis. Goals of treatment seek to maximize health-related quality of life, preventing structural changes and destruction, and normalizing physical function and social participation. Finally, we review the non-pharmacological and pharmacological managements.

Keywords: SAPHO syndrome; anterior chest wall pain; pustulotic arthro-osteitis (PAO); spondyloarthritis.

Publication types

  • Review

MeSH terms

  • Acne Vulgaris*
  • Acquired Hyperostosis Syndrome* / diagnostic imaging
  • Acquired Hyperostosis Syndrome* / epidemiology
  • Chronic Disease
  • Female
  • Humans
  • Hyperostosis*
  • Male
  • Osteitis* / diagnosis
  • Psoriasis*
  • Quality of Life
  • Rare Diseases
  • Skin Diseases, Vesiculobullous*
  • Synovitis*