Successful treatment of primary chronic osteomyelitis in SAPHO syndrome with bisphosphonates.
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.
Just
Alexander
A
Department of Dermatology, Clinic of Dortmund gGmbH, Dortmund, Germany. just@derma.de
Adams
Sabine
S
Brinkmeier
Thomas
T
Barsegian
Vahé
V
Lorenzen
Johannes
J
Schilling
Fritz
F
Frosch
Peter
P
D020083:Acquired Hyperostosis Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D002908:Chronic Disease; D004164:Diphosphonates / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D004164:Diphosphonates