title: Intra-articular glucocorticosteroid injection into sternocostoclavicular joints in patients with SAPHO syndrome.
abstract: OBJECTIVE
  Painful swelling of the anterior chest wall caused by osteitis and hyperostosis in the sternocostoclavicular region are characteristically observed in patients suffering from SAPHO syndrome. Autoimmune triggering of inflammation and bacterial infection is hypothesized to be involved in the pathogenesis. Promising treatment modalities include antirheumatic and antibiotic medications.
  
  
  METHODS
  Ten patients with SAPHO syndrome and symptomatic osteitis in the sternocostoclavicular region were treated by a single instillation of glucocorticosteroids (20 mg triamcinolone) into the sternocostoclavicular joints. The disease activity was evaluated on the basis of a questionnaire asking for osteitis activity (quantified for complains on a scale of 0-6), by Health Assessment Questionnaire (HAQ) score, erythrocyte sedimentation rate, C-reactive protein, and magnet resonance imaging (MRI) scanning of the sternocostoclavicular region (osteitis scores quantified for inflammation on a scale of 0-2 by the radiologist) prior to injection and after 12 weeks. No changes of the preexisting antirheumatic therapy were allowed during the observation interval.
  
  
  RESULTS
  All patients continued the study during the follow-up. The osteitis score changed from 4.2 (mean; standard error (SE) ±0.3) to 3.2 (±0.4), [P = 0.062], the erythrocyte sedimentation rate from 19.0 (range from 12 to 30) to 19.9 (from 12 to 27), [P = 0.430], and the MRI score from 1.6 (±0.2) to 1.5 (±0.2) [P = 1.0]. One patient developed an increase of the clinical osteitis activity from 3 to 5 according the scoring system; only 2 patients showed a reduction of the MRI activity score from 2 to 1.
  
  
  CONCLUSIONS
  Intra-articular glucocorticosteroid instillation does not appear to reduce osteitis in the sternocostoclavicular region in patients with SAPHO syndrome.
authors.affiliation: University Saarland Medical School, Orthopedics, Kirrbergerstraße 1, Homburg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Jung
authors.forename: Marc
authors.initials: M
authors.lastname: Molinger
authors.forename: Dieter
authors.initials: D
authors.lastname: Kohn
authors.forename: Martin
authors.initials: M
authors.lastname: Schreiber
authors.forename: Michael
authors.initials: M
authors.lastname: Pfreundschuh
authors.forename: Gunter
authors.initials: G
authors.lastname: Assmann
mesh_terms: D020083:Acquired Hyperostosis Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D001799:Blood Sedimentation; D005260:Female; D006304:Health Status; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D012720:Severity of Illness Index; D013247:Sternoclavicular Joint / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014221:Triamcinolone