Successful treatment of primary chronic osteomyelitis in SAPHO syndrome with bisphosphonates

• Published in: Journal der Deutschen Dermatologischen Gesellschaft 2008-08, Vol.6 (8), p.657-660
• Main Authors: Just, Alexander, Adams, Sabine, Brinkmeier, Thomas, Barsegian, Vahé, Lorenzen, Johannes, Schilling, Fritz, Frosch, Peter
• Format: Article
• Language: eng ; ger
• Subjects: acne; Acquired Hyperostosis Syndrome - diagnosis; Acquired Hyperostosis Syndrome - drug therapy; Bone Density Conservation Agents - administration & dosage; Chronic Disease; CRMO; Diphosphonates - administration & dosage; Female; Humans; Middle Aged; Osteomyelitis - diagnosis; Osteomyelitis - drug therapy; pustular psoriasis; Treatment Outcome; zoledronic acid
• ISSN: 1610-0379; 1610-0387
• DOI: 10.1111/j.1610-0387.2008.06588.x

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.