SAPHO - Rare But There
Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis
Welcome Back Rheumatology Fans,
I haven’t written about a rare disease, or in this case syndrome in a while so lets get stuck in SAPHO Syndrome. Its a rare but there cause of synovitis which might present to MSK Clinics or Primary Care.
Introduction To SAPHO Syndrome
I am not one for shortening disease names usually but this one is particularly useful to shorten down to SAPHO Syndrome for a couple of reasons. Firstly its rare (<1/10000) so you don’t think about it very often and as a result forget the potential components of the syndrome. Second, if you do remember its quite the mouthful and who really has the time to say out loud..:
Synovitis (inflammation of the synovial lining of the joints)
Acne
Pustulosis (thick, pus filled blisters) usually on the palms and soles of the feet
Hyperostosis (increases in bone formation)
Osteitis (bone inflammation)
Not a lot is known about this condition like, cause, how to treat it, diagnostic criteria and so on, but bare with me as I lay out what I do know about it.
Clinical Information
As I mentioned in the discussion this is a rare inflammatory disease and as such I really wouldn’t be expecting clinicians outside of Rheumatology to be making such a diagnosis. An awareness of its existence to ensure comprehensive screening is necessary. My guess is that you are likely to suspect a more common inflammatory issue like Rheumatoid Arthritis or Psoriatic Arthritis and Rheumatology will sort it out for you. (Physio’s) don’t train a lot in skin lesions and we are not likely to be ordering extensive imaging which makes this syndrome particularly difficult to recognise accurately.
My advice is to consider the Syndrome when these 2 charecteristics co-exist
Osteoarticular involvement (osteitis and/or synovitis and/or hyperostosis)
Skin lesions (Acne and/or pustulosis of the palms/soles)
Typical onset of the disease is between 20-50 years old, diagnosis will be based on clinical findings (skin lesions) and radiological findings (osteitis and/or synovitis and/or hyperostosis).
A classical pattern of bone involvement is of the clavical, first rib and sternum although any bones can be implicated. Other common sites are the vertabral bodies, Sacroilliac Joints and long bones.
There is a slight increase in HLA-B27 positivity (30% of patients).
Treatment
Treatment is mostly symptomatic, steroids, NSAIDs, analgesia and dermatological interventions. There is no major role for MSK Therapies other than functional maintenance/restoration and general health advice.
I will update this as I find more information about this Syndrome!
Further Resources
Second Opinions
Welcome Back Rheumatology Fans! It is 2025 and for the first post of the year I thought I would dive straight in to something common but challenging.
I was diagnosed with SLE in 2000 when I was 33. When I started going through menopause, I began having more health issues. One of the issues was a strange rash on the palm of my hands. As time went on, the same type rash started showing up on my feet, especially, around my toe nails. It begins with tiny itchy blisters deep under the skin that rise to the surface, then, they dry up and peel. After it peels, the skin becomes thin and fragile so that it tears easily. It's worse on my feet than on my hands. It also affects the condition of my nails. These rashes seem to come and go in flares. I have yet to get a diagnosis and have not found any way to treat it. It's not uncommon for people with SLE to have bizarre skin issues and arthritis, so my rashes have been attributed to my Lupus. However, I have never experienced this type of rash before. Your article struck a note with me, because SAPHO sounds awfully similar to what I've been experiencing. I look forward to your next post on SAPHO and your findings.