Skeletal Radiology

, Volume 32, Issue 6, pp 311–327 | Cite as

SAPHO: syndrome or concept? Imaging findings

Review Article


The SAPHO syndrome was a term coined to include a variety of musculoskeletal disorders associated with skin conditions, mainly palmoplantar pustulosis and acne conglobata. It is more correctly a spectrum which includes the following: skin lesions, osteoarticular manifestations of synovitis hyperostosis and osteitis affecting particular target sites, and·a clinical course marked by relapses and remissions. The major sites of involvement are the anterior chest wall, the spine, long bones, flat bones, and large and small joints. The distribution and severity of involvement varies from the adult to the pediatric form of chronic recurrent multifocal osteomyelitis (CRMO). The diagnosis of SAPHO syndrome is not difficult when the typical osteoarticular lesions are located in characteristic target sites. The diagnosis is more difficult if atypical sites are involved and there is no skin disease.


SAPHO CRMO Synovitis Spondyloarthropathy Osteitis Hyperostosis 


  1. 1.
    Windom RE, Sandford JP, Ziff M. Acne conglobata and arthritis. Arthritis Rheum 1961; 4:632–635.Google Scholar
  2. 2.
    Gideon A, Holthusen W, Masel L. Subacute and chronic symmetrical osteomyelitis. Ann Radiol 1972; 15:329–342.PubMedGoogle Scholar
  3. 3.
    Bjorksten B, Gustavson KH, Eriksson B et al. Chronic recurrent multifocal osteomyelitis and pustulosis palmoplantaris. J Pediatr 1978; 932:227–231.Google Scholar
  4. 4.
    Chamot A, Benhamou CL, Kahn MF, et al. Le syndrome acne pustulose hyperostose osteite (SAPHO). Rev Rhum 1987; 54:187–196.Google Scholar
  5. 5.
    Benhamou CL, Chamot AM, Kahn MF. Synovitis-acne-pustulosis-hyperostosis osteomyelitis syndrome (SAPHO). Clin Exp Rheumatol 1988; 6:109–112.PubMedGoogle Scholar
  6. 6.
    Grosshans EM. SAPHO the impossible acronym. Dermatology 1993; 186:161–162.PubMedGoogle Scholar
  7. 7.
    Boutin RD, Resnick D. The SAPHO syndrome: an evolving concept for unifying several idiopathic disorders of bone and skin. AJR Am J Roentgenol 1988; 170:585–591.Google Scholar
  8. 8.
    Freyschmidt J, Sternberg A. The bull's head sign: scintigraphy pattern of sternoclavicular hyperostosis and pustulotic arthrosclerosis. Eur Radiol 1998; 8:807–812.CrossRefPubMedGoogle Scholar
  9. 9.
    Kasperzyk A, Freyschmidt J. Pustolotic arthro-osteitis: spectrum of bone lesions with palmoplantar pustulosis. Radiology 1994; 191:207–211.PubMedGoogle Scholar
  10. 10.
    Sugimoto H, Tamura K, Fujii T. The SAPHO syndrome: defining the radiological spectrum of disease comprising the syndrome. Eur Radiol 1998; 8:800–806.CrossRefPubMedGoogle Scholar
  11. 11.
    Hayem G, Bouchaud-Chabot A, Benali K, et al. SAPHO syndrome: a long term follow up study of 120 cases. Semin Arthritis Rheum 1999; 293:159–171.Google Scholar
  12. 12.
    Jurik AG. Anterior chest wall involvement in patients with pustulosis palmoplantaris. Skeletal Radiol 1990; 19:271–277.PubMedGoogle Scholar
  13. 13.
    Reith JD, Bauer TW, Schils JP. Osseous manifestations of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. Am J Surg Pathol 1996; 20:1368–1377.CrossRefPubMedGoogle Scholar
  14. 14.
    Van Doornum S, Barraclough D, McColl G, Wicks I. SAPHO: Rare or just not recognised? Semin Arthritis Rheum 2000; 30:70–77.CrossRefPubMedGoogle Scholar
  15. 15.
    Davies AM, Marins AJ, Evans N, et al. SAPHO syndrome: 20 year follow up. Skeletal Radiol 1999; 28:159–162.CrossRefPubMedGoogle Scholar
  16. 16.
    Kahn MF, Khan MA. The SAPHO syndrome. Baillieres Clin Rheumatol 1994; 8:333–362.PubMedGoogle Scholar
  17. 17.
    Maugars Y, Berthelot JM, Ducloux JM, Prost A. SAPHO syndrome. a follow up study of 19 cases with special emphasis on enthesis involvement. J Rheumatol 1995; 22:2135–2141.PubMedGoogle Scholar
  18. 18.
    Jurik AG, Egund N. MRI in chronic recurrent multifocal osteomyelitis. Skeletal Radiol 1997; 26:230–238.CrossRefPubMedGoogle Scholar
  19. 19.
    Watts RA, Crisp AJ, Hazleman BL, et al. Arthro-osteitis: a clinical spectrum. Br J Rheum 1993; 32:403–407.Google Scholar
  20. 20.
    Nachtigal A, Cardinal E, Bureau NJ, et al. Vertebral involvement in SAPHO syndrome: MRI findings. Skeletal Radiol 1999; 28:163–168.CrossRefPubMedGoogle Scholar
  21. 21.
    Van Holsbeeck M, Martel W, Dequeker J, et al. Soft tissue involvement, mediastinal pseudotumour, and venous thrombosis in pustulotic arthro-osteitis. Skeletal Radiol 1989; 18:1–8.PubMedGoogle Scholar
  22. 22.
    Toussirot E, Dupond JL, Wendling D. Spondylodiscitis in SAPHO syndrome. A series of eight cases. Ann Rheum Dis 1997; 56:52–58.PubMedGoogle Scholar
  23. 23.
    Sonozaki H, Azuma O, Okai K, et al. Clinical features of 22 cases with "inter-sterno-costo-clavicular " ossification. A new rheumatic syndrome. Arch Orthop Trauma Surg 1979; 95:13–22.PubMedGoogle Scholar
  24. 24.
    Ellis BI, Shier CK, Leisen JC, et al. Acne-associated spondyloarthropathy: radiographic features. Radiology 1987; 162:541–545.PubMedGoogle Scholar
  25. 25.
    Eyrich GKH, Harder C, Sailer HF, et al. Primary chronic osteomyelitis associated with synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO syndrome). J Oral Pathol Med 1999; 28:456–464.PubMedGoogle Scholar
  26. 26.
    Huaux JP, Maldague B. Malghem J, et al. Pustulotic arthro-osteitis and related disorders in children and adults. JBR-BTR 1986; 69:345–354.PubMedGoogle Scholar
  27. 27.
    Rosner IA, Richter DE, Huettner TL, et al. Spondyloarthropathy associated with hidradenitis suppurativa and acne conglobata. Ann Intern Med 1982; 97:520–525.PubMedGoogle Scholar
  28. 28.
    Cotten A. Flipo RM, Mentre A, et al. SAPHO syndrome. Radiographics 1995; 15:1147–1154.PubMedGoogle Scholar
  29. 29.
    Hatem SF, et al. Case 3: Chronic recurrent multifocal osteomyelitis (CRMO). AJR Roentgen 01 1997; 169:285; 289–291.Google Scholar
  30. 30.
    Tyrrell PNM, Cassar-Pullicino VN, Eisenstein JF, et al. Back pain in childhood. Ann Rheum Dis 1996; 55:789–793.PubMedGoogle Scholar
  31. 31.
    Anderson S, et al. Imaging of chronic recurrent multifocal osteomyelitis of childhood first presenting with isolated primary spinal involvement. Skeletal Radiol DOI 10.1007/s00256-002-0602-0Google Scholar
  32. 32.
    Hellman DB. Spondyloarthropathy with hidradenitis suppurativa. JAMA 1992; 267:2363–2365.PubMedGoogle Scholar
  33. 33.
    Schwartz B. Infectious agents. Immunity and rheumatic diseases. Arthritis Rheum 1990; 33:457–465.PubMedGoogle Scholar
  34. 34.
    Kotilainen P, Merilahti-Palo R, Lehtonen OP, et al. Case report. Propionibacterium acnes isolated from sternal osteitis in a patient with SAPHO syndrome. J Rheumatol 1996; 23:1302–1304.PubMedGoogle Scholar
  35. 35.
    Kooijmans-Coutinho MF, Markusse HM, Dijkmans BAC. Infectious arthritis caused by Propionibacterium acnes: a report of two cases. Ann Rheum Dis 1989; 48:851–852.Google Scholar
  36. 36.
    Anneli Savolainen H, Von Essen R, Anti J, Jahkola M. Propionibacterium acnes in purulent arthritis: probable cause of iatrogenic infection (letter). J Rheumatol 1988; 15:6.Google Scholar
  37. 37.
    Sulkowski MS, Abonik IZ, Morris EI, Granger DL. Infectious arthritis due to Propionibacterium acnes in a prosthetic joint. Clin Infect Dis 1994; 19:224–225.PubMedGoogle Scholar
  38. 38.
    Suter F, Silanos MA, Tabacchi G, Maggiolo F. A case of Propionibacterium acnes spinal osteomyelitis. J Clin Microbiol Infect Dis 1992; 11:196–197.Google Scholar
  39. 39.
    Honan M, White GW, Eisenberg GM. Spontaneous infectious diseases in adults. Am J Med 1996; 100:85–89.PubMedGoogle Scholar
  40. 40.
    Wagner AD, Mai U, Hammer M, Zeidler H. Long term antibiotic therapy in patients with SAPHO syndrome (abstract). Arthritis Rheum 1997; 40(Suppl 9):562.Google Scholar
  41. 41.
    Ballara SC, Siraj QH, Maini RN, Venables PJW. Sustained response to doxycycline therapy in two patients with SAPHO syndrome. Arthritis Rheum 1999; 42:819–821.CrossRefPubMedGoogle Scholar
  42. 42.
    Edlund E, Johnsson U, Lidgren L, et al. Palmoplantar pustulosis and sterno-costo-clavicular arthro-osteitis. Ann Rheum Dis 1998; 47:809–815.Google Scholar
  43. 43.
    Rothschild B, Schils J, Lavelle H. Potential therapeutic approach to SAPHO. Semin Arthritis Rheum 2000; 29:332–334.PubMedGoogle Scholar

Copyright information

© ISS 2003

Authors and Affiliations

  1. 1.Department of Medical ImagingHoly Spirit HospitalBrisbaneAustralia
  2. 2.Service de Radiologie OsteoArticulaireHopital Roger SalengroLilleFrance

Personalised recommendations