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Demographic, clinical, and scintigraphic comparison of patients affected by palmoplantar pustulosis and severe acne: a retrospective study

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Abstract

Objective

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome encompasses heterogeneous dermatological manifestations, mainly palmoplantar pustulosis (PPP) and severe acne (SA). This study aims to explore the necessity of stratified management according to skin lesions.

Methods

In a cohort of SAPHO patients, we compared the demographic, clinical, and scintigraphic characteristics of the SAPHO patients whose skin lesion was PPP or SA.

Results

A total of 249 patients were included (227 affected by PPP and 22 affected by SA). Patients with SA were younger at onset (20, interquartile ranges (IQR) 15–30 vs. 37, IQR 30–46 years old; p < 0.001) and enrollment (35, IQR 25–38 vs. 41, IQR 33–50 years old; p = 0.001), and they had a prolonged disease duration (88.5 months, IQR 18.7–216.0 vs. 16.0, IQR 7.0–48.0 months; p < 0.001) and time needed for diagnosis (7.5, IQR 2.0–19.0 vs. 1.0, IQR 1.0–4.0 years; p < 0.001). Adjusted by age, sex, and disease duration, SA was significantly associated with more disease-modifying anti-rheumatic drug (DMARD) use (adjusted odds ratio (OR) 3.72; 95% confidence interval (CI) 1.23, 12.62; p = 0.019) and more sternoclavicular joint involvement (adjusted OR 5.91; 95% CI 1.17, 61.3; p = 0.030) in two separate Firth's logistic regression models.

Conclusion

SAPHO patients affected by PPP or SA as the only skin lesion may have different epidemiologic features, osteoarticular manifestations, and treatment history.

Key Points

• SAPHO patients with PPP or SA were heterogenous in both demographic, clinical, and imaging features.

• SAPHO patients with SA were mainly male and had a significantly younger age and longer duration of symptoms before diagnosis.

• SA in SAPHO patients was significantly associated with more sternoclavicular involvement and more DMARD use history.

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Acknowledgements

We authors would like to thank Dr. Dingding Zhang, Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, for his statistical advice.

We authors appreciate the patients recruited in this study.

Funding

This research was funded by National Natural Science Foundation of China (81822030), Chinese Academy of Medical Sciences (CAMS) Initiative Fund for Medical Sciences (2016-I2M-3-003), Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (2017-I2M-3-001), Capital Medical Research and Development Fund (2016-4-40112), and National Key Research and Development Program of China (2016YFC0901500).

Author information

Author notes

  1. Yueting Li, Chen Li and Nan Wu contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China

    Yueting Li & Xiaochuan Sun

  2. Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China

    Chen Li

  3. Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China

    Nan Wu & Qiyi Li

  4. Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, China

    Nan Wu & Zhihong Wu

  5. Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, China

    Nan Wu & Zhihong Wu

  6. Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China

    Feng Li & Li Li

  7. Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China

    Zhihong Wu

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  1. Yueting Li
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Correspondence to Qiyi Li or Li Li.

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The study was approved by the ethics committee of Peking Union Medical College Hospital (ethics documents number: ZS-944) and complied with the 1964 Helsinki declaration ethical standards.

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Li, Y., Li, C., Wu, N. et al. Demographic, clinical, and scintigraphic comparison of patients affected by palmoplantar pustulosis and severe acne: a retrospective study. Clin Rheumatol 39, 1989–1996 (2020). https://doi.org/10.1007/s10067-019-04904-8

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