I. Spondarthritis hyperostotica pustulo-psoriatica

Abstract

An exemplary case of the entity "Spondarthritis hyperostotica pustulo- psoriatica" from our multicentric study is described. The typical trias of palmo-plantar pustulosis, stemocostocalvicular hyperostosis and spondylopathia is decisively influenced concerning dermatological findings, histopathology (sternoclavicular inflammatory arthritis) and radiological findings (psoriatic spondylitis) by a kind of psoriatic multisystemic disease. In the described case an incomplete SCCH lead to the complication of compression of the subclavian vein. The perivertebral vertical ligamental system showed layer-related ossifications as a hyperostotic desmophytosis. Sclerotic arthritis of the sacro-iliac joints formed the last occurred symptom of trunkal involvement. Manifestation at one extremity was documented as a particularity. We describe a "syndrome of the lower leg" as a rare symptom of "Spond.hyp.pp", we call ,,fibro-osteopathia cruris". We have to discuss this fibular hyperostosis with periosteal proliferations and ossification of the interosseous membrane between the pole of an extreme form of psoriatic enthesopathy and the other pole of chronic sclerosing osteomyelitis. We find typical mechanisms from the field of the poly-nosologic SAPHO-syndrome, whereby the elements "pustulosis" and "infection" are essential catchwords for further investigation concerning etiology of the entities, which form "SAPHO-syndrome" and "acquired hyperostosis syndrome".