Therapeutic strategies for SAPHO syndrome

Abstract

Introduction: SAPHO syndrome is an inflammatory disorder including axial and peripheral skeletal manifestations frequently associated with different forms of skin pustulosis and other neutrophilic dermatosis. Despite a triggering role of an infectious agent emerging, aetiopathogenesis remains obscure. As a consequence its treatment is still empirical. Non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and classical disease-modifying anti-rheumatic drugs s are all used in the treatment of SAPHO syndrome with different results. In refractory cases bisphosphonates (pamidronate) and biological agents, namely anti-TNF-α and anti-IL-1, could also be effective in association. Antibiotics may also play a relevant role, especially in the early phases of the disease.Areas covered: A computerised search was conducted using Medline, PubMed, EMBase and Cochrane Central Register of Controlled Trials (CENTRAL) for articles published in English (up to July 2013) applying the MeSH terms and keywords ‘SAPHO syndrome', ‘bisphosphonates', ‘antibiotics', ‘anti-TNF-α agents' and ‘autoinflammatory diseases'. Boolean operators (NOT; AND; OR) were used in succession to narrow and widen the search.Expert opinion: To prevent new bone formation, continuous NSAID therapy could be explored considering the results obtained in spondyloarthritides, but cardiovascular and gastrointestinal risks have to be taken into account. Furthermore, no experience exists with the new anti-TNF-α agents golimumab and certolizumab pegol. Also, the new anti-IL-1 agent canakinumab deserves to be tried, due to the mechanism of action and suitable dosage regimen. Finally, following the hypothesis of a triggering infectious agent, prolonged and repeated courses of antibiotic therapy may be an option.