Dear Sir: We read with interest the recent Orthopaedic, Radiology, Pathology Conference by Griffith and coworkers entitled "Sclerosis and Swelling of the Clavicle in a 44-Year-Old Woman".2 Although we agree with the authors' diagnosis and some of their views of this noninfectious inflammatory condition, we would like to call to attention recent updates in the nomenclature of this and similar processes. The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) was introduced by Chamot et al1 in 1987 in an attempt to unify a large group of disorders which had in common pustular skin conditions and various osseous manifestations, especially involvement of the anterior chest wall. The best known of the conditions included under the rubric SAPHO syndrome are chronic recurrent multifocal osteomyelitis (CRMO), sternoclavicular hyperostosis, pustulotic arthroosteitis, and chronic sclerosing osteomyelitis.3,4 Patients with these disorders often manifest some type of pustular dermatosis, most commonly palmoplantar pustulosis, cystic acne, or pustular psoriasis. Patients also have complaints related to the skeleton, and often are found to have lytic or sclerotic bone lesions, arthritis, unilateral sacroiliitis, and ankylosing spondylitislike changes. The bony changes preferentially involve the anterior chest wall, particularly the clavicle, and the case report described by Griffith et al. typifies the distribution and radiographic features of these changes. Biopsies from these lesions can show a various histologic appearances, including acute osteomyelitis, chronic osteomyelitis, markedly sclerotic cancellous bone with marrow space fibrosis and minimal inflammation, and Pagetic sclerosis with chronic inflammation.5 Although Griffith and coworkers apparently have recognized chronic sclerosing osteomyelitis (or the SAPHO syndrome) as a noninfectious inflammatory condition and appropriately treated their patient with nonsteroidal antiinflammatory drugs, they repeatedly refer to the process as infectious. The repeated use of the term infection potentially is misleading. The SAPHO syndrome (including chronic sclerosing osteomyelitis) appears to be a noninfectious process which is unlikely to respond to antibiotics. Many previous studies of this syndrome have attempted to identify a causative microorganism, and although Propionobacterium acnes has been isolated from numerous bone biopsies, most authors believe it is a contaminant.3,4,5 Based in part on its similarities to ankylosing spondylitis, increased prevalence of HLA-B27, and occasional association with psoriasis and inflammatory bowel disease, the SAPHO syndrome probably represents a form of seronegative spondyloarthropathy. As noted by Griffith and coworkers, without treatment the clinical course of this condition is characterized by multiple remissions and exacerbations. Whether or not one chooses to use the term SAPHO syndrome, it is important recognize that this condition is not infectious, and should be treated with nonsteroidal antiinflammatory agents instead of antibiotics. True infectious osteomyelitis of the anterior chest wall is rare, and patients who are found to have osteomyelitis involving the thoracic skeleton, particularly if it is multifocal or occurring in the setting of a pustular dermatosis, should be evaluated for the possibility of a noninfectious etiology. John D. Reith, MD Department of Pathology; Shands Hospital; University of Florida College of Medicine; Gainesville, FL Thomas W. Bauer, MD, PhD Departments of Pathology and Orthopaedic Surgery; The Cleveland Clinic Foundation; Cleveland, OH Jean P. Schils, MD Department of Diagnostic Radiology; The Cleveland Clinic Foundation; Cleveland, OH