Sternoclavicular Hyperostosis Research Articles

Assessment ofclinical andradiological characteristics ofJapanese patients with synovitis, acne, pustulosis, hyperostosis, andosteitis syndrome.

This study aimed to analyse the radiological characteristics and clinical diversity of Japanese patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a heterogeneous disorder. Radiographs and clinical information from 115 Japanese patients (female/male: 81/34; mean age at onset: 48.7 years) diagnosed with SAPHO syndrome between January 2007 and December 2020 were retrospectively reviewed. Additionally, the treatment for SAPHO syndrome was explored. Among the 115 patients, 70 patients had complications, including palmoplantar pustulosis, acne, or psoriasis. Imaging studies included bone scintigraphy, magnetic resonance imaging, computed tomography, and positron emission tomography in 71, 58, 70, and 23 patients, respectively. The most frequent lesions were arthritis and hyperostosis of the sternoclavicular joints in 96 patients; spinal lesions, including sacroiliac arthritis, were observed in 85 patients. Peripheral aseptic osteitis was observed in 22 patients, and the tibia was involved in 12. The treatments consisted of analgesics, bisphosphonates, conventional synthetic disease-modifying antirheumatic drugs, and biologics (tumour necrosis factor inhibitors and interleukin-23p19 inhibitors) in 85, 15, 23, and 10 patients (8 and 2 patients), respectively. Sternoclavicular hyperostosis and pustulosis are frequently observed in patients with SAPHO syndrome. Biological agents were more frequently used in patients with peripheral osteitis and arthritis.

Sternoclavicular hyperostosis

Sternoclavicular hyperostosis (SH) is described as bony overgrowth with soft tissue ossification of the medial clavicle, upper ribs, and sternum. It occurs in both sexes with a broad age range from 11 to 88 years. In a review of 251 cases 139 were Japanese and 114 Caucasian. The most common symptom is pain and while the etiology is unknown, SH usually starts with nonspecific inflammation of the sternoclavicular ligaments which may lead to chronic inflammation with progressive hyperostosis and soft tissue ossification. The differential includes osteitis condensans, aseptic necrosis, Tietzes syndrome, osteoarthritis, spontaneous subluxation, osteomyelitis and tumors such as osteosarcoma, metastatic breast and prostate cancer, thyroid cancer or extension from a Pancoast tumor of the lung. Biopsy is planned if further enlargement occurs. Approximately 50% of patients with SH have skin lesions such as palmoplantar pustulosis, pustular psoriasis, hidradenitis suppurativa and psoriasis vulgaris. Patient's may be treated with non-steroidal anti-inflammatory drugs (NSAID's) for relief if needed. Progression can be monitored over time for increased size or symptoms that may justify biopsy or repeat imaging.

Clinical images: Bone histomorphometric analysis of SAPHO syndrome with sternoclavicular hyperostosis

Clinical images: Bone histomorphometric analysis of SAPHO syndrome with sternoclavicular hyperostosis

Ibandronate in Benign Bone Disease

Ibandronate is a potent bisphosphonate which has been most thoroughly assessed in benign bone disease for use in the management of postmenopausal osteoporosis. Its use in corticosteroid-induced osteoporosis, Paget's disease and uncommon benign bone conditions such as localised transient osteoporosis (or bone marrow oedema syndrome) and sternocostoclavicular hyperostosis has also been explored. Recent randomised controlled trial evidence suggests that intermittent high dosage oral ibandronate may be as efficacious as a daily low dose regime for the treatment of post-menopausal osteoporosis, with only a mild increase in adverse events. Movement towards an extended gap between doses has implications for patient compliance and adherence and thus potential benefits for fracture prevention. This review aims to provide an overview of the evidence from randomised controlled trials in humans for the use of ibandronate in benign bone diseases. This includes a discussion of the development program and dosage regimens for the prevention and treatment of post-menopausal osteoporosis, as well as the use of ibandronate in corticosteroid induced osteoporosis, Paget's disease localised transient osteoporosis and sternoclavicular hyperostosis. Adverse effects and long-term safety data will also be reviewed.

Intravenous pamidronate in the treatment of sternoclavicular hyperostosis

AbstractThe SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is a rare clinical entity in which osteosclerosis and osteolysis are consistent radiological findings. We present a patient with SAPHO syndrome manifesting as painful sternoclavicular hyperostosis treated successfully with pamidronate. For the first time, a reduction in isotope bone scan activity was documented in parallel to a favourable clinical response. Bisphosphonates have potent antiosteoclastic and anti‐inflammatory effects. By virtue of their dual effects on bone remodelling and inflammation, they seem an appropriate therapy in the management of SAPHO syndrome. This case demonstrates the efficacy of pamidronate, both clinically and radiologically, as first line therapy for patients with isolated hyperostosis.

Sternoclavicular hyperostosis with pathological fracture of the clavicle—a case report

Sternoclavicular hyperostosis with pathological fracture of the clavicle—a case report

A Case of Bilateral Subclavian Venous Thrombosis Associated with Sternocostoclavicular Hyperostosis

Sternocostoclavicular hyperostosis is an uncommon disease, characterized by an inflammatory arthrosteitis of the sternocostoclavicular region. Clinically, it manifests as a painful swelling of the upper anterior chest wall, which is associated with occasional pustulosis palmaris and plantaris.A 48-year-old man had suffered from pain in both shoulders and the upper anterior part of the chest for 6 months. On examination, a venous engorgement in the neck with dilated collateral veins in the upper chest and shoulders was observed. Swelling was noticed in his face, neck and both arms.Radiologically, the clavicles, the sternum and the first ribs were enlarged with complete fusion between them. 99Tc scintigraphy showed increased uptake in the clavicles and the sternum. Selective venography resulted in a bilateral subclavian and brachiocephalic vein occulation, which resulted from a subclavian vein thrombosis. All the above suggested a sternocostoclavicular hyperostosis. He underwent a vascular graft interposition between the right jugular vein and the left innomianate vein (using 8mm ringed Gore-Tex graft) and a resection of the bilateral medial half of clavicle and 1st rib.Here, we present a case on sternoclavicular hyperostosis with subclavian and brachiocephalic vein thrombosis, and report this case study with a review of the appropriate literature.

Letters to the Editor

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

Die pustulöse Arthro-Osteitis - Modell einer reaktiven Spondarthritis?

Pustulotic arthro-osteitis exemplifies the fact that the catalogue of nosological entities is by no means complete even in rheumatology and that individual symptoms are being recorded by various authors of different disciplines at different times, independent of each other, resulting in a jig-saw puzzle of individual observations that may take years to fit together. As far as pustulotic arthro-osteitis is concerned, it is a particularly unusual and fascinating fact that this disease appears to be a combination of palmo-plantar pustulosis, sternoclavicular hyperostosis and a variety of other skeletal changes plus tangential connections to other (related?) diseases. There are some pointers indicating that it is a reactive spondylarthropathy that is identical with chronic multifocal osteomyelitis occurring in childhood and adolescence. It is interesting to note that very similar arthritic changes have been seen in the course of adjuvant arthritis in the rat where T-lymphocytes were employed. In this particular phenomenon in the rat an abacterial (in this case probably immunologically mediated by the T-lymphocytes) chronic hyperostotic osteomyelitis may also occur.

Bone disease in adolescents with acne fulminans and severe cystic acne: radiologic and scintigraphic findings.

Acne fulminans is an uncommon form of ulcerative acne with acute onset. It usually affects adolescent boys who have associated musculoskeletal pain and septic fever. Osteolytic bone lesions have been reported in these patients. Severe cystic acne occurs almost equally in both sexes, but it has a less dramatic clinical course than acne fulminans and rarely causes ulcerative skin lesions and systemic symptoms. In this study we investigated the imaging features of bone lesions associated with acne fulminans and determined if patients with severe cystic acne have similar bone lesions. From 1970 through 1991, 24 patients with acne fulminans were treated in the dermatologic departments of Finnish hospitals. Radiologic (plain radiographs or conventional tomograms) or scintigraphic data were available for 21 patients and analyzed retrospectively. For comparison, 20 consecutive patients with severe cystic acne were examined prospectively with scintigraphy. Ten patients (48%) with acne fulminans had lytic bone lesions on the radiographs, and the bone scans showed increased uptake in 14 patients (67%). Destructive lesions resembling osteomyelitis were seen in seven patients. The bones of the anterior chest wall were predominantly involved: sternum in four patients, clavicle in three patients, and acromion scapulae in one patient. Sternoclavicular hyperostosis was seen in six patients. Four patients had small lytic lesions in the epiphyseal growth plate or a periosteal reaction. Follow-up was performed in eight patients with acne fulminans and in seven revealed either normal findings or sclerosis and hyperostosis in the previously affected areas of the sternum and clavicles. Slightly increased uptake of radionuclide, usually in the sternum or around the sternoclavicular joints, was seen in nine patients with severe cystic acne, but these findings were regarded as normal and radiographs were not obtained. Lytic lesions in the bones of the anterior chest wall and in the epiphyseal growth plates are common in patients with acne fulminans, but do not seem to occur in patients with severe cystic acne. The prognosis of bone disease associated with acne fulminans appears to be good, and the chronic sequelae, if any, are mild sclerosis and hyperostosis of the affected bones. Acne fulminans should be added to the list of dermatoses associated with bone lesions detectable by radiologic and scintigraphic methods.

Usefulness of bone imaging in diagnosis of sternocostoclavicular hyperostosis

Sternocostoclavicular hyperostosis (SCCH) is a rare disease that is characterized by hyperostosis and soft tissue ossification between the clavicles and the anterior part of the upper ribs. There have been few published reports of 99mTc-MDP bone imaging findings in this disease. Thirty-three patients who were suspected to have SCCH were studied with 99mTc-MDP bone imaging. Bone images were abnormal in 31 (94%) of 33 patients. Chest radiographs were available in 30 patients, but negative in 14 (46%) of them. Bone imaging revealed also radionuclide accumulations in other bones such as the vertebrae, femur or sacroiliac joints in ten (14 sites) of 33 cases. Bone scintigraphy was useful in the diagnosis of sternoclavicular hyperostosis.