Ilium osteitis as the main manifestation of the SAPHO syndrome: response to infliximab therapy and review of the literature

Objective To analyze the clinical efficacy of anti-tumor necrosis factor (TNF)-α therapy in the SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. We describe 2 new cases with ilium osteitis as the main SAPHO syndrome feature and review reported cases treated with anti-TNF-α. Methods A literature search of SAPHO syndrome cases treated with TNF-α blocking therapy with special emphasis on osteoarticular and skin responses was performed. Results Eighteen cases were identified: 17 SAPHO syndrome and 1 chronic recurrent multifocal osteomyelitis, a juvenile variant of SAPHO syndrome. Sixteen were reported cases and 2 were nonreported cases seen in our arthritis unit. Sixteen patients received infliximab and 2 received etanercept, with an early, sustained clinical improvement in most cases. Conclusions Anti-TNF-α therapies are effective treatment for patients with refractory SAPHO syndrome, not only for cutaneous lesions but also for persistent bone lesions such as osteitis.