27th February 2025

SAPHO syndrome

This rare, relapsing-remitting inflammatory disorder classically consists of synovitis, acne, pustulosis, hyperostosis and osteitis. However, presentation is variable, with non-infective osteitis or osteomyelitis as the only core feature. Over half of patients see characteristic anterior chest wall involvement (particularly affecting the sternoclavicular, sternocostal and costoclavicular areas), often seen on radionuclide imaging as ‘bull’s head sign’. The third of patients suffering axial skeletal disease are at risk of critical complications and thus require more aggressive treatment. While plain film or CT imaging will identify the affected areas, radionuclide bone scanning is helpful in differentiating SAPHO syndrome from similar conditions.