SAPHO syndrome (ICD-10 M86.3 / ICD-11 4A61) is a chronic inflammatory condition of the bones and joints. Oral NSAIDs are the standard first-line approach for pain relief — but when they fail to meet their target, a structured next-line protocol applies.

Previous Line — First-Line Failure Condition

NSAIDs, taken orally as first-line treatment for pain relief, did not achieve adequate pain reduction as measured by Visual Analogue Scale (VAS) pain scores. The protocol described here is the structured step taken after that failure.

Next-Line Treatment Approach — Partial Overview

In NSAID-refractory SAPHO syndrome, the protocol involves bisphosphonate therapy and, where appropriate, conventional DMARDs. The specific agent selection, sequence, route, and dosing are set out in full in the structured regimen.

References

DOI: 10.1136/rmdopen-2023-003688

Treatment with bisphosphonates improved osteoarticular disease in a majority of patients across studies.
This included patients refractory to NSAIDs and corticosteroid injections.
Across studies, pamidronate was the most frequently chosen bisphosphonate (n=122/176 patients, 69.3%; 12/17 studies, 70.6%).
cDMARDs are usually used when symptoms persist despite NSAID treatment.
Methotrexate and sulfasalazine were most commonly used.
Three studies suggested beneficial effects of methotrexate on osteoarticular and cutaneous involvement.
Improvement was described as partial or complete pain resolution.
Where available, MRI confirmed rapid and sustained improvement of spinal BMO in two studies including 44 patients (for 37 of whom MRI studies were available).
Some studies reported reduction of osteolytic lesions coinciding with complete clinical, laboratory and radiological remission.

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SAPHO Syndrome Refractory to NSAIDs: What to Do When First-Line Therapy Fails