Treatment of SAPHO Syndrome After Inadequate Response to Bisphosphonates or DMARDs
Clinical Scenario
SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) continues to cause active disease despite first-line medical management. When established initial therapies do not achieve adequate pain control and suppress bone inflammation, a structured next-line approach is required.
First-Line Treatment Has Not Achieved Target Response
This protocol applies when prior therapy — including bisphosphonates such as pamidronate, alendronate, or zoledronic acid, and/or conventional DMARDs such as methotrexate or sulfasalazine — has not achieved partial or complete pain resolution, improvement of spinal bone marrow oedema on MRI, or meaningful reduction of ESR and CRP levels.
Next-Line Approach
For otherwise treatment-refractory SAPHO syndrome, a TNF inhibitor is considered. Clinical goals include partial or complete reduction of pain, improved Bath Ankylosing Spondylitis Disease Activity Index, and resolution of bone inflammation on imaging. The specific agent selection, eligibility criteria, and monitoring guidance are contained in the structured protocol.
References
DOI: 10.1136/rmdopen-2023-003688
- bDMARDs are used in otherwise treatment refractory patients.
- A total of 90 patients from 11 studies were treated with TNFi.
- Overall, reported effects were positive.
- Most studies reported partial or complete clinical response, including reduction of pain, disease activity as measured with BASDAI and other osteoarticular presentations including sacroiliitis.
- In SAPHO clinical benefits of TNF inhibitors include resolution of bone inflammation and associated pain as well as skin disease.
View source ↗