Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare chronic inflammatory disorder of bone, joint, and skin characterized by synovitis, osteitis, hyperostosis, and enthesitis, typically with pain, swelling, and tenderness in affected areas. A variety of regions may be involved, especially the anterior chest wall; other parts of the axial skeleton, including the sacroiliac joint and spine; and medium to large lower-extremity joints. Radiographic changes may include hyperostotic changes, sclerotic lesions, osteolysis, periosteal reaction, and osteoproliferation involving entheses. The skin manifestations include a spectrum of follicular occlusion and neutrophilic dermatoses including severe acne, hidradenitis suppurative, palmoplantar pustulosis, and pyoderma gangrenosum. The time interval between the occurrence of initial skin and arthritis/osteitis symptoms is less than two years in approximately 70 percent of patients, but not all patients exhibit cutaneous manifestations.
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