Successful Treatment of SAPHO Syndrome Complicated with Ankylosing Spondylitis by Secukinumab: A Case Report

Abstract

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is characterized by a wide range of dermatological and musculoskeletal manifestations, and its outcome has recently been improved greatly by optimizing management. However, the treatment strategies are not standardized and require further refinement. Secukinumab, a fully human monoclonal antibody targeting IL-17A, is approved for the treatment of autoimmune psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Here, a 53-year-old man was diagnosed with AS, and he presented scattered pustulosis in both hands and feet with a 5-year history of recurrent lumbosacral area pain and abnormal pain in the neck and front chest area. Secukinumab improved the patient’s cutaneous lesion and prevented musculoskeletal pain by substituting adalimumab. Although only a few cases have been reported that secukinumab can effectively treat SAPHO syndrome complicated with AS, the efficacy remains controversial. Therefore, we hope to provide a novel valuable therapeutic strategy for SAPHO syndrome management, particularly in patients with skin lesions.

Successful Treatment of Refractory Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome and Paradoxical Psoriasis with Secukinumab: A Case Report

“…Despite a limited response to traditional treatment regimens and adalimumab, both skin and osteoarticular symptoms improved after switching to secukinumab. 18 Cheng et al found that in patients with SAPHO syndrome, secukinumab demonstrated a higher improvement rate in cutaneous symptoms compared to osteoarticular symptoms. 19 This difference may be attributed to the involvement of distinct inflammatory pathways in cutaneous and osteoarthritis symptoms among patients with SAPHO syndrome.…”

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome may present with extra‐articular and cutaneous manifestations

“…However, some researchers have suggested that SAPHO syndrome can be classified as a form of spondyloarthritis, a potential transitional stage between ankylosing spondylitis (AS) and psoriatic arthritis 2,3 . Both SAPHO syndrome and spinal arthritis affect the axial and sacroiliac joints in a similar manner, exhibiting shared characteristics and even instances of co‐occurrence 4,5 . SAPHO syndrome may be associated with the HLA‐B27 gene 2 .…”