Alhayali Mustafa
Rheumatology, Center of Spine and Joint Diseases, Baghdad, IRQ.
Cureus. 2024 Aug 5;16(8):e66169. doi: 10.7759/cureus.66169. eCollection 2024 Aug.
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is primarily manifested by persistent inflammation affecting the musculoskeletal system and the skin. The treatment of SAPHO syndrome remains a challenge. Tofacitinib is a Janus kinase (JAK) inhibitor that inhibits a range of cytokines. Here, we report a patient who had been diagnosed with SAPHO syndrome refractory to initial treatment and responded well to tofacitinib. An 18-year-old male was presented to our center with polyarthritis, associated with sternal and clavicular pain. There was a nine-month history of skin lesions affecting his chest and back and was diagnosed with a case of SAPHO syndrome. Nonsteroidal anti-inflammatory drugs, conventional disease-modifying antirheumatic agents, and biological drugs were unhelpful. After five weeks of starting tofacitinib at 5mg twice daily in combination with methotrexate, the patient reported significant improvement in dermatological and osteoarticular symptoms. JAK inhibitors, especially tofacitinib, can be a good choice for the treatment of SAPHO refractory to disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor (TNF) inhibitors.
滑膜炎、痤疮、脓疱病、骨肥厚和骨炎（SAPHO）综合征主要表现为影响肌肉骨骼系统和皮肤的持续性炎症。SAPHO综合征的治疗仍然是一项挑战。托法替布是一种抑制多种细胞因子的 Janus激酶（JAK）抑制剂。在此，我们报告一例被诊断为对初始治疗难治的SAPHO综合征患者，其对托法替布反应良好。一名18岁男性因多关节炎伴胸骨和锁骨疼痛就诊于我们中心。他有9个月的胸部和背部皮肤病变病史，被诊断为SAPHO综合征。非甾体抗炎药、传统改善病情抗风湿药和生物药物均无效。在开始每天两次服用5mg托法替布联合甲氨蝶呤治疗5周后，患者报告皮肤和骨关节症状有显著改善。JAK抑制剂，尤其是托法替布，对于治疗对改善病情抗风湿药（DMARDs）和肿瘤坏死因子（TNF）抑制剂难治的SAPHO综合征可能是一个不错的选择。
