Toussirot E, Dupond J L, Wendling D
Department of Rheumatology, University hospital J Minioz, Besancon, France.
Ann Rheum Dis. 1997 Jan;56(1):52-8. doi: 10.1136/ard.56.1.52.
To determine the frequency, clinical features, and radiological and bone scintigraphic changes of spondylodiscitis in patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis).
The study was retrospective. Data from patients with the diagnostic criteria of SAPHO syndrome were analysed for clinical features, biological data (HLA B antigen), and pelvic and spine x rays. Spine computed tomography (CT) or magnetic resonance imaging (MRI) were also examined in some cases.
25 patients with a diagnosis of SAPHO were seen since 1985. Eight had spondylodiscitis. These included five with palmoplantar pustulosis, one with pustular psoriasis, one with psoriasis vulgaris, and one with chronic recurrent multifocal osteomyelitis without skin disease. The skin lesion occurred before the spondylodiscitis in four cases. Chest wall involvement was observed in four cases and sacroiliac joint lesions only in the case with osteomyelitis. HLA B27 was always negative and HLA B8 was found in four cases. Radiological findings consisted of erosive or sclerosing remodelling of endplates with a narrowed disc space; a reduced height of the vertebral body was also observed in some cases. These spinal lesions occurred in the three vertebral segments. Multiple sites of spondylodiscitis in the same patient were common. Bone scan showed mildly increased uptake and CT and MRI were useful for detecting signs of infection such as abscess. Enhanced signals on T2 weighted sequence or after injection of gadolinium were often observed. Follow up study of most of these patients suggests that the prognosis of spondylodiscitis in the SAPHO syndrome is favourable.
Despite few description in the literature, spondylodiscitis in the SAPHO syndrome is common (32% in this series). These radiological findings are similar to the discovertebral changes of spondylodiscitis in ankylosing spondylitis, thus giving support to the relations between SAPHO syndrome and spondylarthropathies. However, this does not mean that the pathogenic mechanisms are the same in these two conditions.
确定伴有滑膜炎、痤疮、脓疱病、骨质增生和骨炎（SAPHO）患者的脊椎椎间盘炎的发生率、临床特征以及放射学和骨闪烁显像变化。
本研究为回顾性研究。分析符合SAPHO综合征诊断标准患者的数据，包括临床特征、生物学数据（HLA B抗原）以及骨盆和脊柱X线片。部分病例还进行了脊柱计算机断层扫描（CT）或磁共振成像（MRI）检查。
自1985年以来共诊治25例SAPHO患者，其中8例发生脊椎椎间盘炎。包括5例掌跖脓疱病患者、1例脓疱型银屑病患者、1例寻常型银屑病患者和1例无皮肤病变的慢性复发性多灶性骨髓炎患者。4例患者皮肤病变先于脊椎椎间盘炎出现。4例患者有胸壁受累，仅骨髓炎患者有骶髂关节病变。HLA B27均为阴性，4例患者HLA B8阳性。放射学表现为终板侵蚀性或硬化性重塑伴椎间盘间隙变窄；部分病例还观察到椎体高度降低。这些脊柱病变发生在三个椎体节段。同一患者多个部位发生脊椎椎间盘炎很常见。骨扫描显示摄取轻度增加，CT和MRI有助于检测感染征象如脓肿。T2加权序列或注射钆后常观察到信号增强。对大多数这些患者的随访研究表明，SAPHO综合征中脊椎椎间盘炎的预后良好。
尽管文献中描述较少，但SAPHO综合征中的脊椎椎间盘炎很常见（本系列中占32%）。这些放射学表现与强直性脊柱炎中脊椎椎间盘炎的椎间盘变化相似，从而支持了SAPHO综合征与脊柱关节病之间的关系。然而，这并不意味着这两种情况的致病机制相同。
