is a rare disorder characterized by cutaneous and osteoarticular manifestations that include acne, palmoplantar pustulosis, psoriasis, arthralgia, chest pain, and enthesitis
skin manifestations may be evident at the time of presentation with osteoarticular symptoms, but may have occurred years earlier or may develop later
laboratory evaluation is nonspecific, and magnetic resonance imaging is the modality of choice for evaluating osteoarticular manifestations
bone biopsies are performed to rule out malignancy and infection and primarily exhibit a sterile neutrophilic inflammatory infiltrate early in the disease; late-stage findings include enlarged sclerotic trabeculae with increased osteocytes and marrow fibrosis
generally considered to be a rare condition, possibly due to being underdiagnosed - a prevalence estimate of <1/10,000 is frequently mentioned
SAPHO syndrome may present at any age but is most commonly seen in children and young to middle-aged adults - there may be a female preponderance
bony involvement is most notable at the sternoclavicular joint
anterior chest wall is affected in 63% to 73% of patients with SAPHO syndrome
in early disease, radiography is often normal
early lesions, when present, are osteolytic and may be accompanied by endosteal or periosteal reaction. As the disease progresses, the lesions become sclerotic
pathognomonic bull's head sign can be seen with whole-body scintigraphy and refers to increased radiotracer uptake in the sternoclavicular joints and sternum-the manubrium represents the skull of the bull, and the sternoclavicular joints are the horns (1)
unlike plain radiography, whole-body scintigraphy and whole-body magnetic resonance imaging may identify subclinical disease, although magnetic resonance imaging is preferred because it has similar sensitivity without the radiation exposure
bone biopsy is also necessary to rule out malignancy and osteomyelitis (1)
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