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A 35-year-old woman presented with anterior chest wall pain and palmoplantar pustulosis (PPP). The results of a whole-body bone scan showed that the patient had areas of increased radioactive uptake in bilateral sternoclavicular joints, and showed typical ‘bull’s head’ symptoms (figure 1A). Therefore, she was diagnosed as synovitis, acne, pustulosis, hyperostosis, osteitis(SAPHO) syndrome. After 6 months of adalimumab (40 mg every 2 weeks) treatment, the patient’s symptoms were significantly relieved, and then the drug was discontinued. However, 1 year later, the patient recurred with bone pain and rash (online supplemental figure 1) as well as sausage finger symptoms (figure 1B and D). Therefore, the patient’s symptoms indicated that she might suffer from SAPHO combined with psoriatic arthritis (PsA), and sausage finger was an important clinical manifestation. Interleukin-17 treatment (150 mg once a week for the first 5 weeks, then once every 4 weeks) significantly relieved the patient’s bone pain and skin lesions (online supplemental figure 2), and the toes returned to normal (figure 1C). SAPHO syndrome is characterised by PPP and anterior chest wall pain, with a ‘bull’s head’ sign on bone scan; skin lesions present with a psoriasiform rash, suggesting an overlap between SAPHO syndrome and PsA.1 This case is the first report of SAPHO syndrome and PsA with sausage fingers. There is an overlap between SAPHO syndrome and PsA, and adalimumab treatment may take longer duration to avoid sudden drug withdrawal leading to recurrence of the disease and the onset of sausage finger.
Supplemental material
Bone scintigraphy and sausage finger images of the patient with SAPHO syndrome. (A) Technetium 99m-methyl diphosphonate whole body bone scintigraphy showed that abnormal accumulation of radioactivity in bilateral sternoclavicular joints, left sacroiliac joints, bilateral greater trochanters and bilateral ischia. (B) Before interleukin (IL)-17 treatment, the patient’s toes showed sausage finger symptoms. (C) After IL-17 treatment, the symptoms of sausage fingers on the feet of patients were significantly improved. (D) Ultrasound of the foot joints. Red arrow represents localised synovial thickening of the joint.
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Ethics approval
This work was approved by the medical ethics committee of Fangshan Hospital of Beijing University of Chinese Medicine with the following reference numbers: FZJ JS-2021-002. Participants gave informed consent to participate in the study before taking part.
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Footnotes
Contributors CL designed this study. HJ provided efforts for manuscript writing. LL and ZL was responsible for data collection. All authors approved the final manuscript.
Funding This work was supported by the National Natural Science Foundation of China (grant number: 82074246).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.