Infliximab has become increasingly important in the treatment of SAPHO (
synovitis,
acne, pustulosis,
hyperostosis, and
osteitis) syndrome. There is, however, little experience with this
biological agent, and treatment protocols usually follow the regimens for
spondylarthropathies. We report a patient with a highly unusual and severe clinical presentation of
SAPHO syndrome including widespread bone and
skin disease, and
collagenous colitis.
Infliximab treatment (5 mg/kg) given at weeks 0, 2 and 6 and every 8 weeks thereafter, induced rapid remission of the osteoarticular symptoms, although the skin lesions improved only partially, and after 10 months continuous
therapy with
infliximab a bone scan even uncovered new active bone lesions.
Collagenous colitis is unresponsive to tumour
necrosis factor α (TNFα) blocking agents. This moderate response to
infliximab may indicate that a more aggressive treatment protocol is mandatory. We further believe that remission of osteoarticular complaints should be routinely confirmed by scintigraphic findings to verify treatment response.