[SAPHO-Synovitis, acne, pustulosis, hyperosteosis, osteitis].

Abstract

Clinical/methodological problem: SAPHO (synovitis, acne, pustulosis, hyperosteosis, osteitis) is a rare rheumatological disease characterized by combined osteoarticular and dermatological manifestations. Due to the nonspecific clinical presentation and skin findings, which may occur nonsimultaneously to the osteoarticular manifestations, diagnosis is usually delayed. Imaging plays a crucial role in identifying characteristic changes and distinguishing from differential diagnoses.

Standard radiological procedures: X‑ray diagnostics, computed tomography (CT), and skeletal scintigraphy are established procedures for detecting typical osseous changes such as hyperostosis, sclerosis, and osteitis. Magnetic resonance imaging (MRI) allows early detection of inflammatory bone and soft tissue changes.

Methodological innovations/performance: Whole-body MRI is used for the systematic detection of multifocal lesions. Compared to scintigraphy, MRI offers the possibility of differentiating between active and inactive lesions without the use of ionizing radiation.

Achievements: Whole-body MRI is an important addition to conventional methods, especially for the early and noninvasive assessment of active disease processes and is an integral part of diagnostic evaluation.

Recommendation for practice: In cases where the differential diagnosis is unclear, histological evaluation of the bone lesions must be performed.