Long-term effectiveness of the combination of iguratimod and alendronate in SAPHO syndrome: a prospective cohort study.

OBJECTIVE

To evaluate the long-term effectiveness of the combination of Iguratimod (IGU) and Alendronate for patients with Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) syndrome.

METHODS

A prospective cohort study was conducted on patients diagnosed with SAPHO syndrome at Peking University Third Hospital and Beijing Jishuitan Hospital from 2017 to 2024. The initial treatment regimen comprised a combination of IGU and Alendronate. Patients who were followed up for >2 years were included in our study. We collected demographic data, clinical symptoms, recurrence rates, treatment duration and overall response to therapy for all patients.

RESULTS

Seventeen patients were recruited for our cohort, with a median (IQR) follow-up of 2.91 (2.34) years. The mean treatment duration was 39.10 months. Among patients with osteoarticular involvement (17/17), 35.30% (6/17) achieved complete improvement without any recurrence, 11.76% (2/17) showed partial improvement and 52.94% (9/17) experienced intermittent flares. For patients with skin involvement (11/17), 63.64% (7/11) achieved complete improvement, 27.27% (3/11) had partial improvement and 9.09% (1/11) experienced intermittent recurrence. Notably, 88.26% (15/17) regained complete independence and resumed work, and 94.12% (16/17) experienced alleviation of anxiety and insomnia. By the end of last follow-up, 52.94% (9/17) had ceased treatment after a mean duration of 25.22 months and 22.22% (2/9) of them encountered recurrence.

CONCLUSION

The combination of IGU and Alendronate as initial treatment may be effective for the long-term management of SAPHO syndrome. ∼41% of the patients could discontinue treatment after more than two years without recurrence.