[Arthroosteitis pustulosa, spondarthritis hyperostotica pustulo-psoriatica, SAPHO syndrome: clinical experiences and review of the literature].

Pustulotic arthroosteitis is characterized by the association of inflammatory and hyperostotic skeletal changes, primarily of the anterior chest wall, and chronic recurrent skin lesions of the palms and soles known as pustulosis palmaris et plantaris. Since its first description by Sonozaki in 1981 in Japan, it has also been reported by several European authors and become widely accepted as a separate entity within the spectrum of the seronegative spondylarthropathies. In this report, we describe 11 cases seen in our clinic in the years 1985 to 1992. Course and severity of the disease varied greatly among individual patients. In four of them a difference of up to 6 years between the onset of skin and skeletal symptoms were noted. Besides chronic recurrent nonspecific osteomyelitis in two cases, neither an association to other rheumatic or dermatologic diseases nor to HLA-B27 could be found. Corticosteroids, non-steroidal anti-inflammatory drugs, immunosuppressive agents, and antibiotics were all used with uncertain therapeutic success. Based on these data, we suppose that pustulotic arthroosteitis is more common in Germany than previously thought, and has to be considered as an important differential diagnosis of sternoclavicular arthritis. In a review of the available literature, the current opinions on nomenclature, etiology, pathogenesis, and treatment are discussed.