Misdiagnosis analysis of SAPHO syndrome in elderly women with bone pain as the chief complaint

YU Xian; ZENG Shaojing; MENG Jiaojiao; ZHOU Yue; CHEN Shuchun; REN Luping; LYU Xiuqin

doi:10.3969/j.issn.1002-3429.2026.04.002

Abstract：Objective To investigate the clinical characteristics of elderly female patients with diabetes mellitus(DM)complicated by synovitis,acne,pustulosis,hyperostosis,osteitis(SAPHO)syndrome,who presented with bone pain as the chief complaint.Methods The clinical data of one elderly female patient with SAPHO syndrome,who was admitted in 2023 and had been misdiagnosed as other diseases previously,was retrospectively analyzed.Results An elderly patient was admitted to the hospital primarily due to generalized pain lasting for 14 years,which had worsened over the past month.The patient had been repeatedly misdiagnosed with cervical spondylosis,lumbar spondylosis,osteoporosis,osteoarthritis,gout,diabetic peripheral neuropathy,and other conditions,but symptomatic treatment yielded no satisfactory results.After admission,based on a comprehensive analysis of the patient's clinical manifestations(including bone pain and pustular rash)and whole-body bone scintigraphy findings showing tracer concentration at the bilateral first costosternal junctions and sternal angle,the diagnosis of SAPHO syndrome was confirmed.The duration of misdiagnosis was 14 years.Following the initiation of immunomodulatory therapy after confirmation,the patient's condition improved significantly.During the follow-up period,the patient's pain-related symptoms were significantly improved compared with the baseline status.Conclusion SAPHO syndrome has diverse etiologies and is prone to missed diagnosis and misdiagnosis,requiring careful clinical differentiation.The disease lacks specific clinical manifestations,and early symptoms are often atypical.Enhancing the understanding of this disease and raising clinical vigilance are conducive to early diagnosis and prompt treatment.