Overview
Acquired hyperostosis syndrome (AHS), also known as sternocostoclavicular hyperostosis, pustulotic arthro-osteitis, or SAPHO syndrome, is a chronic inflammatory disorder characterized by localized bone hyperostosis, often involving the sternocostoclavicular region, and sometimes associated with skin conditions like palmoplantar pustulosis, psoriasis, or severe acne 12.Diagnosis
Key Sites of Involvement: Predominantly sternocostoclavicular region (80% of cases), with involvement of spine, pelvis, and appendicular skeleton less frequently 2.
Imaging Findings: Radiographic appearance includes increased bone density with blurred margins; scintigraphy shows intense tracer accretion 2.
Scintigraphy Utility: Bone scintigraphy is more sensitive than conventional radiomorphological imaging, particularly useful for detecting focal hyperactivities at the anterior ends of ribs and sternocostal joint involvement 1.Management
Symptomatic Treatment: Therapeutic approaches are primarily symptomatic 2.
Anti-inflammatory Radiation Therapy: Long-lasting improvement reported in some cases 2.Special Populations
Comorbidities: AHS often coexists with palmoplantar pustulosis, psoriasis, or severe acne, which may influence management strategies 2.Key Recommendations
Utilize bone scintigraphy for enhanced diagnostic sensitivity in suspected AHS cases (Evidence: Moderate 1).
Consider symptomatic and anti-inflammatory treatments, with percutaneous radiation therapy as an option for achieving long-term improvement (Evidence: Weak 2).
Evaluate for associated dermatological conditions like psoriasis or palmoplantar pustulosis, as they may guide comprehensive management (Evidence: Expert opinion 2).References
1 Dihlmann W, Dihlmann SW, Hering L. Acquired hyperostosis syndrome--AHYS--(sternocostoclavicular hyperostosis, pustulotic arthro-osteitis, SAPHO-syndrome): bone scintigraphy of the anterior chest wall. Clinical rheumatology 1997. link
2 Dihlmann W, Schnabel A, Gross WL. The acquired hyperostosis syndrome: a little known skeletal disorder with distinctive radiological and clinical features. The Clinical investigator 1993. link