Pamidronate treatment in SAPHO syndrome

Objective. Pamidronate is usually administered because of its antiosteoclastic effects but seems to have anti-inflammatory properties also. SAPHO syndrome is characterized by both increased bone remodeling and inflammatory osteitis, indicating that it may respond favorably to pamidronate’s dual mechanism of action. Patients and methods. We report five cases of SAPHO syndrome refractory to standard treatments. All patients were taking nonsteroidal anti-inflammatory drugs, either alone or in combination with analgesics, glucocorticoids, and/or second-line drugs. We used intravenous pamidronate during exacerbations of the disease. The primary evaluation criterion was the reduction in the visual analog scale (VAS) score for pain, and a response was defined as a greater than 50% reduction. Results. Four of the five patients had a response after 1 week. Two of these four patients still met the response criterion after 3 months. Four of the five patients were able to reduce the dosage of their usual medications. In one patient, pamidronate therapy was associated with an increase in the intervals between exacerbations.