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Among those with dermatological manifestations, 54.2% (84/155) patients had dermatological manifestations before osteoarticular symptoms, whereas 18.7% (29/155) and 27.1% (42/155) had dermatological manifestations after and at the same time as osteoarticular symptoms, respectively.

Clinical features of osteoarticular symptoms were insidious and variable, from slight to severe inflammatory pain in different locations with or without swelling.

One hundred and sixty-four patients suffered from pain in the anterior chest wall, followed by spine (12 in the cervical region, 36 in the thoracic region and 111 in the lumbosacral region) and peripheral joint (136 patients) involvement. One hundred and thirty-one (79.9%), 85 (51.8%), 100 (61%) and 54 (32.9%) patients took NSAIDs, CSs, DMARDs and oral bisphosphonates, respectively. SAPHO syndrome is predominant in middle-age women, characterized by dermatological and osteoarticular manifestations with unknown aetiology.

CT scan and bone scintigraphy are useful for diagnosis.

Nowadays, SAPHO syndrome is considered to be a rare disease.

Only 7.3% of patients had a low titre of ANA, and 1.2 and 2.4% were RF and HLA-B27 positive, respectively. CT scans of the whole spinal column with multiplanar reconstructions were performed in 53 patients at the radiology department in our hospital.

The disorders of the osteoarticular involvement observed on CT images are shown in Table 2.

The ACW, which consists of the sternocostal joint, sternoclavicular joint and manubriosternal joint, is the most common target area involved in SAPHO syndrome, with 90.6% (48/53) of patients affected.

One hundred and sixty-four patients (111 women and 53 men) who met the inclusion criteria were recruited to our cohort.

The mean age of the patients was 40.71 years and the mean age at onset of symptoms was 36.84 years. Interestingly, most of the patients were misdiagnosed with other diseases, such as costochondritis and AS, when they first presented to the doctors (Among them, 155 patients had both osteoarticular symptoms and dermatological manifestations, whereas nine patients had only osteoarticular symptoms without skin involvement.

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Since then, more than 50 different names have been used to describe the combination of osteoarticular and dermatological manifestations, such as pustulotic arthro-osteitis, sternocostoclavicular hyperostosis, acne-associated spondyloarthropathy and chronic recurrent multifocal osteomyelitis (CRMO) [1].

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