Efficacy of tofacitinib in synovitis, acne, pustulosis, hyperostosis and osteitis syndrome: a pilot study with clinical and MRI evaluation

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a chronic inflammatory disease that severely affects patients’ quality of life. Therapies including tumour necrosis factor inhibitors (TNFi) and bisphosphonates (BPs) yield variable efficacy.1 Tofacitinib, a Janus kinase inhibitor, may suppress osteoclast-mediated joint damage by inhibiting the RANKL pathway.2 A previous study proved the safety and efficacy of tofacitinib in psoriatic arthritis resistant to TNFi over 3 months.3 Additionally, we reported a case where tofacitinib in combination with methotrexate and Tripterygium wilfordii Hook was effective in SAPHO syndrome.4 To further explore tofacitinib efficacy in SAPHO syndrome, we retrospectively reviewed the medical records of patients enrolled from January 2019 to December 2019 in our dynamic cohort of SAPHO syndrome.5 Patients were included if they: (1) received tofacitinib without concomitant TNFi, BPs, or other disease-modifying antirheumatic drugs and (2) had complete clinical data and MRI of SAPHO-related lesions with pain before (within 1 week) and during tofacitinib treatment. The pain visual analogue scale (VAS) score and …