Peking Union Hospital: After tonsilization, the symptoms of bone pain and rash in patients with SAPHO patients are improved

Have you ever seen such a disease? When the condition is severe, the patient's hands and feet are full of pustules, and you can only wear gloves when you go out. Patient's bone pain cone is piercing, and often can only walk by wheelchair. This is a chronic inflammatory disease called SAPHO syndrome. It is a type of rheumatism and immune. The incidence rate is less than 1/10000. So far, there is no SAPHO syndrome treatment guide in the world, and experienced symptomatic treatment is mainly used in clinical practice. The disease control methods are very limited. Based on the comprehensive diagnosis and treatment of multi -disciplinary comprehensive diagnosis and treatment, the breakthrough discovery and clinical verification of tonsilization may be effective for SAPHO syndrome, and the symptoms of bone pain and rash in patients with postoperative patients can be significantly improved. So far, more than 200 patients have undergone tonsillment surgery, with an average follow -up of 12 months. The relief rates of rash and bone pain have reached 62%and 77%, respectively.

SAPHO syndrome is a group of special clinical syndrome that affects bone joints and skin. The cause and pathogenesis are not clear. Infection is one of the trigger factors that are considered possible. And disease. The pathogens that may participate in the pathogenic are: Poisacia, Staphylococcus aureus, Plasma, etc. During the inflammation of the Sapho syndrome, the number of peripheral blood TH17 cells peripheralized in patients increased, and inflammatory cytokines, such as IL-17, IL-8, and TNF-α.

Due to the unknown cause and pathogenesis, the incidence is low, and the lack of large -scale clinical studies, the treatment experience of SAPHO syndrome is mostly from case reports and a single center sample research. There are no guidelines and consensus as a reference. Deputy Chief Physician Zhao Lidan of the Department of Rheumatology and Immunology introduced that for patients with mild patients, non -steroidal anthahow is often used as symptomatic treatment for symptomatic treatment to reduce patient pain. For patients with medium -weight, non -steroidal anti -inflammatory drugs are often not satisfactory. Clinically, the second line of glycoplasitic hormone, antibiotics, immunosuppressants, and biposcinosate will be tried. In recent years, clinical clinical has also tried to use the treatment of biological agents and small molecules targeted drugs for SAPHO syndrome, and has achieved significant effects among patients. However, drugs are more expensive, increasing the economic burden of patients, and also increasing the risk of infection.

Some refractory SAPHO syndrome patients are still difficult to work after trying various treatments, or although initial treatment is effective, it is rapidly resistant to drugs, the symptoms continue to exist, the quality of life is severely reduced, and even the pessimism of patients. Clinical examinations have found that these patients are often accompanied by tonsillitis, and there is a continuous swelling or even pus in tonsils, which meets the indicators of tonsils. Therefore, the Department of Rheumatology often referred these patients to the Department of ONES and throat and received further treatment.

▲ SAPHO syndrome patients with swollen tonsils (data chart)

Deputy Chief Physician Wang Yiyi has been engaged in clinical and scientific research for many years. He has accumulated rich experience in the diagnosis and treatment of otolaryngology and difficulty in systemic diseases related to systemic diseases. She introduced that the academic community has proven that tonsilization can effectively treat palmist pustular diseases and psoriasis. SAPHO syndrome's skin lesions are similar to the palmista pustular disease and psoriasis, and may have a similar pathological mechanism. Therefore, it is possible to relieve the symptoms of SAPHO syndrome through tonsillial resection.

Wang Yi's team reviewed sexual analysis of 44 cases of complete data and the cure SAPHO syndrome with recurrent seizures with tonsillitis and received tonsilization. Patients were discontinued after surgery. After 12 months of follow -up, the patient's rash and bone pain relief rates reached 62%and 77%, respectively. Three patients insisted on follow -up for two years, and the rash and bone pain were completely relieved and did not relapse.

A small number of patients with skin lesions (21%) and bone pain (13%) exacerbated within one month after surgery. It is speculated that it may be because the tonsils are pulled during the operation, which causes the lymphocyte activated in the tonsil to escape into the peripheral blood circulation, causing the target to target the target The temporary worsening of organ injury. The postoperative patient's resistance weakened and the immune regulation ability also decreased, which may also be one of the factors for the worsening condition. But this part of the patient's rash and bone pain is often gradually reduced after one month. As far as the current observation is concerned, the longer the tonsilization time, the better the effect of the patient recovery.

"Some refractory SAPHO syndrome patients are not obvious after removing the tonsils in the outer hospital. I will comprehensively observe the patient's upper respiratory tract, including the gland samples of the nasopharynx. In order to achieve better clinical effects. "Wang Yi introduced.

▲ In 2021, as a member of the Central Organization Department and the Central Committee of the Communist Party Central Aid, Wang Yi (left) has completed more than 70 tonsills in the SAPHO syndrome patients in Qinghai.

At present, Sapho syndrome has neither mature treatment guide nor exclusive special effects. To this end, the Beijing Union Hospital established the SAPHO syndrome patient group. In diagnosis and treatment and long -term follow -up, pay attention to and understand the patient's condition changes at any time, and give life guidance. For the difficult situation of new issues, consult relevant documents, find the latest evidence, pass the latest evidence, pass the latest evidence, pass the latest evidence, pass the latest evidence, pass the latest evidence, pass the latest evidence, pass the latest evidence, and pass the latest evidence. Disciplinary cases of multiple disciplines, and try their best to help patients solve problems.

(Guangming Daily All -Media Reporter Cui Xingyi Correspondent Qian Zhizhu)

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