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SAPHO syndrome — SCE Rheumatology MCQ

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EasySpondyloarthropathiesSAPHO syndromeSCE Rheumatology

A 63-year-old man has anterior chest wall pain and pustular skin lesions. Examination shows sternoclavicular tenderness is present. Investigations show bone scan shows uptake at the sternoclavicular region. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: B — SAPHO syndrome

SAPHO syndrome is the best answer because the pattern described is most consistent with SAPHO syndrome, including the distribution of symptoms and the targeted investigation results. Neonatal lupus risk is a plausible distractor, but it does not account for the key discriminator in the stem. Granulomatosis with polyangiitis and Rheumatoid arthritis would be more appropriate in a different clinical pattern or at another point in the pathway, while Diffuse idiopathic skeletal hyperostosis is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: NICE NG65; EULAR/ASAS axial spondyloarthritis recommendations; BNF