ABSTRACT
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome includes both dermatological and rheumatologic symptoms. Being a rare condition, the diagnosis is frequently late. The authors report a case of a 13-year-old boy diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome with unusual severe systemic repercussions. The patient presented with acne conglobata, inability to walk due to pain and weakness and weight loss. Bone scintigraphy was suggestive of sacroiliitis, and lumbar spine x-ray showed signs of hyperostosis. His clinical state improved after treatment with nonsteroidal anti-inflammatory drugs, methotrexate, clindamycin, and isotretinoin. A review of the clinical aspects of this syndrome is presented, emphasizing how this underdiagnosed syndrome can lead to severe weight loss and significant functional and psychological impairment at an early age.
Subject(s)
Acquired Hyperostosis Syndrome/diagnosis , Acquired Hyperostosis Syndrome/drug therapy , Delayed Diagnosis , Multimodal Imaging/methods , Adolescent , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Clindamycin/administration & dosage , Drug Therapy, Combination , Follow-Up Studies , Humans , Isotretinoin/administration & dosage , Male , Methotrexate/administration & dosage , Positron-Emission Tomography/methods , Rare Diseases , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
INTRODUCTION: Management of adolescent obesity in clinical practice has been usually centered on the promotion of healthy eating and an active lifestyle, with a weak evidence base. In search of creative and more effective interventions, our objective was to evaluate the immediate and follow-up effectiveness of a residential camp program for obese adolescents. METHODS: A total of 28 obese adolescents (15 girls), mean age 13.3±1.7 years and body mass index (BMI) 30.3±5.4 kg/m2, who were attending a tertiary health unit, enrolled in a 2-week camp. The activities were prepared and supervised by different specialists. All adolescents were assessed for anthropometric and psychosocial variables including body image, self-esteem, quality of life and depressive symptoms. Evaluations were conducted on the first and last day of the camp and at 6 months' follow-up. The effect of treatment was analyzed using analysis of variance (ANOVA) mixed models. RESULTS: At the end of the camp, weight was reduced by -2.7±1.2%, BMI by -0.8±0.4 units and waist circumference by -2.8±9.8 cm. A reduction in depressive symptoms was identified, with greater reductions in BMI associated with a more significant improvement in depressive symptoms. At the 6 months' follow-up only girls maintained BMI reduction, with boys having increased their BMI. DISCUSSION: In the short-term the camp was effective in reducing BMI and improving depressive symptoms. Only girls were able to proceed with BMI reduction at 6 months. These gender differences should be further explored. Ongoing research is examining the maintenance of these improvements.
