**Author details**

confused with a tumor (signs mainly observed at clavicular level), etc. Recurrent chronic multifocal osteomyelitis could cause permanent bone deformities, irregularities in limb length,

114 Anatomy, Posture, Prevalence, Pain, Treatment and Interventions of Musculoskeletal Disorders

With a little-known entity with few studies, this treatment is not protocolized [15] (**Table 5**). Nonsteroidal anti-inflammatory drugs (NSAIDs), sulfasalazine, systemic corticosteroids, colchicine, methotrexate, and antibiotics such as tetracyclines have been used with varying results. NSAIDs and analgesics are used as a symptomatic treatment of disease. There is no NSAID that has shown to be more effective than other. Almost all patients receive NSAIDs, obtaining a good result, but due to recurrence, loss of efficacy, or progression of disease, it is necessary

As we have said before, it is believed that this disease might have an infectious origin, mainly *Propionibacterium acnes*, so several antibiotics have been used, although they have not been proved to be really effective. Tetracyclines have been shown to be effective in controlling

Immunosuppressants, such as sulfasalazine or methotrexate, have been used in cases resistant to NSAIDs [17] and antibiotics, and although they have shown improvement in some

The use of bisphosphonates has been described as effective, although the majority of cases in which it has been used have been endovenous. Bisphosphonates are synthetic analogs of pyrophosphate; their function is to inhibit bone resorption by altering the function and metabolism of osteoclasts. Due to these properties, they have been used in treatment of primary and secondary osteoporosis, Paget's disease, bone metastasis, and disorders of bone

Pamidronate and zoledronic acid have been used. Pamidronate has been used at a dose of 60 mg/day IV in a single dose, during a very short cycle of days in a row or repeating the dose several months later [19]. In most cases an improvement in pain and in the evolution of

> – Antibiotics – Sulfasalazine – Methotrexate – Leflunomide – Bisphosphonates – TNF antagonists

patients, results have not been conclusive, and there are studies in this regard.

**Symptomatic Modifier of disease**

and growth problems.

to establish other treatments.

severe forms of acne [16].

metabolism [18].

– Analgesics – NSAIDs – Glucocorticoids – Calcitonin

**Table 5.** SAPHO syndrome treatment.

**9. Treatment**

José Ángel López Díaz<sup>1</sup> \*, Luis Geniz Rubio<sup>2</sup> and Sara Alcántara Luna3

