SAPHO syndrome is an entity that associates musculoskeletal disorders with dermatological alterations. The most characteristic clinical manifestation of the SAPHO syndrome is pain in the anterior chest wall, due to the involvement of the sternoclavicular and costochondral joints. The etiology of SAPHO syndrome is unclear. The treatment is not protocolized. Nonsteroidal anti-inflammatory drugs (NSAIDs), sulfasalazine, systemic corticosteroids, colchicine, methotrexate, and antibiotics such as tetracyclines have been used with varying results. The use of bisphosphonates has been described as effective. Biological therapy also seems to be effective. More trials with these drugs are needed to evaluate their effectiveness against this disease and to establish the number of doses, the amount, and the interval between them. In this chapter we describe the case of a patient with SAPHO syndrome who had a good response to oral alendronate.
Urticaria is a common process. The true incidence is not known; it is believed that between 15 and 25% of the population may suffer at some point in his life. Acute urticaria has a prevalence of 20% and the chronic form 0.5–1%. Urticaria is a disease that affects the skin and mucosa, characterized by the presence of hives. It occurs as a localized intracutaneous edema circled and an area of redness (erythema), which is typically itchy. There are histaminergic foods and drugs that worsen the prognosis of the disease. Foods which rely on aging to taste nice are always presumed to be high in histamine (chocolate, yogurt, seafood, strawberries, etc.) and drugs like nonsteroidal anti-inflammatory drugs. For diagnosis we have several tools (urticarial activity score, chronic urticaria quality-of-life questionnaire (CU-Q2oL), urticaria control test, etc., among which the most useful, simple, and cost-effective is the clinic history). The treatment of choice are antihistamines, from a daily tablet up to four tablets as maximum dose. Corticosteroids are excluded to exacerbations and must be prescribed in short guideline (maximum 10 days) without progressive decrease. Severe forms of urticaria resistant to treatment with antihistamines are treated with biological agents like omalizumab.
Part of the book: Topics in Primary Care Medicine