A Case of SAPHO Syndrome Presenting as Isolated Iliitis and Spondylitis
Bibliographic record
Abstract
To the Editor: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome has a variable presentation and it is now believed that a number of previously described entities are cases of SAPHO. These include chronic recurrent multifocal osteomyelitis (CRMO) and pustulotic arthro-osteitis1. We describe a case of SAPHO presenting with iliitis and pyoderma gangrenosum as the sole manifestations. A 39-year-old man was reviewed in the rheumatology outpatients department. He gave a history of episodic pain in both hips and his lower back since the age of 18 years. He had previously been diagnosed with HLA-B27-negative spondyloarthropathy at another center and had had a left hip replacement at the age of 22 years for secondary left hip osteoarthritis, and subsequently a revision of this at the age of 36 years when he fractured his left femur in a fall. He had developed a pyoderma gangrenosum at age 38 years. His clinical history and laboratory, radiological, and pathological investigations were reviewed. He had had persistently elevated inflammatory markers over the years, his latest erythrocyte sedimentation rate was 76 mm/h, C-reactive protein 73 mg/l, hemoglobin 10.2 g/dl, and platelets 596 × 109 … Address correspondence to Dr. Conway; E-mail: drrichardconway{at}gmail.com
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.007 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".