CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Successful Management of Refractory SAPHO Syndrome with Guselkumab-Upadacitinib Combination
Di JIN 1
Mingyuan Xu 1
Xiaoli WANG 2
Qi Ruo Ruo 3
Junting Tang 4
Yeqiang Liu 1
1. Shanghai Skin Diseases Hospital, Shanghai, China
2. Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
3. Tongji University School of Medicine, Shanghai, China
4. Children's Hospital of Shanghai, Shanghai, China
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Abstract
SAPHO syndrome is a rare chronic aseptic inflammatory disorder characterized by the concurrence of osteoarticular inflammation and cutaneous lesions. Single-target therapies have limited efficacy owing to the involvement of multiple inflammatory pathways and their synergistic crosstalk. To the best of our knowledge, this is the first report of refractory SAPHO syndrome achieving clinical remission with the combination of guselkumab (an IL-23 inhibitor) and upadacitinib (a JAK inhibitor). A 38-year-old male with refractory SAPHO experienced complete pain resolution within 2 weeks and significant improvement in cutaneous lesions by 4 weeks post-treatment, with a favorable safety profile observed throughout the follow-up period. We further analyzed the underlying inflammatory mechanisms to provide a therapeutic reference for the management of similar refractory cases
Summary
Keywords
guselkumab, IL-23 inhibitor, JAKinhibitor, SAPHO syndrome, Upadacitinib
Received
13 November 2025
Accepted
27 January 2026
Copyright
© 2026 JIN, Xu, WANG, Ruo, Tang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Junting Tang; Yeqiang Liu
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