{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T11:43:15Z","timestamp":1788090195270,"version":"build-2803163510"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>SAPHO syndrome is a rare autoinflammatory disorder with osteoarticular and cutaneous involvement. Paradoxical skin lesions have been reported during treatment with tumor necrosis factor-\u03b1 (TNF-\u03b1) inhibitors. We describe a 42-year-old man with a 6-year history of SAPHO syndrome presenting with chronic sternoclavicular and lumbosacral pain and sterile pustules on the lower extremities. Conventional therapy with etoricoxib and methotrexate improved musculoskeletal symptoms but failed to resolve skin lesions, while adalimumab treatment led to progressive worsening of cutaneous manifestations. Following a switch to upadacitinib (15 mg once daily), rapid improvement of skin lesions and sustained control of musculoskeletal symptoms were achieved without adverse events. This case suggests that Janus kinase inhibition may represent a therapeutic option for TNF-\u03b1 inhibitor\u2013induced paradoxical skin lesions in SAPHO syndrome.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1818853","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:43:34Z","timestamp":1780551814000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Rapid improvement with upadacitinib in a case of paradoxical skin lesions associated with SAPHO syndrome"],"prefix":"10.3389","volume":"17","author":[{"given":"Jinwan","family":"Du","sequence":"first","affiliation":[{"name":"Liang Jiang Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yirou","family":"Gao","sequence":"additional","affiliation":[{"name":"School of Chinese Medicine, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaohui","family":"Geng","sequence":"additional","affiliation":[{"name":"School of Life Science, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Li","sequence":"additional","affiliation":[{"name":"Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shike","family":"Shang","sequence":"additional","affiliation":[{"name":"Liang Jiang Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2010.04.003","article-title":"Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: clinical features and possible immunopathogenesis","volume":"40","author":"Collamer","year":"2010","journal-title":"Semin Arthritis Rheumatism"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ken185","article-title":"Characterization of the immune response in the synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome","volume":"47","author":"Hurtado-Nedelec","year":"2008","journal-title":"Rheumatology"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-018-4355-0","article-title":"Paradoxical skin lesions induced by anti-TNF-\u03b1 agents in SAPHO syndrome","volume":"38","author":"Li","year":"2018","journal-title":"Clin Rheumatol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.16126","article-title":"Analysis of anti-tumor necrosis factor-induced skin lesions reveals strong T helper 1 activation with some distinct immunological characteristics","volume":"178","author":"Stoffel","year":"2018","journal-title":"Br J Dermatol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s40257-017-0296-7","article-title":"Clinical signs, pathophysiology and management of cutaneous side effects of anti-tumor necrosis factor agents","volume":"18","author":"Segaert","year":"2017","journal-title":"Am J Clin Dermatol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2147\/jir.s353539","article-title":"New Insights in the Treatment of SAPHO Syndrome and Medication Recommendations","volume":"15","author":"Cheng","year":"2022","journal-title":"Journal of Inflammation Research"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.15231","article-title":"Clinical application of JAK inhibitors in SAPHO syndrome","volume":"27","author":"Wu","year":"2024","journal-title":"International J Rheumatic Dis"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-017-0701-5","article-title":"JAK\u2013STAT Signaling as a Target for Inflammatory and Autoimmune Diseases: Current and Future Prospects","volume":"77","author":"Banerjee","year":"2017","journal-title":"Drugs"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.14930","article-title":"JAKi: Can it be used to treat SAPHO syndrome","volume":"27","author":"Yue","year":"2024","journal-title":"International J. Rheumatic Dis"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.14774","article-title":"Novel JAK-1 inhibitor upadacitinib as a possible treatment for refractory SAPHO syndrome: A case report","volume":"26","author":"Ma","year":"2023","journal-title":"International J Rheumatic Dis"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000011149","article-title":"Case report: successful treatment of refractory SAPHO syndrome with the JAK inhibitor tofacitinib","volume":"97","author":"Yang","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.70101","article-title":"JAK inhibitors for treatment of SAPHO syndrome: a systematic review of 72 cases","volume":"7","author":"Fazeli","year":"2025","journal-title":"ACR Open Rheumatol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1038\/nrd.2017.267","article-title":"JAK inhibition as a therapeutic strategy for immune and inflammatory diseases","volume":"17","author":"Schwartz","year":"2017","journal-title":"Nat Rev Drug Discov"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1818853\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:43:35Z","timestamp":1780551815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1818853\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":13,"alternative-id":["10.3389\/fimmu.2026.1818853"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1818853","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]},"article-number":"1818853"}}