Abstract Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic autoinflammatory disease characterized primarily by cutaneous manifestations and osteoarticular involvement, and remains challenging to treat. Its pathogenesis is not fully understood and may involve genetic, immunological and environmental factors. Environmental factors play a significant role in autoimmune diseases such as asthma, urticaria, and rheumatic heart disease.