Приведен обзор данных о своеобразном редком ревматологическом синдроме – остеоартропатии передней части грудной клетки (ОАПГК), для которой характерно воспалительное поражение костных, суставных и связочных структур, формирующих каркас передней части грудной клетки. ОАПГК является частью хронического небактериального остеомиелита (ХНО), который встречается как у взрослых, так и у детей и в ряде случаев может быть следствием генетических мутаций. Основу патологии составляет остеит (очаговое поражение грудины, ключиц и ребер с тенденцией к деструкции преимущественно суставных отделов и развитию пролиферации костной ткани – гиперостоз), артрит с возможным исходом в анкилоз, а также энтезит и лигаментит с развитием эктопической оссификации пораженных мягких тканей. У многих больных наблюдаются также однотипные дерматологические изменения: чаще всего ладонно-подошвенный пустулез, а иногда инверсные акне (гнойный гидраденит и шаровидные акне). В статье описаны характерные рентгенологические, сцинтиграфические и МРТ-изменения опорно-двигательного аппарата. Разбирается классификация ХНО. Указываются заболевания, которые могут имитировать ОАПГК. Сообщается о методах лечения ХНО, в том числе бисфосфонатах и биологических препаратах.
This article reviews the data on a unique, rare rheumatologic syndrome – osteoarthropathy of the anterior thorax (OAAT), characterized by inflammation of the bone, joint, and ligament structures that form the skeleton of the anterior thorax. OAAT is part of chronic non-bacterial osteomyelitis, which occurs in adults and children and may be due to genetic mutations. The basis of this disorder is osteitis (focal lesion of the sternum, clavicles, and ribs with a tendency to the destruction of mainly articular parts and development of bone proliferation – hyperostosis), arthritis with possible ankylosis development, as well as enthesitis and ligamentitis with ectopic ossification of affected soft tissues. Many patients also show similar dermatological changes: commonly palmar and plantar pustulosis and sometimes acne inversa (purulent hidradenitis and globular acne). The article describes typical radiological, scintigraphic, and MRI changes in the musculoskeletal system. The classification of chronic non-bacterial osteomyelitis is reviewed. Diseases that may mimic OAAT are listed. Treatments for chronic non-bacterial osteomyelitis, including bisphosphonates and biologics, are reported.
Keywords: osteoarthropathy of the anterior thorax, chronic non-bacterial osteomyelitis, pustular osteoarthropathy, pustular arthro-osteitis, SAPHO syndrome, palmar and plantar pustulosis
1. Тюхова Е.Ю., Бочкова А.Г., Братыгина Е.А., Бунчук Н.В. Синдром SAPHO: описание двух наблюдений. Научно-практическая ревматология. 2009;47(5):77-82 [Tiukhova EIu, Bochkova AG, Bratygina EA, Bunchuk NV. Sindrom SAPHO: opisanie dvukh nabliudenii. Nauchno-prakticheskaia revmatologiia. 2009;47(5):77-82 (in Russian)].
2. Jurik AG, Klicman RF, Simoni P, et al. SAPHO and CRMO: The Value of Imaging. Semin Musculoskelet Radiol. 2018;22(2):207-24. DOI:10.1055/s-0038-1639469
3. Sonozaki H, Mitsui H, Miyanaga Y, et al. Clinical features of 53 cases with pustulotic arthro-osteitis. Ann Rheum Dis. 1981;40(6):547-53. DOI:10.1136/ard.40.6.547
4. Bjorkstén B, Boquist L. Histopathological aspects of chronic recurrent multifocal osteomyelitis. J Bone Joint Surg Br. 1980;62(3):376-80. DOI:10.1302/0301-620X.62B3.7410472
5. Reith JD, Bauer TW, Schils JP. Osseous manifestations of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. Am J Surg Pathol. 1996;20(11):1368-77. DOI:10.1097/00000478-199611000-00008
6. Hedrich CM, Morbach H, Reiser C, Girschick HJ. New insights into adult and paediatric chronic non-bacterial osteomyelitis CNO. Curr Rheumatol Rep. 2020;22(9):52. DOI:10.1007/s11926-020-00928-1
7. Ramautar AI, Appelman-Dijkstra NM, Lakerveld S, et al. Chronic nonbacterial osteomyelitis of the sternocostoclavicular region in adults: a single-center Dutch cohort study. JBMR Plus. 2021;5(5):e10490. DOI:10.1002/jbm4.10490
8. Nguyen MT, Borchers A, Selmi C, et al. The SAPHO syndrome. Semin Arthritis Rheum. 2012;42(3):254-65. DOI:10.1016/j.semarthrit.2012.05.006
9. Leerling A, Dekkers O, Appelman-Dijkstra N, Winter E. Clinical and therapeutic diversity in adult chronic nonbacterial osteomyelitis (CNO) of the sternocostoclavicular region: a meta-analysis. Rheumatology (Oxford). 2022;61(5):1810-8. DOI:10.1093/rheumatology/keac443
10. Liu S, Tang M, Cao Y, Li C. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: review and update. Ther Adv Musculoskelet Dis. 2020;12:1759720X20912865. DOI:10.1177/1759720X20912865
11. Yu M, Cao Y, Li J, et al. Anterior chest wall in SAPHO syndrome: magnetic resonance imaging findings. Arthritis Res Ther. 2020;22(1):216. DOI:10.1186/s13075-020-02309-6
12. Arnoldi AP, Schlett CL, Douis H, et al. Whole-body MRI in patients with non-bacterial osteitis: radiological findings and correlation with clinical data. Eur Radiol. 2017;27(06):2391-9.
13. Freyschmidt J, Sternberg A. The bullhead sign: scintigraphic pattern of sternocostoclavicular hyperostosis and pustulotic arthroosteitis. Eur Radiol. 1998;8(05):807-2.
14. Mandell GA, Contreras SJ, Conard K, et al. Bone scintigraphy in the detection of chronic recurrent multifocal osteomyelitis. J Nucl Med. 1998;39(10):1778-83.
15. Sun X, Li C, Cao Y, et al. F-18 FDG PET/CT in 26 patients with SAPHO syndrome: a new vision of clinical and bone scintigraphy correlation. J Orthop Surg Res. 2018;13(1):120. DOI:10.1186/s13018-018-0795-0
16. Voit AM, Arnoldi AP, Douis H, et al. Whole-body magnetic resonance imaging in chronic recurrent multifocal osteomyelitis: clinical long term assessment may underestimate activity. J Rheumatol. 2015;42(08):1455-62.
17. Earwaker JW, Cotten A. SAPHO: syndrome or concept? Imaging findings. Skeletal Radiol. 2003;32(06):311-27.
18. Sonozaki H, Azuma A, Okai K, et al. Clinical features of 22 cases with “inter-sterno-costo-clavicular ossification”. A new rheumatic syndrome. Arch Orthop Trauma Surg (1978). 1979;95(1-2):13-22. DOI:10.1007/BF00379164
19. Chigira M, Shimizu T. Computed tomographic appearances of sternocostoclavicular hyperostosis. Skeletal Radiol. 1989;18(5):347-52. DOI:10.1007/BF00361423
20. Yamamoto T, Hiraiwa T, Tobita R, et al. Characteristics of Japanese patients with pustulotic arthro-osteitis associated with palmoplantar pustulosis: a multicenter study. Int J Dermatol. 2020;59(4):441-4. DOI:10.1111/ijd.14788
21. Mejjad O, Daragon A, Louvel JP, et al. Osteoarticular manifestations of pustulosis palmaris et plantaris and of psoriasis: two distinct entities. Ann Rheum Dis. 1996;55(3):177-80. DOI:10.1136/ard.55.3.177
22. Duffin KC, Bachelez H, Mease PJ, et al. Pustular Psoriasis and Associated Musculoskeletal Disorders. J Rheumatol Suppl. 2021;97:34-8. DOI:10.3899/jrheum.201673
23. Giedion A, Holthusen W, Masel LF, Vischer D. Subacute and chronic “symmetrical” osteomyelitis. Ann Radiol (Paris). 1972;15(3):329-42. Multiple languages. PMID: 4403064.
24. Takeuchi S, Hanakita J, Takahashi T, et al. Destructive spondylodiscitis associated with SAPHO syndrome: A case report and literature review. Surg Neurol Int. 2022;13:345. DOI:10.25259/SNI_626_2022
25. Chamot AM, Benhamou CL, Kahn MF, et al. Acnepustulosis-hyperostosis-osteitis syndrome. Results of a national survey. 85 cases. Rev Rhum Mal Osteoartic. 1989;54:187-96.
26. Efthimiou P, Petryna O, Nakasato P, Kontzias A. New insights on multigenic autoinflammatory diseases. Ther Adv Musculoskelet Dis. 2022;14:1759720X221117880. DOI:10.1177/1759720X221117880
27. Ferguson PJ, El-Shanti H. Majeed Syndrome: A Review of the Clinical, Genetic and Immunologic Features. Biomolecules. 2021;11(3):367. DOI:10.3390/biom11030367
28. Li Y, Yu M, Lu M. Pathophysiology, clinical manifestations and current management of IL-1 mediated monogenic systemic autoinflammatory diseases, a literature review. Pediatr Rheumatol Online J. 2022;20(1):90. DOI:10.1186/s12969-022-00728-0
29. Koryllou A, Mejbri M, Theodoropoulou K, et al. Chronic Nonbacterial Osteomyelitis in Children. Children (Basel). 2021;8(7):551. DOI:10.3390/children8070551
30. Theumann NH, So A, Mouhsine E, et al. SAPHO syndrome masquerading as metastatic bone disease. Australas Radiol. 2005;49(5):418-21. DOI:10.1111/j.1440-1673.2005.01475.x
31. Jurik AG. Anterior chest wall involvement in seronegative arthritides. A study of the frequency of changes at radiography. Rheumatol Int. 1992;12(1):7-11. DOI:10.1007/BF00246870
32. Weber U, Lambert RG, Rufibach K, et al. Anterior chest wall inflammation by whole-body magnetic resonance imaging in patients with spondyloarthritis: lack of association between clinical and imaging findings in a cross-sectional study. Arthritis Res Ther. 2012;14(1):R3. DOI:10.1186/ar3551
33. Zhang LH, Han SB, Song L, et al. Comparative analysis and differentiation between SAPHO syndrome and spondyloarthropathies using whole-spine MRI. Clin Radiol. 2021;76(5):394.e9-14. DOI:10.1016/j.crad.2020.12.005
34. Yap FHX, Olsson-White D, Roddy J, et al. Long-term clinical outcomes in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome. Mayo Clin Proc Innov Qual Outcomes. 2021;5(3):574-82. DOI:10.1016/j.mayocpiqo.2021.02.009
35. Sallés M, Olivé A, Perez-Andres R, et al. The SAPHO syndrome: a clinical and imaging study. Clin Rheumatol. 2011;30(02):245-9.
36. Ballara SC, Siraj QH, Maini RN, Venables PJ. Sustained response to doxycycline therapy in two patients with SAPHO syndrome. Arthritis Rheum. 1999;42(04):819-21.
37. Rozin AP, Nahir AM. Is SAPHO syndrome a target for antibiotic therapy? Clin Rheumatol. 2007;26(05):817-20.
38. Xiang Y, Wang Y, Cao Y, et al. Tonsillitis as a possible predisposition to synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Int J Rheum Dis. 2021;24:519-25.
39. Ferguson PJ, Sandu M. Current understanding of the pathogenesis and management of chronic recurrent multifocal osteomyelitis. Curr Rheumatol Rep. 2012;14(02):130-41.
40. Hayem G, Bouchaud-Chabot A, Benali K, et al. SAPHO syndrome: a long-term follow-up study of 120 cases. Semin Arthritis Rheum. 1999;29(03):159-71.
41. Amital H, Applbaum YH, Aamar S, et al. SAPHO syndrome treated with pamidronate: an open-label study of 10 patients. Rheumatology (Oxford). 2004;43(05):658-61.
42. Li C, Zhao Y, Zuo Y, et al. Efficacy of bisphosphonates in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: a prospective open study. Clin Exp Rheumatol. 2019;37:663-9.
43. Andreasen CM, Jurik AG, Deleuran BW, et al. Pamidronate in chronic non-bacterial osteomyelitis: a randomized, double-blinded, placebo-controlled pilot trial. Scand J Rheumatol. 2020;49:312-22.
44. Kopterides P, Pikazis D, Koufos C. Successful treatment of SAPHO syndrome with zoledronic acid. Arthritis Rheum. 2004;50(9):2970-3. DOI:10.1002/art.20464
45. Adamo S, Nilsson J, Krebs A, et al. Successful treatment of SAPHO syndrome with apremilast. Br J Dermatol. 2018;179(4):959-62. DOI:10.1111/bjd.16071
46. Daoussis D, Konstantopoulou G, Kraniotis P, et al. Biologics in SAPHO syndrome: A systematic review. Semin Arthritis Rheum. 2019;48(4):618-25. DOI:10.1016/j.semarthrit.2018.04.003
47. Cheng W, Li F, Tian J, et al. New Insights in the Treatment of SAPHO Syndrome and Medication Recommendations. J Inflamm Res. 2022;15:2365-80. DOI:10.2147/JIR.S353539
48. Li C, Li Z, Cao Y, et al. X. Tofacitinib for the treatment of nail lesions and palmoplantar pustulosis in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome. JAMA Dermatol. 2021;157(1):74-8. DOI:10.1001/jamadermatol.2020.3095
________________________________________________
1. Tiukhova EIu, Bochkova AG, Bratygina EA, Bunchuk NV. Sindrom SAPHO: opisanie dvukh nabliudenii. Nauchno-prakticheskaia revmatologiia. 2009;47(5):77-82 (in Russian).
2. Jurik AG, Klicman RF, Simoni P, et al. SAPHO and CRMO: The Value of Imaging. Semin Musculoskelet Radiol. 2018;22(2):207-24. DOI:10.1055/s-0038-1639469
3. Sonozaki H, Mitsui H, Miyanaga Y, et al. Clinical features of 53 cases with pustulotic arthro-osteitis. Ann Rheum Dis. 1981;40(6):547-53. DOI:10.1136/ard.40.6.547
4. Bjorkstén B, Boquist L. Histopathological aspects of chronic recurrent multifocal osteomyelitis. J Bone Joint Surg Br. 1980;62(3):376-80. DOI:10.1302/0301-620X.62B3.7410472
5. Reith JD, Bauer TW, Schils JP. Osseous manifestations of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. Am J Surg Pathol. 1996;20(11):1368-77. DOI:10.1097/00000478-199611000-00008
6. Hedrich CM, Morbach H, Reiser C, Girschick HJ. New insights into adult and paediatric chronic non-bacterial osteomyelitis CNO. Curr Rheumatol Rep. 2020;22(9):52. DOI:10.1007/s11926-020-00928-1
7. Ramautar AI, Appelman-Dijkstra NM, Lakerveld S, et al. Chronic nonbacterial osteomyelitis of the sternocostoclavicular region in adults: a single-center Dutch cohort study. JBMR Plus. 2021;5(5):e10490. DOI:10.1002/jbm4.10490
8. Nguyen MT, Borchers A, Selmi C, et al. The SAPHO syndrome. Semin Arthritis Rheum. 2012;42(3):254-65. DOI:10.1016/j.semarthrit.2012.05.006
9. Leerling A, Dekkers O, Appelman-Dijkstra N, Winter E. Clinical and therapeutic diversity in adult chronic nonbacterial osteomyelitis (CNO) of the sternocostoclavicular region: a meta-analysis. Rheumatology (Oxford). 2022;61(5):1810-8. DOI:10.1093/rheumatology/keac443
10. Liu S, Tang M, Cao Y, Li C. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: review and update. Ther Adv Musculoskelet Dis. 2020;12:1759720X20912865. DOI:10.1177/1759720X20912865
11. Yu M, Cao Y, Li J, et al. Anterior chest wall in SAPHO syndrome: magnetic resonance imaging findings. Arthritis Res Ther. 2020;22(1):216. DOI:10.1186/s13075-020-02309-6
12. Arnoldi AP, Schlett CL, Douis H, et al. Whole-body MRI in patients with non-bacterial osteitis: radiological findings and correlation with clinical data. Eur Radiol. 2017;27(06):2391-9.
13. Freyschmidt J, Sternberg A. The bullhead sign: scintigraphic pattern of sternocostoclavicular hyperostosis and pustulotic arthroosteitis. Eur Radiol. 1998;8(05):807-2.
14. Mandell GA, Contreras SJ, Conard K, et al. Bone scintigraphy in the detection of chronic recurrent multifocal osteomyelitis. J Nucl Med. 1998;39(10):1778-83.
15. Sun X, Li C, Cao Y, et al. F-18 FDG PET/CT in 26 patients with SAPHO syndrome: a new vision of clinical and bone scintigraphy correlation. J Orthop Surg Res. 2018;13(1):120. DOI:10.1186/s13018-018-0795-0
16. Voit AM, Arnoldi AP, Douis H, et al. Whole-body magnetic resonance imaging in chronic recurrent multifocal osteomyelitis: clinical long term assessment may underestimate activity. J Rheumatol. 2015;42(08):1455-62.
17. Earwaker JW, Cotten A. SAPHO: syndrome or concept? Imaging findings. Skeletal Radiol. 2003;32(06):311-27.
18. Sonozaki H, Azuma A, Okai K, et al. Clinical features of 22 cases with “inter-sterno-costo-clavicular ossification”. A new rheumatic syndrome. Arch Orthop Trauma Surg (1978). 1979;95(1-2):13-22. DOI:10.1007/BF00379164
19. Chigira M, Shimizu T. Computed tomographic appearances of sternocostoclavicular hyperostosis. Skeletal Radiol. 1989;18(5):347-52. DOI:10.1007/BF00361423
20. Yamamoto T, Hiraiwa T, Tobita R, et al. Characteristics of Japanese patients with pustulotic arthro-osteitis associated with palmoplantar pustulosis: a multicenter study. Int J Dermatol. 2020;59(4):441-4. DOI:10.1111/ijd.14788
21. Mejjad O, Daragon A, Louvel JP, et al. Osteoarticular manifestations of pustulosis palmaris et plantaris and of psoriasis: two distinct entities. Ann Rheum Dis. 1996;55(3):177-80. DOI:10.1136/ard.55.3.177
22. Duffin KC, Bachelez H, Mease PJ, et al. Pustular Psoriasis and Associated Musculoskeletal Disorders. J Rheumatol Suppl. 2021;97:34-8. DOI:10.3899/jrheum.201673
23. Giedion A, Holthusen W, Masel LF, Vischer D. Subacute and chronic “symmetrical” osteomyelitis. Ann Radiol (Paris). 1972;15(3):329-42. Multiple languages. PMID: 4403064.
24. Takeuchi S, Hanakita J, Takahashi T, et al. Destructive spondylodiscitis associated with SAPHO syndrome: A case report and literature review. Surg Neurol Int. 2022;13:345. DOI:10.25259/SNI_626_2022
25. Chamot AM, Benhamou CL, Kahn MF, et al. Acnepustulosis-hyperostosis-osteitis syndrome. Results of a national survey. 85 cases. Rev Rhum Mal Osteoartic. 1989;54:187-96.
26. Efthimiou P, Petryna O, Nakasato P, Kontzias A. New insights on multigenic autoinflammatory diseases. Ther Adv Musculoskelet Dis. 2022;14:1759720X221117880. DOI:10.1177/1759720X221117880
27. Ferguson PJ, El-Shanti H. Majeed Syndrome: A Review of the Clinical, Genetic and Immunologic Features. Biomolecules. 2021;11(3):367. DOI:10.3390/biom11030367
28. Li Y, Yu M, Lu M. Pathophysiology, clinical manifestations and current management of IL-1 mediated monogenic systemic autoinflammatory diseases, a literature review. Pediatr Rheumatol Online J. 2022;20(1):90. DOI:10.1186/s12969-022-00728-0
29. Koryllou A, Mejbri M, Theodoropoulou K, et al. Chronic Nonbacterial Osteomyelitis in Children. Children (Basel). 2021;8(7):551. DOI:10.3390/children8070551
30. Theumann NH, So A, Mouhsine E, et al. SAPHO syndrome masquerading as metastatic bone disease. Australas Radiol. 2005;49(5):418-21. DOI:10.1111/j.1440-1673.2005.01475.x
31. Jurik AG. Anterior chest wall involvement in seronegative arthritides. A study of the frequency of changes at radiography. Rheumatol Int. 1992;12(1):7-11. DOI:10.1007/BF00246870
32. Weber U, Lambert RG, Rufibach K, et al. Anterior chest wall inflammation by whole-body magnetic resonance imaging in patients with spondyloarthritis: lack of association between clinical and imaging findings in a cross-sectional study. Arthritis Res Ther. 2012;14(1):R3. DOI:10.1186/ar3551
33. Zhang LH, Han SB, Song L, et al. Comparative analysis and differentiation between SAPHO syndrome and spondyloarthropathies using whole-spine MRI. Clin Radiol. 2021;76(5):394.e9-14. DOI:10.1016/j.crad.2020.12.005
34. Yap FHX, Olsson-White D, Roddy J, et al. Long-term clinical outcomes in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome. Mayo Clin Proc Innov Qual Outcomes. 2021;5(3):574-82. DOI:10.1016/j.mayocpiqo.2021.02.009
35. Sallés M, Olivé A, Perez-Andres R, et al. The SAPHO syndrome: a clinical and imaging study. Clin Rheumatol. 2011;30(02):245-9.
36. Ballara SC, Siraj QH, Maini RN, Venables PJ. Sustained response to doxycycline therapy in two patients with SAPHO syndrome. Arthritis Rheum. 1999;42(04):819-21.
37. Rozin AP, Nahir AM. Is SAPHO syndrome a target for antibiotic therapy? Clin Rheumatol. 2007;26(05):817-20.
38. Xiang Y, Wang Y, Cao Y, et al. Tonsillitis as a possible predisposition to synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Int J Rheum Dis. 2021;24:519-25.
39. Ferguson PJ, Sandu M. Current understanding of the pathogenesis and management of chronic recurrent multifocal osteomyelitis. Curr Rheumatol Rep. 2012;14(02):130-41.
40. Hayem G, Bouchaud-Chabot A, Benali K, et al. SAPHO syndrome: a long-term follow-up study of 120 cases. Semin Arthritis Rheum. 1999;29(03):159-71.
41. Amital H, Applbaum YH, Aamar S, et al. SAPHO syndrome treated with pamidronate: an open-label study of 10 patients. Rheumatology (Oxford). 2004;43(05):658-61.
42. Li C, Zhao Y, Zuo Y, et al. Efficacy of bisphosphonates in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: a prospective open study. Clin Exp Rheumatol. 2019;37:663-9.
43. Andreasen CM, Jurik AG, Deleuran BW, et al. Pamidronate in chronic non-bacterial osteomyelitis: a randomized, double-blinded, placebo-controlled pilot trial. Scand J Rheumatol. 2020;49:312-22.
44. Kopterides P, Pikazis D, Koufos C. Successful treatment of SAPHO syndrome with zoledronic acid. Arthritis Rheum. 2004;50(9):2970-3. DOI:10.1002/art.20464
45. Adamo S, Nilsson J, Krebs A, et al. Successful treatment of SAPHO syndrome with apremilast. Br J Dermatol. 2018;179(4):959-62. DOI:10.1111/bjd.16071
46. Daoussis D, Konstantopoulou G, Kraniotis P, et al. Biologics in SAPHO syndrome: A systematic review. Semin Arthritis Rheum. 2019;48(4):618-25. DOI:10.1016/j.semarthrit.2018.04.003
47. Cheng W, Li F, Tian J, et al. New Insights in the Treatment of SAPHO Syndrome and Medication Recommendations. J Inflamm Res. 2022;15:2365-80. DOI:10.2147/JIR.S353539
48. Li C, Li Z, Cao Y, et al. X. Tofacitinib for the treatment of nail lesions and palmoplantar pustulosis in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome. JAMA Dermatol. 2021;157(1):74-8. DOI:10.1001/jamadermatol.2020.3095
Авторы
Н.В. Бунчук*
Академическая клиника неврологии и стоматологии «Сесиль», Москва, Россия
*nbunchuk@yahoo.com
________________________________________________
Nikolay V. Bunchuk*
Academic Clinic of Neurology and Dentistry “Cecil”, Moscow, Russia
*nbunchuk@yahoo.com