Introduction: Sapho syndorm is a syndrom characterizing with osteoarticular end dermatologic symptoms. Acronym „SAPHO“ means: S-Sinovitis, A-Acne, H-Hyperostosis, O-Osteytis. SAPHO syndrom has a 50 different names in existing literature. For now, etiology remains unclear, but it belongs to group of seronegative spondylarthropathies. Therapy of SAPHO includes NSAIL, glucocorticosteroids, disease modifying anthireumatic drugs (DMARD), antibiotics, bifosfonatos, and anti TNF - alfa drugs with variable success. Case outline: Pacent P.Z, 47 age, female, comes in the hospital, because of pain in anterior chest, with propagation in right arm, end morning stiffness in sacral part, which passes short after. Also, with recidivant pustules on the palms, bilaterally, which precedes itch. Bone scintigraphy was performed: There is a clear increasing binding of radiopharmacs in projection of strenoclavicular joint, and slightly in both shoulders and both knees. HP: Pustulosis palmoplantaris. We introduced in therapy azithromycin in the dose of 500 mg, two times weekly, for 16 weeks. Patient, one year after, is without relapses of arthritis and skin lesions. Conclusion: This report has goal, to get more knowledge about this rare disease, and to be easier for recognition. Also we want to introduce other physicians, of varying specialities, like orthopaedics, and other surguries, with this disease, not only rheuamatologists, dermatologists, and pediatrics.

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