Sir, Non-bacterial osteitis (NBO) may be used to describe the SAPHO syndrome, chronic recurrent multifocal osteomyelitis (CRMO), pustulotic arthro-osteitis and others manifesting primarily as sterile osteitis [1, 2]. Osteitis may occur in combination with acne, psoriasis, palmoplantar pustulosis and IBD. Vertebral osteitis may occur, but patients rarely develop typical SpA and tend to lack the human leucocyte antigen B27 (HLA-B27) [3]. Over a 12-month period we encountered four white, middle-aged women, mean age 59 years (range 51-61 years), all systemically well, with mid-dorsal spinal osteitis but no sacroiliitis or skin disease and with strikingly similar radiological appearances. We speculate that their form of dorsal spinal osteitis may represent a distinct entity within the spectrum of NBO and briefly discuss nosologic and aetiologic issues.
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