We report on two patients with painful hyperostosis of the mandible and the thoracic skeleton. Other symptoms were arthralgia, arthritis, osteitis, and palmoplantar pustulosis. Radiographic analysis revealed regions of circumscribed hyperostosis which showed in increased uptake in scintiscan. Metastasis, chronic osteomyelitis, Ewing's sarcoma, or Paget's disease were excluded and the diagnosis Sapho syndrome was made. This recently introduced acronym describes a disease with Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis. Because of the possible axial skeleton involvement, an association to the spondylathropathy group is still being discussed. The etiopathogenesis of this rheumatologic disease is not known.