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Multiple Epiphyseal Dysplasia

Polyepiphyseal Dysplasia


Presentation

  • To the best of our knowledge, no other similarly affected family has been presented in the literature.[ncbi.nlm.nih.gov]
  • Two children presented with asymmetrical genu valgum; 1 with knee pain, genu valgum, loose bodies, and early degenerative joint disease of both knees; and 2 with limp.[ncbi.nlm.nih.gov]
  • The presenting signs are often rheumatological ('joint pain') or neurological ('myopathy') in nature, and the cardinal feature of skeletal dysplasia (short stature) may not be present.[ncbi.nlm.nih.gov]
  • This case was a unique presentation within the family, suggesting a mutation in the affected child.[ncbi.nlm.nih.gov]
  • Although surgery was initially recommended, conservative chiropractic management was employed and resulted in complete resolution of the patient's presenting hip symptoms.[ncbi.nlm.nih.gov]
Fatigue
  • The disease has symptom fatigue, has symptom joint pain. polyepiphyseal dysplasia Fairbank's disease MED edit English multiple epiphyseal dysplasia An osteochondrodysplasia that has material basis in defective cartilage mineralization into bone which[wikidata.org]
  • The disease has_symptom fatigue, has_symptom joint pain.[bioportal.bioontology.org]
  • The progression of the disease also affects muscles, with increasing atrophy, resulting in muscle fatigue and pain. Muscular atrophy has not been reported earlier in cases with COL9A2 mutations.[ncbi.nlm.nih.gov]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 13, 2019[patientslikeme.com]
Soft Tissue Mass
  • An 11-yr-old male patient suffered from occasional right hip pain and limited range of motion, as well as a nontender soft tissue mass in the right knee.[ncbi.nlm.nih.gov]
Leukonychia
  • He also had hypoplasia of the corpus callosum and leukonychia totalis, which were not described in the previous cases.[ncbi.nlm.nih.gov]
Waddling Gait
  • Patients with MED and a waddling gait but minimal radiographic hip involvement should be evaluated for a primary myopathy and a mutation in type IX collagen.[ncbi.nlm.nih.gov]
  • Clinical description EDM1 (see this term) is clinically the best characterized form of EMD and is marked by a waddling gait and pain at onset, and moderate short stature. The main complication is early arthrosis of the hip.[orpha.net]
  • Joint pain, joint deformity, waddling gait, and short stature are the main clinical signs and symptoms.[uniprot.org]
  • Physical exam is notable for a valgus left knee and a waddling gait. Radiographs of the pelvis, knees, and left hand are provided in figures A-C. Genetic testing reveals a mutation of the cartilage oligomeric matrix protein(COMP).[orthobullets.com]
  • Waddling gait Signs: Joint deformity (eg. valgus knee). Early OA. Joint contractures. Hyperextensible fingers Minor (investigative) findings On x-ray: Instability of upper C-spine. Bilateral epipyseal defects on pelvic film.[slideshare.net]
Stiff Gait
  • MED affects both sexes, and onset of symptoms usually begins early in or before the third decade of life [ 3 ], although in some forms patients experience joint pain, stiffness, gait abnormalities and retarded growth in early childhood [ 4 ].[doi.org]

Workup

  • […] survey helps to differentiate between these two disease processes because LCP does not demonstrate the deformities about the knee and other joints typically seen with MED. 18 Acetabular changes associated with MED are typically found at the initial workup[journals.lww.com]

Treatment

  • Larger improvements in Harris hip scores were identified after conservative treatment (P 0.003). Favorable midterm outcomes were obtained for the treatment of hip deformity in multiple epiphyseal dysplasia patients by conservative treatment.[ncbi.nlm.nih.gov]
  • Treatment of the hip deformity in multiple epiphyseal dysplasia is a challenge for orthopedic surgeons.We reviewed the clinical features and treatment options of hip joints affected by multiple epiphyseal dysplasia in 6 young patients (4 boys and 2 girls[ncbi.nlm.nih.gov]
  • Management and treatment Current treatments involve mainly physiotherapy and orthopedic care. Hip replacement is frequently required, but the age at intervention is variable.[orpha.net]
  • We report on a 27-year-old male patient suffering from clinical symptoms of autosomal recessive MED with habitual dislocation of a multilayered patella on both sides, on the surgical treatment and on short-term clinical outcome.[ncbi.nlm.nih.gov]
  • All patients experienced pain relief and improved quality of life after surgical treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Molecular diagnosis is important for accurate prognosis and genetic counselling.[ncbi.nlm.nih.gov]
  • Molecular diagnosis is important for genetic counselling and for an accurate prognosis. Even in case of a multilayered patella in MED, habitual patella dislocation could be managed successfully by medialisation of the tibial tuberosity.[ncbi.nlm.nih.gov]
  • These differences in clinical manifestation and prognosis justify molecular differentiation between the two genotypes.[ncbi.nlm.nih.gov]
  • Long-term prognosis varies widely, because of the range of severities 2. dysplasia-med REFERENCES[slideshare.net]
  • Coverage of each disorder includes more details on treatment and prognosis.[books.google.com]

Etiology

  • Abstract Seven patients (10 hips), five with multiple epiphyseal dysplasia and two with spondyloepiphyseal dysplasia, were studied as to the etiology of a significant change in their baseline symptoms.[ncbi.nlm.nih.gov]
  • Etiology EDM1 is transmitted in an autosomal dominant manner and is caused by mutations in the gene ( COMP ; 19p13.1) encoding the cartilage oligomeric matrix protein.[orpha.net]
  • The exact etiology of MED remains unclear.[emedicine.medscape.com]
  • Unger S, Hecht JT (2001) Pseudoachondroplasia and multiple epiphyseal dysplasia: new etiologic developments. Am J Med Genet 106:244–260 Google Scholar 6. Lachman R, Sillence D, Rimoin D, et al (1981) Diastrophic dysplasia: the death of a variant.[doi.org]

Epidemiology

  • Summary Epidemiology The average prevalence is estimated at around 1/20,000. Clinical description EDM1 (see this term) is clinically the best characterized form of EMD and is marked by a waddling gait and pain at onset, and moderate short stature.[orpha.net]
  • Introduction A form of dwarfism characterized by irregular, delayed ossification at multiple epiphyses spectrum of disorders with a spectrum of phenotypes Epidemiology prevalence approximately 1:10000 presents between age 5-14 years of age location caused[orthobullets.com]
  • Congenital generalised bone dysplasias: a clinical, radiological, and epidemiological survey. J Med Genet . 1989; 26(1):37-44. Wynne-Davies R, Gormley J. The prevalence of skeletal dysplasias.[healio.com]
  • Epidemiology of osteochondrodysplasias: changing trends due to advances in prenatal diagnosis. Am J Med Genet 1996;61:49-58. Bonafe L, Cormier-Daire V, Hall C, Lachman R, Mortier G, Mundlos S, et al.[archivesofrheumatology.org]
  • Epidemiology: Clinical Findings: Patients typically present later in childhood with joint pain in the lower extremities, decreased range of motion, gait disturbance, or angular deformities of the knees, such as genu varum or valgum.[posna.org]
Sex distribution
Age distribution

Pathophysiology

  • Understanding the precise effect that these molecular changes have on the integrity of the cartilage extracellular matrix will lead the way in identifying the complex disease pathophysiology that defines MED.[ncbi.nlm.nih.gov]
  • There is a mild version (‘ribbing’) and a more typical, severe, form (‘Fairbanks’) Pathophysiology Irregular, delayed, ossification of multiple epiphyses. A defect in COMP (cartilege, oligomeric matrix protein) causes the most common form.[slideshare.net]
  • Pathophysiology delay of epiphyseal endochondral ossification lack of osseous support yields secondary articular cartilage deformity most commonly affects proximal femur and proximal humerus Genetics autosomal dominant is most common mutation in COMP[orthobullets.com]
  • However, some causative genes resulting in maturational delay in the epiphysis of the bone have been previously reported.( 6 ) Conservative treatment methods are applied as the genetic mechanisms play a role in the pathophysiology.[archivesofrheumatology.org]
  • Pathophysiology Cartilage oligomeric matrix protein (COMP) and matrilin-3 (MATN3) are thought to bridge extracellular matrix proteins. Collagen IX is important for the adhesive properties of cartilage.[emedicine.medscape.com]

Prevention

  • We strive to maximize children’s mobility, correct deformity, and prevent future complications.[nemours.org]
  • Home Health Centers Wellness, Prevention & General Health Arthritis Asthma & Allergies Child & Adolescent Health Diabetes Digestive Disorders / GERD Emotional Well-Being Heart Disease High Cholesterol Hypertension Pain Disorders Men's Health Senior Health[drdoleary.com]
  • Mutations in the SLC26A2 gene alter the structure of developing cartilage, preventing bones from forming properly and resulting in the skeletal problems characteristic of recessive multiple epiphyseal dysplasia.[wikidoc.org]
  • […] spectrum of skeletal disorders caused by mutations in the gene, which encodes a protein that is essential for the normal development of cartilage and its conversion to bone. [3] Mutations in the SLC26A2 gene alter the structure of developing cartilage, preventing[ipfs.io]
  • There is no current treatment to prevent worsening or change the course of Multiple Epiphyseal Dysplasia. Ultimately, there is a future potential for genetic intervention.[congenitalhand.wustl.edu]

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