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Fredwall S, AlSayed M, Ben-Omran T, Boero S, Cormier-Daire V, Fauroux B, Guillén-Navarro E, Innig F, Kunkel P, Lampe C, Maghnie M, Mohnike K, Mortier G, Pejin Z, Sessa M, Sousa SB, Irving M. European Achondroplasia Forum Practical Considerations for Following Adults with Achondroplasia. Adv Ther 2024; 41:2545-2558. [PMID: 38748332 PMCID: PMC11213767 DOI: 10.1007/s12325-024-02880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/19/2024] [Indexed: 06/29/2024]
Abstract
Achondroplasia is a lifelong condition requiring lifelong management. There is consensus that infants and children with achondroplasia should be managed by a multidisciplinary team experienced in the condition. However, many people are lost to follow-up after the transition from paediatric to adult care, and there is no standardised approach for management in adults, despite the recent availability of international consensus guidelines. To address this, the European Achondroplasia Forum has developed a patient-held checklist to support adults with achondroplasia in managing their health. The checklist highlights key symptoms of spinal stenosis and obstructive sleep apnoea, both among the most frequent and potentially severe medical complications in adults with achondroplasia. The checklist acts as a framework to support individuals and their primary care provider in completing a routine review. General advice on issues such as blood pressure, pain, hearing, weight, adaptive aids, and psychosocial aspects are also included. The checklist provides key symptoms to be aware of, in addition to action points so that people can approach their primary care provider and be directed to the appropriate specialist, if needed. Additionally, the European Achondroplasia Forum offers some ideas on implementing the checklist during the transition from paediatric to adult care, thus ensuring the existing multidisciplinary team model in place during childhood can support in engaging individuals and empowering them to take responsibility for their own care as they move into adulthood.
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Affiliation(s)
- Svein Fredwall
- Sunnaas Rehabilitation Hospital, TRS National Resource Centre for Rare Disorders, Nesodden, Norway.
| | - Moeenaldeen AlSayed
- Department of Medical Genomics, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
- Faculty of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Tawfeg Ben-Omran
- Division of Genetics and Genomic Medicine, Sidra Medicine and Hamad Medical Corporation, Doha, Qatar
| | | | | | - Brigitte Fauroux
- Necker University Hospital and Paris Cité University, Paris, France
| | - Encarna Guillén-Navarro
- Medical Genetics Division and Pediatrics Department, Virgen de la Arrixaca University Hospital, IMIB-Pascual Parrilla, University of Murcia, Murcia, Spain
- CIBERER-ISCIII, Madrid, Spain
| | | | - Philip Kunkel
- University Medical Centre Mannheim, Mannheim, Germany
| | - Christian Lampe
- Clinic of Child and Youth Medicine, University Hospital Mannheim, Mannheim, Germany
| | - Mohamad Maghnie
- Paediatric Endocrinology Unit, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16147, Genoa, Italy
| | - Klaus Mohnike
- Children's Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Geert Mortier
- Centre for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | | | - Marco Sessa
- Italian Association on Achondroplasia, Milan, Italy
| | - Sérgio B Sousa
- Medical Genetics Department, Hospital Pediátrico de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra, Hospital Pediátrico de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- University Clinic of Genetics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- ERN-BOND, Bologna, Italy
| | - Melita Irving
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Cheung MS, Mohnike K. Meeting Report from 2nd ICCBH-ERN BOND Spinal Complications in Children and Adults with Achondroplasia Workshop, Dublin, Ireland, 2nd July 2022. Bone 2022; 165:116574. [PMID: 36183981 DOI: 10.1016/j.bone.2022.116574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/02/2022]
Abstract
A pre-meeting workshop on spinal complications in children and adults with achondroplasia was held in Dublin, Ireland at the 10th International Conference on Children's Bone Health (ICCBH) 2-5 July 2022. The pathophysiology, natural history and medical/surgical management of thoraco-lumbar kyphosis and spinal stenosis remains poorly described in the literature. The structure of the workshop consisted of lectures, a debate and an interactive round table discussion. In total over 100 delegates affiliated to over 70 institutions from 20 countries were in attendance.
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Affiliation(s)
- Moira S Cheung
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK.
| | - Klaus Mohnike
- University of Otto von Guericke University, Magdeburg, Germany
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3
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Savarirayan R, Ireland P, Irving M, Thompson D, Alves I, Baratela WAR, Betts J, Bober MB, Boero S, Briddell J, Campbell J, Campeau PM, Carl-Innig P, Cheung MS, Cobourne M, Cormier-Daire V, Deladure-Molla M, Del Pino M, Elphick H, Fano V, Fauroux B, Gibbins J, Groves ML, Hagenäs L, Hannon T, Hoover-Fong J, Kaisermann M, Leiva-Gea A, Llerena J, Mackenzie W, Martin K, Mazzoleni F, McDonnell S, Meazzini MC, Milerad J, Mohnike K, Mortier GR, Offiah A, Ozono K, Phillips JA, Powell S, Prasad Y, Raggio C, Rosselli P, Rossiter J, Selicorni A, Sessa M, Theroux M, Thomas M, Trespedi L, Tunkel D, Wallis C, Wright M, Yasui N, Fredwall SO. International Consensus Statement on the diagnosis, multidisciplinary management and lifelong care of individuals with achondroplasia. Nat Rev Endocrinol 2022; 18:173-189. [PMID: 34837063 DOI: 10.1038/s41574-021-00595-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 12/31/2022]
Abstract
Achondroplasia, the most common skeletal dysplasia, is characterized by a variety of medical, functional and psychosocial challenges across the lifespan. The condition is caused by a common, recurring, gain-of-function mutation in FGFR3, the gene that encodes fibroblast growth factor receptor 3. This mutation leads to impaired endochondral ossification of the human skeleton. The clinical and radiographic hallmarks of achondroplasia make accurate diagnosis possible in most patients. However, marked variability exists in the clinical care pathways and protocols practised by clinicians who manage children and adults with this condition. A group of 55 international experts from 16 countries and 5 continents have developed consensus statements and recommendations that aim to capture the key challenges and optimal management of achondroplasia across each major life stage and sub-specialty area, using a modified Delphi process. The primary purpose of this first International Consensus Statement is to facilitate the improvement and standardization of care for children and adults with achondroplasia worldwide in order to optimize their clinical outcomes and quality of life.
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Affiliation(s)
- Ravi Savarirayan
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia.
| | - Penny Ireland
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Melita Irving
- Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Dominic Thompson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Inês Alves
- ANDO Portugal / ERN BOND, Évora, Portugal
| | | | - James Betts
- Centre for Nutrition, Exercise & Metabolism, Department for Health, University of Bath, Bath, UK
| | - Michael B Bober
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Jenna Briddell
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Jeffrey Campbell
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | | | - Moira S Cheung
- Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Martyn Cobourne
- Centre for Craniofacial and Regenerative Biology, King's College London, London, UK
| | | | | | | | | | - Virginia Fano
- Paediatric Hospital Garrahan, Buenos Aires, Argentina
| | | | - Jonathan Gibbins
- Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Mari L Groves
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Therese Hannon
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julie Hoover-Fong
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Greenberg Center for Skeletal Dysplasias, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Juan Llerena
- National Institute Fernandes Figueira, Rio de Janeiro, Brazil
| | | | | | | | - Sharon McDonnell
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Klaus Mohnike
- Universitätskinderklinik, Otto-von-Guericke Universität, Magdeburg, Germany
| | - Geert R Mortier
- Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Amaka Offiah
- Sheffield Children's Hospital, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Keiichi Ozono
- Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Steven Powell
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Yosha Prasad
- Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, London, UK
| | | | - Pablo Rosselli
- Fundación Cardio infantil Facultad de Medicina, Bogota, Colombia
| | - Judith Rossiter
- University of Maryland St. Joseph Medical Center, Towson, MD, USA
| | | | | | - Mary Theroux
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Matthew Thomas
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - David Tunkel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Colin Wallis
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michael Wright
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Svein Otto Fredwall
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Hoover-Fong J, Cheung MS, Fano V, Hagenas L, Hecht JT, Ireland P, Irving M, Mohnike K, Offiah AC, Okenfuss E, Ozono K, Raggio C, Tofts L, Kelly D, Shediac R, Pan W, Savarirayan R. Lifetime impact of achondroplasia: Current evidence and perspectives on the natural history. Bone 2021; 146:115872. [PMID: 33545406 DOI: 10.1016/j.bone.2021.115872] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/18/2022]
Abstract
Achondroplasia, the most common form of disproportionate short stature, is caused by a variant in the fibroblast growth factor receptor 3 (FGFR3) gene. Advances in drug treatment for achondroplasia have underscored the need to better understand the natural history of this condition. This article provides a critical review and discussion of the natural history of achondroplasia based on current literature evidence and the perspectives of clinicians with extensive knowledge and practical experience in managing individuals with this diagnosis. This review draws evidence from recent and ongoing longitudinal natural history studies, supplemented with relevant cross-sectional studies where longitudinal research is lacking, to summarize the current knowledge on the nature, incidence, chronology, and interrelationships of achondroplasia-related comorbidities across the lifespan. When possible, data related to adults are presented separately from data specific to children and adolescents. Gaps in knowledge regarding clinical care are identified and areas for future research are recommended and discussed.
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Affiliation(s)
- Julie Hoover-Fong
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Moira S Cheung
- Guy's and St. Thomas' NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Virginia Fano
- Department of Growth and Development, Hospital Garrahan, Buenos Aires, Argentina
| | - Lars Hagenas
- Karolinska Institute, Division of Pediatric Endocrinology, Department of Women's and Children's Health, Stockholm, Sweden
| | - Jacqueline T Hecht
- University of Texas, Houston, McGovern Medical School, Department of Pediatrics, Houston, TX, USA
| | - Penny Ireland
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Melita Irving
- Guy's and St. Thomas' NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Klaus Mohnike
- Otto-von-Guericke-University Magdeburg, Department of Pediatrics, Magdeburg, Germany
| | - Amaka C Offiah
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Ericka Okenfuss
- Kaiser Permanente - Sacramento Medical Center, Department of Genetics, Sacramento, CA, USA
| | - Keiichi Ozono
- Osaka University Graduate School of Medicine, Department of Pediatrics, Osaka, Japan
| | - Cathleen Raggio
- Hospital for Special Surgery, Pediatric Orthopedic Surgery Service, New York, NY, USA
| | - Louise Tofts
- Kids Rehab, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Dominique Kelly
- BioMarin Pharmaceutical Inc., Global Medical Affairs, Novato, CA, USA
| | - Renée Shediac
- BioMarin Pharmaceutical Inc., Global Medical Affairs, Novato, CA, USA
| | - Wayne Pan
- BioMarin Pharmaceutical Inc., Global Medical Affairs, Novato, CA, USA
| | - Ravi Savarirayan
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia
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Mehany SN, Patsch JM. Imaging of pediatric bone and growth disorders: Of diagnostic workhorses and new horizons. Wien Med Wochenschr 2021; 171:102-110. [PMID: 33570693 PMCID: PMC8016808 DOI: 10.1007/s10354-021-00815-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022]
Abstract
Children and adolescents with bone and growth disorders require interdisciplinary care from various specialists including pediatric radiologists with a focus on musculoskeletal disorders. This article covers routine topics, differential diagnoses, and selected research imaging in children with osteogenesis imperfecta (OI), X‑linked hypophosphatemic rickets (XLH), achondroplasia, and other bone and growth disorders from the standpoint of a tertiary referral center.
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Affiliation(s)
- Sarah N Mehany
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Vienna Bone and Growth Center, Vienna General Hospital and Medical University of Vienna, Vienna, Austria
| | - Janina M Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
- Vienna Bone and Growth Center, Vienna General Hospital and Medical University of Vienna, Vienna, Austria.
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6
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Cheung MS, Irving M, Cocca A, Santos R, Shaunak M, Dougherty H, Siddiqui A, Gringras P, Thompson D. Achondroplasia Foramen Magnum Score: screening infants for stenosis. Arch Dis Child 2021; 106:180-184. [PMID: 32883660 DOI: 10.1136/archdischild-2020-319625] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Achondroplasia is associated with foramen magnum stenosis (FMS) and significant risk of morbidity and sudden death in infants. A sensitive and reliable method of detecting infants who require decompressive surgery is required. This study aims to describe the incidence and severity of FMS in an unselected, sequential series of infants using a novel MRI score and retrospectively correlate severity with clinical examination and cardiorespiratory sleep (CRS) studies. METHODS The Achondroplasia Foramen Magnum Score (AFMS) was developed and scores were retrospectively correlated with clinical and CRS data over a 3-year period. RESULTS Of 36 infants (M:F, 18:18), 2 (5.6%) did not have FMS (AFMS0); 13 (36.1%) had FMS with preservation of the cerebrospinal fluid (CSF) spaces (AFMS1); 3 (8.3%) had FMS with loss of the CSF space but no spinal cord distortion (AFMS2); 13 (36.1%) had FMS with flattening of the cervical cord without signal change (AFMS3); and 5 (13.9%) had FMS resulting in cervical cord signal change (AFMS4). Mean Total Apnea and Hypopnea Index (TAHI) for AFMS0-4 was 3.4, 6.41, 2.97, 10.5 and 25.8, respectively. Severe TAHI had a specificity of 89% but only a 59% sensitivity for AFMS3-4. Neurological examination was normal in 34/36 (94%) patients. Overall, 9/36 (25%) infants required neurosurgery with minimal surgical complications. CONCLUSIONS Clinical examination and CRS have a low sensitivity for predicting the effects of foramen stenosis on the spinal cord. Routine screening with MRI using AFMS can aid in detecting early spinal cord changes and has the potential to reduce infant morbidity and mortality.
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Affiliation(s)
- Moira S Cheung
- Department of Paediatric Endocrinology, Evelina London Children's Hospital, London, UK
| | - Melita Irving
- Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alessandra Cocca
- Department of Paediatric Endocrinology, Evelina London Children's Hospital, London, UK
| | - Rui Santos
- Department of Paediatric Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Meera Shaunak
- Department of Paediatric Endocrinology, Evelina London Children's Hospital, London, UK
| | - Harry Dougherty
- Department of Paediatric Endocrinology, Evelina London Children's Hospital, London, UK
| | - Ata Siddiqui
- Department of Neuroradiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Gringras
- Department of Sleep and Neurodisability, Evelina London Children's Hospital, London, UK
| | - Dominic Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital, London, UK
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Högler W, Ward LM. New developments in the management of achondroplasia. Wien Med Wochenschr 2020; 170:104-111. [PMID: 32144686 PMCID: PMC7098936 DOI: 10.1007/s10354-020-00741-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/13/2020] [Indexed: 12/14/2022]
Abstract
Achondroplasia is the most common form of disproportionate short stature. A dominantly inherited FGFR3 mutation permanently activates the fibroblast growth factor receptor 3 (FGFR3) and its downstream mitogen-activated protein kinase (MAPK) signalling pathway. This inhibits chondrocyte differentiation and puts a break on growth plate function, in addition to causing serious medical complications such as foramen magnum and spinal stenosis and upper airway narrowing. A great deal has been learned about complications and consequences of FGFR3 activation and management guidance is evolving aimed to reduce the increased mortality and morbidity in this condition, particularly deaths from spinal cord compression and sleep apnoea in infants and small children. To date, no drugs are licensed for treatment of achondroplasia. Here, we report on the various substances in the drug development pipeline which target elements in molecular disease mechanism such as FGF (fibroblast growth factor) ligands, FGFR3, MAPK signalling as well as the C‑type natriuretic peptide receptor NPR‑B (natriuretic peptide receptor B).
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Affiliation(s)
- Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Krankenhausstraße 26-30, 4020, Linz, Austria. .,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
| | - Leanne M Ward
- Departments of Paediatrics and Surgery, University of Ottawa, Ottawa, Canada.,Division of Endocrinology and Metabolism, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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