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Thammaroj P, Chowchuen P, Foocharoen C. Clinical course and factors associated with progressive acro-osteolysis in early systemic sclerosis: a retrospective cohort study. Sci Rep 2024; 14:5129. [PMID: 38429484 PMCID: PMC10907566 DOI: 10.1038/s41598-024-55877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/28/2024] [Indexed: 03/03/2024] Open
Abstract
To examine clinical course of early systemic sclerosis (SSc) and identify factors for progression of acro-osteolysis by a retrospective cohort study. Dual time-point hand radiography was performed at median interval (range 3.0 ± 0.4 years) in 64 recruited patients. Progressive acro-osteolysis was defined as the worsening of severity of acro-osteolysis according to rating scale (normal, mild, moderate, and severe). Incidence of the progression was determined. Cox regression was analyzed for the predictors. A total of 193.6 per 100 person-years, 19/64 patients had progressive acro-osteolysis with incidence of 9.8 per 100-person-years (95% CI 6.3-15.4). The median time of progressive acro-osteolysis was 3.5 years. Rate of progression increased from 1st to 3rd years follow-up with the progression rate at 1-, 2- and 3-years were 0, 2.0 and 18.3%, respectively. Patients with positive anti-topoisomerase I tended to have more progressive acro-osteolysis but no significant predictors on Cox regression. 44%, 18%, and 33% of who had no, mild, and moderate acro-osteolysis previously developed progression and 10 turned to be severe acro-osteolysis. In conclusion, the incidence of progressive acro-osteolysis was uncommon in early SSc but the rate of progression was pronouncedly increasing after three years follow-up. A half of the patients progressed to severe acro-osteolysis.
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Affiliation(s)
- Punthip Thammaroj
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Rd, Nai-Mueang, Mueang District, Khon Kaen, 40002, Thailand.
| | - Prathana Chowchuen
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Rd, Nai-Mueang, Mueang District, Khon Kaen, 40002, Thailand
| | - Chingching Foocharoen
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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2
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Badiee F, Fatemi A, Zahedpasha R, Gharib MH, Jokar M, Livani S, Aghaie M, Abdolahi N. Hands and feet radiologic involvements in systemic sclerosis. BMC Rheumatol 2023; 7:9. [PMID: 37208734 DOI: 10.1186/s41927-023-00336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/04/2023] [Indexed: 05/21/2023] Open
Abstract
AIM Systemic sclerosis (SSc) is a rare autoimmune disorder characterized by vascular and fibrosing involvement of the skin and internal organs. In this study, we determined the prevalence and characteristics of radiological hands and feet involvements in Iranian SSc patients to identify the associations between clinical features and radiologic findings. METHODS 43 SSc patients (41 women and 2 men), with a median age of 44.8 years (ranges 26-70 years) and a mean disease duration of 11.8 years (ranges 2-28 years) were studied in this cross-sectional study. RESULTS 42 patients had radiological changes both in their hands and feet. Only one patient had alteration just in hand. The most frequent changes that we found in hand were Juxta-articular Osteoporosis (93%), Acro-osteolysis (58.2%), and Joint Space Narrowing (55.8%). The prevalence of joint space narrowing or acro-osteolysis was higher in subjects with active skin involvement [modified Rodnan skin score (mRSS) > 14] [16/21 vs. 4/16 for patients with inactive skin involvement (mRSS < 14); p = 0.002]. The most frequent changes that we found in the foot were Juxta-articular Osteoporosis (93%), Acro-osteolysis (46.5%), Joint Space Narrowing (58.1%), and subluxation (44.2%). The presence of anti-ccp antibody was detected in 4 (9.3%), while positive rheumatoid factor was found in 13 (30.2%) of SSc patients. CONCLUSION This study corroborates that arthropathy is common in SSc patients. The introduction of the specific radiological involvements of SSc needs to be confirmed by further studies, in order to define the appropriate prognosis and treatment of patients.
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Affiliation(s)
- Fatemeh Badiee
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Fatemi
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Zahedpasha
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Hadi Gharib
- Department of Radiology, School of Medicine, 5Th Azar Hospital, Gorgan, Golestan, Iran
- Golestan University of Medical Sciences, Gorgan, Golestan, Iran, Islamic Republic of
| | - Mohammadhassan Jokar
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Somayeh Livani
- Golestan University of Medical Sciences, Gorgan, Golestan, Iran, Islamic Republic of
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Gorgan, Iran, Islamic Republic of
| | - Mehrdad Aghaie
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Nafiseh Abdolahi
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
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Affiliation(s)
- Jannie Dahl Hald
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark; Centre for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Denmark.
| | - Signe Beck-Nielsen
- Centre for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Pernille Axel Gregersen
- Centre for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Denmark; Department of Clinical Genetics, Aarhus University Hospital, Denmark
| | - Hans Gjørup
- Centre of Oral Health in Rare Diseases, Department of Maxillofacial Surgery, Aarhus University Hospital, Denmark
| | - Bente Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Kim KJ, Hong N, Lee S, Shin S, Rhee Y. Exploratory use of romosozumab for osteoporosis in a patient with Hajdu-Cheney syndrome: a case report. Osteoporos Int 2023; 34:1005-1009. [PMID: 36622389 DOI: 10.1007/s00198-023-06668-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/30/2022] [Indexed: 01/10/2023]
Abstract
Hajdu-Cheney syndrome (HCS) is an inherited skeletal disorder caused by mutations in the Notch homolog protein 2 gene (NOTCH2). Treatment of this rare disease is challenging because there are no established guidelines worldwide. Previous case reports using bisphosphonates, denosumab, or teriparatide suggested that curative treatment for HCS did not exist yet in terms of preventing the disease progression. Therefore, the efficacy of romosozumab for osteoporosis in patients with HCS needs to be evaluated. Herein, we report the case of a 43-year-old woman who had progressive acro-osteolysis and repeated fractures since the age of 29 years. Next-generation sequencing confirmed HCS with a mutation at nucleotide 6758G>A, leading to Trp2253Ter replacement in NOTCH2. Romosozumab treatment was initiated because she had already received bisphosphonate for more than 10 years at other hospitals. After 1 year of romosozumab treatment, the bone mineral density (BMD) increased by 10.2%, 6.3%, and 1.3%, with Z scores of -2.9, -1.6, and -1.2 at the lumbar spine, femoral neck, and total hip, respectively. In addition, C-telopeptide was suppressed by 26.4% (0.121 to 0.089 ng/mL), and procollagen type I N-terminal propeptide increased by 18.7% (25.2 to 29.9 ng/mL). This was the first report of romosozumab treatment in patient with osteoporosis and HCS in Korea. One year of romosozumab treatment provided substantial gains in BMD with maintaining the last acro-osteolytic status without deteriorating, representing a possible treatment option for HCS.
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Affiliation(s)
- K J Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - N Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - S Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, 26426, Republic of Korea
| | - S Shin
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Y Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Bailey CT, Zelaya R, Kayder OO, Cecava ND. Acro-osteolysis: imaging, differential diagnosis, and disposition review. Skeletal Radiol 2023; 52:9-22. [PMID: 35969258 DOI: 10.1007/s00256-022-04145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/02/2023]
Abstract
Acro-osteolysis is the osseous destruction of the hand or foot distal phalanges. The categories of the disease include terminal tuft, midshaft, or mixed types. Recognition of acro-osteolysis is straightforward on radiographs, but providing an accurate differential diagnosis and appropriately recommending advanced imaging or invasive tissue diagnosis can be more elusive. A radiologist's ability to provide advanced assessment can greatly aid clinicians in expedient diagnosis and management of the array of diseases presenting with acro-osteolysis.
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Echaubard S, Pebrel-Richard C, Chausset A, Kemeny JL, Merlin E, Laffargue F. Is an association of acro-osteolysis, bone fragility, and enchondromatosis a newfound disease caused by an amplification of PTHLH? A case report. Pediatr Rheumatol Online J 2022; 20:58. [PMID: 35908058 PMCID: PMC9338489 DOI: 10.1186/s12969-022-00720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Acro-osteolysis (AO) refers to resorption of the distal finger and toe phalanges. It displays two patterns: (i) diffuse AO and (ii) transverse or bandlike AO. AO can be a sign of local distress (e.g. of toxic origin), but is very often a sign of a constitutional or systemic acquired disorder. CASE PRESENTATION A 15-year-old girl was referred to a paediatric rheumatologist for recurrent pain in her fingertips. She presented a particular cross-sectional AO associated with the presence of intraosseous cysts and bone fragility with atypical fractures. Initial laboratory tests and radiological examination did not allow an etiological diagnosis. Genetic studies revealed a 12p11.22-p11.23 microduplication of 900 kb including the PTHLH (parathyroid hormone-like hormone) gene, which encodes for a hormone involved in the regulation of endochondral ossification and differentiation of chondrocytes, via its PTHLH receptor. CONCLUSIONS To date, 12p11.22-p11.23 duplications have been reported in five families with skeletal abnormalities, and in particular AO and enchondromatosis associated with bone fragility. This new observation, added to the other reported cases, suggests a close relationship between the presence of this microduplication and the skeletal abnormalities found in the patient. We suggest the descriptive name ABES (acro-osteolysis, bone fragility and enchondromatosis syndrome) to designate this disorder.
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Affiliation(s)
- Stéphane Echaubard
- Service de Pédiatrie, CHU de Clermont-Ferrand, CHU Estaing, 1 place Lucie & Raymond Aubrac, 63003, Clermont-Ferrand, France.
| | - Céline Pebrel-Richard
- grid.411163.00000 0004 0639 4151Service de Cytogénétique Médicale, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Aurélie Chausset
- grid.411163.00000 0004 0639 4151Service de Pédiatrie, CHU de Clermont-Ferrand, CHU Estaing, 1 place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, France ,grid.411163.00000 0004 0639 4151Unité CRECHE, INSERM CIC 1405, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Jean-Louis Kemeny
- grid.411163.00000 0004 0639 4151Service d’Anatomo-Pathologie, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Etienne Merlin
- grid.411163.00000 0004 0639 4151Service de Pédiatrie, CHU de Clermont-Ferrand, CHU Estaing, 1 place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, France ,grid.411163.00000 0004 0639 4151Unité CRECHE, INSERM CIC 1405, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Fanny Laffargue
- grid.411163.00000 0004 0639 4151Service de Génétique Médicale, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
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Kamath SU, Krishnamurthy SL, Annappa R. Hereditary Sensory and Autonomic Neuropathy Type II in a Female Child with Multiple Orthopaedic Ailments: Diagnosis and Operative Management. Indian J Orthop 2022; 56:1482-7. [PMID: 35928661 DOI: 10.1007/s43465-022-00671-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
Hereditary Sensory and Autonomic Neuropathy (HSAN) Type II is an autosomal recessive genetic disease which presents predominantly with sensory neuropathy and neuropathic ulcers. HSAN Type II is a rare disease, and in the few cases that have been reported, the focus has been on identifying genetic markers of the disease. Orthopaedic conditions may be a major presentation of the disease, and the prevention of superficial trauma and foot care is the only definitive management.
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8
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Sharma A, Upmanyu A, Parate AR, Kasat VO. Pycnodysostosis- a rare disorder with distinctive craniofacial dysmorphia. A case report. J Oral Biol Craniofac Res 2021; 11:529-535. [PMID: 34377661 PMCID: PMC8327332 DOI: 10.1016/j.jobcr.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/18/2021] [Accepted: 07/10/2021] [Indexed: 11/23/2022] Open
Abstract
Pycnodysostosis is a rare autosomal recessive condition caused by the mutation of CTSK gene. CTSK regulates the activity of Cathepsin K which is responsible for osteoclast-mediated bone resorption. This mutation causes the bones to become dense, sclerotic, brittle, and thus, prone to fracture. Affected individuals have normal cognitive development and life expectancy, however, the quality of life depends on the early diagnosis of the condition. The patient presents with striking clinical (short stature, brachydactyly) and radiological (frontal and parieto-occipital bossing, open sutures, and fontanelles, acro-osteolysis of terminal phalanges) features making the diagnosis clinico-radiographic. In atypical or mild cases with overlapping features, gene mapping is advocated. A plethora of dental anomalies and characteristic craniofacial dysmorphia puts the dentist in a position to diagnose such a case.
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Affiliation(s)
- Anka Sharma
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Aurangabad, Maharashtra, 431001, India
| | | | - Amit R Parate
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Aurangabad, Maharashtra, 431001, India
| | - Vikrant O Kasat
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Aurangabad, Maharashtra, 431001, India
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9
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Limenis E, Stimec J, Kannu P, Laxer RM. Lost bones: differential diagnosis of acro-osteolysis seen by the pediatric rheumatologist. Pediatr Rheumatol Online J 2021; 19:113. [PMID: 34261502 PMCID: PMC8278612 DOI: 10.1186/s12969-021-00596-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Acro-osteolysis is a radiographic finding which refers to bone resorption of the distal phalanges. Acro-osteolysis is associated with various conditions and its presence should prompt the clinician to search for the underlying etiology. The aim of this review is to discuss disorders with which acro-osteolysis is associated and their distinguishing features, with a focus on the pediatric population. METHODS A targeted literature review was performed using the term "acro-osteolysis" in combination with other key terms. The primary search results were supplemented using reference citations. Articles published prior to the year 2000 were included if they described additional associations not encountered in the more recent literature. RESULTS Genetic disorders (particularly primary hypertrophic osteoarthropathy and skeletal dysplasias) and rheumatic diseases (particularly psoriatic arthritis and systemic sclerosis) are the most frequently encountered conditions associated with acro-osteolysis in children. Hyperparathyroidism, neuropathy, local trauma and thermal injury, and spinal dysraphism should also be included in the differential diagnosis. CONCLUSION Although acro-osteolysis is uncommon, its presence should prompt the clinician to consider a differential diagnosis based on clinical and radiographic features.
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Affiliation(s)
- Elizaveta Limenis
- Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| | - Jennifer Stimec
- grid.42327.300000 0004 0473 9646Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Peter Kannu
- grid.42327.300000 0004 0473 9646Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Ronald M. Laxer
- grid.42327.300000 0004 0473 9646Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
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10
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Bollow M. [Atypical arthritis of the hands : Collagenosis-part 2]. Radiologe 2021; 61:470-482. [PMID: 33792744 DOI: 10.1007/s00117-021-00842-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Progressive systemic scleroderma (PSS) and mixed connective tissue disease (MCTD) represent vasculitic autoimmune diseases from the group of collagenoses with manifestations in various organ systems such as the skin, the internal organs and the joints. OBJECTIVE To present the atypical arthritis patterns of the hands in PSS and MCTD that differ from those in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in the context of clinical and serologic findings and in consideration of the classification of PSS and MCTD. MATERIALS AND METHODS Narrative review based on the current literature on the subject from the radiological and rheumatological point of view. RESULTS In PSS, combinations of acral soft tissue atrophy, nonreactive acro-osteolysis, and interstitial calcifications can be visualized by projection radiography, which in the final stage can lead to a scleroderma claw hand. Digital pharmacoangiography of the hands can be used to reliably diagnose manifest vascular occlusions of the digital arteries. MCTD is characterized by various overlapping symptoms of at least two systemic autoimmune diseases and most frequently presents in the hand with symmetrical involvement of the PIP (proximal interphalangeal), MCP (metacarpophalangeal) and wrist joints with the manifestation of so-called "puffy fingers". CONCLUSIONS The presented morphological atypical arthritis patterns of the hands in PSS and MCTD differ considerably from the typical patterns in the hands in RA and PsA. MRI is useful to diagnose early stages and pharmacoangiography can be used to differentiate between temporary and manifest digital vascular occlusions.
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Affiliation(s)
- Matthias Bollow
- Klinik für diagnostische und interventionelle Radiologie, Augusta-Kranken-Anstalt Bochum, Bergstraße 26, 44791, Bochum, Deutschland. .,Ruhr-Universität Bochum, Bochum, Deutschland.
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11
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Jiménez I, Medina-Gontier J, Caballero J, Medina J. Hand Deformities in Hajdu-Cheney Syndrome: A Case Series of 3 Patients Across 3 Consecutive Generations. J Hand Surg Am 2021; 46:73.e1-73.e5. [PMID: 32241674 DOI: 10.1016/j.jhsa.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/20/2019] [Accepted: 02/14/2020] [Indexed: 02/02/2023]
Abstract
Hajdu-Cheney syndrome is a rare condition characterized by acro-osteolysis, osteoporosis, and multiple craniofacial anomalies. The goal of treatment is to reduce the associated symptoms and to prevent osteoporotic fractures. This is a report of 3 patients across consecutive generations demonstrating variable phenotypic severity. The hand surgeon was the first medical care provider visited by the patients because of the shortening of the fingers.
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Affiliation(s)
- Isidro Jiménez
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain; Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | | | - Jonathan Caballero
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - José Medina
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain; Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Valenzuela A, Baron M, Rodriguez-Reyna TS, Proudman S, Khanna D, Young A, Hinchcliff M, Steen V, Gordon J, Hsu V, Castelino FV, Schoenfeld S, Li S, Wu JY, Fiorentino D, Chung L. Calcinosis is associated with ischemic manifestations and increased disability in patients with systemic sclerosis. Semin Arthritis Rheum 2020; 50:891-896. [PMID: 32898758 DOI: 10.1016/j.semarthrit.2020.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Calcinosis is a debilitating complication of systemic sclerosis (SSc) with no effective treatments. We sought to identify clinical correlations and to characterize complications and disability associated with calcinosis in a multi-center, international cohort of SSc patients. METHODS We established a cohort of 568 consecutive SSc patients who fulfill 2013 revised ACR/EULAR criteria at 10 centers within North America, Australia, and Mexico. Calcinosis was defined as subcutaneous calcium deposition by imaging and/or physical examination, or a clear history of extruded calcium. All patients completed the Scleroderma Health Assessment Questionnaire Disability Index and Cochin Hand Functional Scale. RESULTS 215 (38%) patients had calcinosis. In multivariable analysis, disease duration (OR=1.24, p = 0.029), digital ischemia (OR=1.8, p = 0.002) and Acro-osteolysis (OR=2.97, p = 0.008) were significantly associated with calcinosis. In the subset of patients with bone densitometry (n = 68), patients with calcinosis had significantly lower median T-scores than patients without (-2.2 vs. -1.7, p = 0.004). The most common location of calcinosis lesions was the hands (70%), particularly the thumbs (19%) with decreasing frequency moving to the fifth fingers (8%). The most common complications were tenderness (29% of patients) and spontaneous extrusion of calcinosis through the skin (20%), while infection was rare (2%). Disability and hand function were worse in patients with calcinosis, particularly if locations in addition to the fingers/thumbs were involved. CONCLUSIONS We confirmed a strong association between calcinosis and digital ischemia. Calcinosis in SSc patients most commonly affects the hands and is associated with a high burden of disability and hand dysfunction.
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Affiliation(s)
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Canada
| | - Tatiana S Rodriguez-Reyna
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Department of Immunology and Rheumatology, Mexico
| | - Susanna Proudman
- Royal Adelaide Hospital North Terrace, Rheumatology Unit and Discipline of Medicine, University of Adelaide, Australia
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Department of internal medicine, Division of Rheumatology, USA
| | - Amber Young
- University of Michigan Scleroderma Program, Department of internal medicine, Division of Rheumatology, USA
| | - Monique Hinchcliff
- Yale University School of Medicine, Section of Rheumatology, Allergy and Clinical Immunology, USA
| | | | - Jessica Gordon
- Hospital for Special Surgery, Department of Rheumatology, USA
| | - Vivien Hsu
- Rutgers-RWJ Medical School, Rheumatology Division, USA
| | | | | | - Shufeng Li
- Stanford University School of Medicine, Department of Dermatology, USA
| | - Joy Y Wu
- Stanford University School of Medicine, Department of Medicine, Division of Endocrinology, USA
| | - David Fiorentino
- Stanford University School of Medicine, Department of Dermatology, USA
| | - Lorinda Chung
- Stanford University School of Medicine and Palo Alto VA Health Care System, Department of Immunology and Rheumatology and Dermatology (by courtesy), USA.
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Zeng C, Lin Y, Lu Z, Chen Z, Jiang X, Mao X, Liu Z, Lu X, Zhang K, Yu Q, Wang X, Huang Y, Liu L. Distinct severity of phenotype in Hajdu-Cheney syndrome: a case report and literature review. BMC Musculoskelet Disord 2020; 21:154. [PMID: 32143606 PMCID: PMC7060511 DOI: 10.1186/s12891-020-3181-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Hajdu-Cheney syndrome (HCS) is a rare inherited skeletal disorder caused by pathogenic mutations in exon 34 of NOTCH2. Its highly variable phenotypes make early diagnosis challenging. In this paper, we report a case of early-onset HCS with severe phenotypic manifestations but delayed diagnosis. Case presentation The patient was born to non-consanguineous, healthy parents of Chinese origin. She presented facial anomalies, micrognathia and skull malformations at birth, and was found hearing impairment, congenital heart disease and developmental delay during her first year of life. Her first visit to our center was at 1 year of age due to cardiovascular repair surgery for patent ductus arteriosus (PDA) and ventricular septal defect (VSD). Skull X-ray showed wormian bones. She returned at 7 years old after she developed progressive skeletal anomalies with fractures. She presented with multiple wormian bones, acro-osteolysis, severe osteoporosis, bowed fibulae and a renal cyst. Positive genetic test of a de novo heterozygous frameshift mutation in exon 34 of NOTCH2 (c.6426dupT) supported the clinical diagnosis of HCS. Conclusion This is the second reported HCS case caused by the mutation c.6426dupT in NOTCH2, but presenting much earlier and severer clinical expression. Physicians should be aware of variable phenotypes so that early diagnosis and management may be achieved.
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Affiliation(s)
- Chunhua Zeng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Yunting Lin
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Zhikun Lu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Zhen Chen
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Xiaoling Jiang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Xiaojian Mao
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Zongcai Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Xinshuo Lu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Kangdi Zhang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Qiaoli Yu
- Department of Dentistry, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Xiaoya Wang
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Yonglan Huang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd, Guangzhou, 510623, China.
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14
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Jirečková J, Magner M, Lambert L, Baxová A, Leiská A, Kopečková L, Fajkusová L, Zeman J. The Age Dependent Progression of Hajdu-Cheney Syndrome in Two Families. Prague Med Rep 2019; 119:156-164. [PMID: 30779700 DOI: 10.14712/23362936.2019.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Hajdu-Cheney syndrome (HCS) is a rare multi-system disease with autosomal dominant inheritance and skeletal involvement, resulting mostly in craniofacial dysmorphy with mid-face hypoplasia, dental anomalies, short stature, scoliosis, shortening of the digits and nail beds, acro-osteolysis and osteoporosis. We report the progression of clinical and radiographic findings in five patients with Hajdu-Cheney syndrome from two families. A custom capture array designed to capture exons and adjacent intron sequences of 230 selected genes were used for molecular analyses, and the pathogenic variants identified were confirmed by PCR and Sanger sequencing. In both families we observed age-dependent changes in the disease, with a progression of pain in older patients, a shortening of digits and nail beds on both the hands and feet, kyphoscoliosis and the persistence of Wormian bones in lambdoid sutures. Molecular analyses performed in two patients revealed that they are heterozygotes for a c.6255T>A (p.Cys2085*) variant in the NOTCH2 gene, resulting in a premature stop-codon. Bone mineral density (Z-score < -2) did not improved in a girl treated with calcium and vitamin D supplementation during childhood and bisphosphonate during adolescence. Hajdu-Cheney syndrome is a slowly progressive disease with a frequently unfavourable prognosis in elderly patients, especially for the development of dental anomalies, osteoporosis and the progression of skeletal complications requiring orthopedic surgeries.
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Affiliation(s)
- Jitka Jirečková
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Magner
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Lukáš Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Alice Baxová
- Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Alena Leiská
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Lenka Kopečková
- Centre of Molecular Biology and Gene Therapy, Masaryk University in Brno and University Hospital Brno, Brno, Czech Republic
| | - Lenka Fajkusová
- Centre of Molecular Biology and Gene Therapy, Masaryk University in Brno and University Hospital Brno, Brno, Czech Republic
| | - Jiří Zeman
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
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15
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Graversen L, Handrup MM, Irving M, Hove H, Diness BR, Risom L, Svaneby D, Aagaard MM, Vogel I, Gjørup H, Davidsen M, Hellfritzsch MB, Lauridsen E, Gregersen PA. Phenotypic presentations of Hajdu-Cheney syndrome according to age - 5 distinct clinical presentations. Eur J Med Genet 2020; 63:103650. [PMID: 30980954 DOI: 10.1016/j.ejmg.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 11/22/2022]
Abstract
We present five Danish individuals with Hajdu-Cheney syndrome (HJCYS) (OMIM #102500), a rare multisystem skeletal disorder with distinctive facies, generalised osteoporosis and progressive focal bone destruction. In four cases positive genetic screening of exon 34 of NOTCH2 supported the clinical diagnosis; in one of these cases, mosaicism was demonstrated, which, to our knowledge, has not previously been reported. In one case no genetic testing was performed since the phenotype was definite, and the diagnosis in the mother was genetically confirmed. The age of the patients differs widely from ten to 57 years, allowing a natural history description of the phenotype associated with this ultra-rare condition. The evolution of the condition is most apparent in the incremental bone loss leading to osteoporosis and the acro-osteolysis, both of which contribute significantly to disease burden.
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16
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Lambert JC, Baudart P, De Sandre-Giovannoli A, Molin A, Marcelli C. Lamin A/C gene (LMNA) mutation associated with laminopathy: A rare cause of idiopathic acro-osteolysis. Joint Bone Spine 2018; 86:525-527. [PMID: 30528549 DOI: 10.1016/j.jbspin.2018.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/28/2018] [Indexed: 12/22/2022]
Affiliation(s)
| | - Pauline Baudart
- CHU de Caen, department of rheumatology, avenue de la Côte de Nacre, Caen, 14000, France
| | - Annachiara De Sandre-Giovannoli
- AP-HM, department of medical genetics, La Timone Children's hospital, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - Arnaud Molin
- CHU de Caen, department of genetics, avenue de la Cote de Nacre, Caen, 14000, France
| | - Christian Marcelli
- CHU de Caen, department of rheumatology, avenue de la Côte de Nacre, Caen, 14000, France; Université Caen Normandie, medical School, Caen, 14000, France
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17
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Lin YT, Loh CYY. The 'Te' Technique for Restoring Fingertip Stability Post Traumatic Acro-Osteolysis - A Report and Review of Management Options. J Hand Surg Asian Pac Vol 2017; 22:441-444. [PMID: 29117838 DOI: 10.1142/s0218810417500472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fractures of the distal phalanx can result in bony non-union, resulting in acro-osteolysis and subsequent fingertip instability due to soft tissue dissociation from bone. Conventional methods of treating this involve osseous fixation, but do not address the laxity and lack of soft tissue stability with bone. Current techniques also do not address the management of such conditions if bony fragments are too small to reduce. We present a novel method that addresses both soft tissue and bony deformity in this condition. METHODS A review of current techniques in the literature is provided as well as an in depth description of our technique using a representative case. RESULTS Follow-up results and photographs are presented in this article. Functional assessment is also provided in the article as part of the follow-up. CONCLUSIONS This technique is applicable for cases where severe resorption of distal phalanx has occurred, leaving little or no purchase for bony fixation. Hence, the technique can not only be applied post traumatic acro-osteolysis, but also other conditions where secondary soft tissue lengthening occurs and fingertip instability is formed as a result.
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Affiliation(s)
- Yu-Te Lin
- 1 Center for Vascularized Composite Allotransplantation, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taiwan.,2 College of Medicine, Chang Gung University, Taiwan
| | - Charles Yuen Yung Loh
- 1 Center for Vascularized Composite Allotransplantation, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taiwan.,2 College of Medicine, Chang Gung University, Taiwan
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18
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Jerzakowski G, Lasek T. Letter to the Editor concerning "Hajdu Cheney syndrome; report of a novel NOTCH2 mutation and treatment with denosumab" by G. Adami et al. Bone 2016;92:150-156. Bone 2017; 101:1-2. [PMID: 28411109 DOI: 10.1016/j.bone.2017.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Grzegorz Jerzakowski
- The Department of Trauma Surgery and Orthopedics of 7th Navy Hospital, Gdańsk, Poland.
| | - Tomasz Lasek
- The Department of Trauma Surgery and Orthopedics of 7th Navy Hospital, Gdańsk, Poland
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19
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Rochoux Q, Léon N, Bréhin AC, Michel M, Orcel P, Marcelli C. A case of Hajdu-Cheney syndrome associated with psoriatic rheumatism, two causes of acro-osteolysis. Joint Bone Spine 2017; 85:493-494. [PMID: 28600213 DOI: 10.1016/j.jbspin.2017.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Quitterie Rochoux
- CHU de Caen, Department of Rheumatology, avenue de la Côte-de-Nacre, 14033 Caen, France; Université Caen Normandie, Medical School, 2, rue des Rochambelles, 14000 Caen, France.
| | - Nathalie Léon
- CHU de Caen, Department of Rheumatology, avenue de la Côte-de-Nacre, 14033 Caen, France
| | - Anne-Claire Bréhin
- Université Caen Normandie, Medical School, 2, rue des Rochambelles, 14000 Caen, France; CHU de Caen, Department of Genetics, avenue de la Côte-de-Nacre, 14033 Caen, France
| | - Murielle Michel
- CHU de Caen, Department of Rheumatology, avenue de la Côte-de-Nacre, 14033 Caen, France; Université Caen Normandie, Medical School, 2, rue des Rochambelles, 14000 Caen, France
| | - Philippe Orcel
- Lariboisière University Hospital, Department of Rheumatology, 2, rue Ambroise-Paré, 75010 Paris, France
| | - Christian Marcelli
- CHU de Caen, Department of Rheumatology, avenue de la Côte-de-Nacre, 14033 Caen, France; Université Caen Normandie, Medical School, 2, rue des Rochambelles, 14000 Caen, France
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20
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Choi WS, Park SY, Ban YS, Kim JH. Acro-osteolysis and calcinosis in patient with scleroderma: A case report. Acta Orthop Traumatol Turc 2017; 51:88-90. [PMID: 28017514 DOI: 10.1016/j.aott.2015.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/29/2015] [Accepted: 03/28/2015] [Indexed: 11/24/2022]
Abstract
Acro-osteolysis is a rare disease characterized by bone resorption involving the distal phalanges of the hand. We present a unique case of progressive acro-osteolysis of the distal phalanges and articular calcifications in a patient with scleroderma. The calcified deposit in a proximal interphalangeal joint was excised under local anesthesia. The medical treatment was arranged under the supervision of a rheumatologist.
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21
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Dokou P, Karoussis IK, Papavasiliou G, Kamposiora P, Vrahopoulos TP, Vrotsos JA. Osseointegration of Dental Implants in a Patient with Hajdu-cheney Syndrome. Open Dent J 2016; 10:575-586. [PMID: 27857819 PMCID: PMC5093869 DOI: 10.2174/1874210601610010575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 09/02/2016] [Accepted: 10/06/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Hajdu-Cheney Syndrome (HCS) is a rare hereditary bone metabolism disorder characterized by acro-osteolysis, short stature, craniofacial changes, periodontitis and premature tooth loss. Extensive search of the current literature revealed no reports of implant placement in patients with HCS. Case Report: A 22-year old woman with osteoporosis, generalized advanced chronic periodontitis and premature tooth loss was referred to the Postgraduate Clinic of Periodontology, University of Athens-Greece. The patient was diagnosed in 2001 with HCS. The patient received non-surgical periodontal treatment and several teeth were extracted due to extensive alveolar bone loss. After careful consideration of the possible implications deriving from the patient’s condition and having taken her young age into account, initially, a dental implant was placed in the upper right first premolar region. Specific protocols such as longer healing periods were implemented, so five years after placement and successful osseointegration of this implant, four additional dental implants were placed in the posterior regions of the maxilla and the mandible. Prosthetic rehabilitation followed 6 months after implant placement. Upon completion of periodontal treatment, the patient was enrolled in a periodontal maintenance program. Results: Clinical and radiographic examination of the patient during the periodontal maintenance program after implant placement revealed no abnormalities in the implant region. Conclusion: Patients with HCS suffer from periodontitis, bone destruction and premature tooth loss. This case indicates the successful osseointegration of dental implants in patients with HCS. However, further research is required in order to determine the predictability of dental implant placement in those patients.
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Affiliation(s)
- Panagiota Dokou
- Department of Periodontology, School of Dentistry, University of Athens, Greece
| | - Ioannis K Karoussis
- Department of Periodontology, School of Dentistry, University of Athens, Greece
| | - George Papavasiliou
- Department of Prosthodontics, School of Dentistry, University of Athens, Greece
| | - Phophi Kamposiora
- Department of Prosthodontics, School of Dentistry, University of Athens, Greece
| | | | - John A Vrotsos
- Department of Periodontology, School of Dentistry, University of Athens, Greece
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22
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Abstract
Notch plays an important function in skeletal homeostasis, osteoblastogenesis, and osteoclastogenesis. Hajdu-Cheney syndrome (HCS) is a rare disease associated with mutations in NOTCH2 leading to the translation of a truncated NOTCH2 stable protein. As a consequence, a gain-of-NOTCH2 function is manifested. HCS is inherited as an autosomal dominant disease although sporadic cases exist. HCS is characterized by craniofacial developmental defects, including platybasia and wormian bones, osteoporosis with fractures, and acro-osteolysis. Subjects may suffer severe neurological complications, and HCS presents with cardiovascular defects and polycystic kidneys. An experimental mouse model harboring a HCSNotch2 mutation exhibits osteopenia secondary to enhanced bone resorption suggesting this as a possible mechanism for the skeletal disease. If the same mechanisms were operational in humans, anti-resorptive therapy could correct the bone loss, but not necessarily the acro-osteolysis. In conclusion, HCS is a devastating disease associated with a gain-of-NOTCH2 function resulting in diverse clinical manifestations.
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Affiliation(s)
- Ernesto Canalis
- Departments of Orthopaedic Surgery and Medicine, and the UConn Musculoskeletal Institute, UConn Health, Farmington, CT, 06030-5456, USA.
| | - Stefano Zanotti
- Departments of Orthopaedic Surgery and Medicine, and the UConn Musculoskeletal Institute, UConn Health, Farmington, CT, 06030-5456, USA
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23
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Graille J, Beylot-Barry M, Drapé JL, Doutre MS, Cogrel O. [Tranverse acro-osteolysis: A rare cause of nail dystrophy]. Ann Dermatol Venereol 2016; 143:284-8. [PMID: 26944769 DOI: 10.1016/j.annder.2016.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/20/2015] [Accepted: 01/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acro-osteolysis (AO) involves partial or total destruction of the distal phalanges of the fingers or toes. The range of forms of AO is extremely wide. A distinction is generally made between the acquired forms and the genetic and idiopathic forms. Herein we report a case of idiopathic transverse single-finger AO associated with onychopathy. PATIENT AND METHODS A 48-year-old woman consulted for a nail lesion involving brachyonychia in the right index finger alone (pseudo-clubbing appearance of the finger). The remainder of the clinical examination was normal, particularly in terms of neurological and dermatological investigations. Standard x-rays revealed transverse osteolysis of the middle third of the distal phalanx, occurring solely in the right index finger. DISCUSSION While certainty regarding diagnosis of AO depends upon radiological findings, the radiological appearance is not specific. Two subgroups suggesting aetiological diagnosis may be distinguished: transverse AO with banding and longitudinal AO. With transverse AO, the diaphysis of the distal phalanx presents osteolysis with banding, but with sparing of the base of the band (pseudo-fracture appearance); this appearance is suggestive of toxic causes, congenital familial conditions or repetitive micro-trauma. Upon x-ray examination, the longitudinal forms exhibit concentric resorption of the band and these forms are more often seen in a setting of neurological, vascular or metabolic disorders. The associated nail involvement frequently present helps clarify the diagnosis, with nail plate shape being dependent on the integrity of the underlying bone. CONCLUSION Herein we report the first case of transverse AO in a single finger associated with brachyonychia, and with no discernible cause.
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Affiliation(s)
- J Graille
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - M Beylot-Barry
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - J-L Drapé
- Service de radiologie « B », hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - M-S Doutre
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - O Cogrel
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
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24
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Deprouw C, Feydy A, Giraudet Le Quintrec JS, Ruiz B, Kahan A, Allanore Y. A very rare cause of acro-osteolysis: Hajdu-Cheney syndrome. Joint Bone Spine 2015; 82:455-9. [PMID: 26184537 DOI: 10.1016/j.jbspin.2015.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/17/2015] [Indexed: 12/01/2022]
Abstract
Acro-osteolysis is not uncommon and occurs in several conditions. Additional clinical and paraclinical findings and sometimes the performance of molecular tests can help to clarify the diagnosis. Here, we report the case of a 36-year-old woman who was referred to our department because of acute pain in the extremity of the left index finger. However, subsequent clinical examination also revealed short digits with pseudo-clubbing related to acro-osteolysis. Furthermore, severe osteoporosis, a moderate dysmorphic face, joint hypermobility, biological variables within normal ranges and her clinical history led us to consider the diagnosis of Hajdu-Cheney syndrome. Molecular analysis confirmed the diagnosis with the identification of a mutation in the NOTCH2 gene. The patient received bisphosphonate therapy, which resulted in some clinical and biological improvement 12 months later.
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Affiliation(s)
- Camille Deprouw
- Service de rhumatologie A, hôpital Cochin, AP-HP, université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Antoine Feydy
- Service de radiologie B, hôpital Cochin, AP-HP, université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Janine-Sophie Giraudet Le Quintrec
- Service de rhumatologie A, hôpital Cochin, AP-HP, université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Orphanet - Inserm US14, plateforme maladies rares, 96, rue Didot, 75014 Paris, France
| | - Barbara Ruiz
- Inserm U1016 UMR 8104, hôpital Cochin, université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - André Kahan
- Service de rhumatologie A, hôpital Cochin, AP-HP, université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Yannick Allanore
- Service de rhumatologie A, hôpital Cochin, AP-HP, université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016 UMR 8104, hôpital Cochin, université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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25
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Abstract
Hajdu-Cheney syndrome is a very rare connective tissue disorder. It has autosomal dominant inheritance or may occur due to spontaneous de novo mutation. Recent research suggests that it is caused by heterozygous mutation of terminal exon of NOTCH 2. Most characteristic findings include transverse band of acro-osteolysis involving the phalanges of both hands and feet and osteoporosis and deformities involving skull, mandible, spine and other bones. Patient may progressively develop kyphoscoliosis, basilar invagination, and bone fractures due to bone softening. Treatment is symptomatic. In this case report we present clinical and radiological features of a 43-year-old female patient who presented with features of Hajdu-Cheney syndrome.
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Affiliation(s)
- Shailesh Palav
- Department of Radiology, Goa Medical College, Bambolim, Goa, India
| | - Jeevan Vernekar
- Department of Radiology, Goa Medical College, Bambolim, Goa, India
| | - Sweta Pereira
- Department of Radiology, Goa Medical College, Bambolim, Goa, India
| | - Ankush Desai
- Department of Endocrinology, Goa Medical College, Bambolim, Goa, India
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26
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Gu JM, Hu YQ, Zhang H, Wang C, Hu WW, Yue H, Liu YJ, Zhang ZL. A mutation in NOTCH2 gene in a Chinese patient with Hajdu-Cheney syndrome. Joint Bone Spine 2013; 80:548-9. [PMID: 23566664 DOI: 10.1016/j.jbspin.2013.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 02/10/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Jie-mei Gu
- Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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27
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Abstract
A 25-year-old woman patient presented with shortening of fingers with racket nails and numerous yellowish papules over the hands and forearms for 21 years. X-ray of the hands revealed destructive osteolytic changes in all the terminal phalanges. Skin biopsy from the yellowish papules showed epidermal proliferation, perivascular mononuclear infiltrate, thickening of dermal collagen, septal fibrosis and loss of adipocytes mimicking sclerodermatous changes in the dermis and hypodermis. The patient did not have any history of similar illness in the family or occupational exposure to vinyl chloride. After excluding all other possibilities of acral-osteolysis, we diagnosed the case as idiopathic non-familial variety of acro-osteolysis. This is a rare entity characterized by terminal resorption of fingers, sometimes associated with Raynaud's phenomena and yellowish cutaneous papules.
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Affiliation(s)
- Pijush K Datta
- From the Department of Dermatology, Medical College, Kolkata, India
| | - Sanjay Ghosh
- Department of Dermatology, M G M Medical College and L. S. K. Hospital, Kishanganj, India
| | - Abhishek De
- Department of Dermatology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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