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Tumminelli C, Pastore S, Taddio A. Chronic limping in childhood, what else other than juvenile idiopathic arthritis: a case series. Pediatr Rheumatol Online J 2023; 21:142. [PMID: 38001451 PMCID: PMC10668342 DOI: 10.1186/s12969-023-00927-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Limping is a common clinical symptom in childhood; different clinical conditions may lead to limping and the diagnosis of the underlying cause may often be a challenge for the pediatrician. CASE PRESENTATION We describe the clinical manifestations, radiological pictures and disease course of other causes of limping in childhood, through a case series of seven cases and a brief discussion of each disease. CONCLUSIONS although trauma is the most common cause of acute limping, when there is no history of traumatic events and the limping has a chronic course, Juvenile Idiopathic Arthritis is usually the most likely clinical diagnosis. However, other some rare conditions should be taken into account if JIA is not confirmed or if it presents with atypical clinical picture.
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Affiliation(s)
| | - Serena Pastore
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo" (IRCCS), Trieste, Italy
| | - Andrea Taddio
- University of Trieste, Trieste, Italy.
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo" (IRCCS), Trieste, Italy.
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Bağrul İ, Ceylaner S, Yildiz YT, Tuncez S, Aydin EA, Bağlan E, Ozdel S, Bülbül M. A novel mutation in the proteoglycan 4 gene causing CACP syndrome: two sisters report. Pediatr Rheumatol Online J 2023; 21:8. [PMID: 36694203 PMCID: PMC9875468 DOI: 10.1186/s12969-023-00793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome, caused by biallelic pathogenic mutations in the proteoglycan 4 (PRG4) gene, is characterized by early-onset camptodactyly, noninflammatory arthropathy, coxa vara deformity, and rarely, pericardial effusion. This syndrome can mimic juvenile idiopathic arthritis. CACP syndrome is caused by mutations in the proteoglycan 4 (PRG4) gene. To date, only 36 pathogenic mutations have been reported in this gene, but none have been reported from Azerbaijan. CASE PRESENTATION Herein, we report two siblings presented with chronic polyarthritis, had a prior diagnosis of juvenile idiopathic arthritis, but was subsequently diagnosed as CACP syndrome with novel mutation in the PRG4 gene. CONCLUSION Our report expands the knowledge of PRG4 mutations, which will aid in CACP patient counseling.
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Affiliation(s)
- İlknur Bağrul
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Serdar Ceylaner
- Department of Genetics, Intergen Genetics Centre, Ankara, Turkey
| | - Yasemin Tasci Yildiz
- Department of Pediatric Radiology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Serife Tuncez
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Elif Arslanoglu Aydin
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Esra Bağlan
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Semanur Ozdel
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Mehmet Bülbül
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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Madhusudan S, Gupta A, Prakash M, Matta D, Suri D, Singh S. Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome: a mimicker of juvenile idiopathic arthritis. Scand J Rheumatol 2015; 45:77-78. [PMID: 26508154 DOI: 10.3109/03009742.2015.1085085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- S Madhusudan
- a Department of Paediatrics , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - A Gupta
- a Department of Paediatrics , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - M Prakash
- b Department of Radiodiagnosis , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - D Matta
- c Centre for DNA Fingerprinting and Diagnostics , Hyderabad , India
| | - D Suri
- a Department of Paediatrics , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - S Singh
- a Department of Paediatrics , Postgraduate Institute of Medical Education and Research , Chandigarh , India
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Albuhairan I, Al-Mayouf SM. Camptodactyly-arthropathy-coxavara-pericarditis syndrome in Saudi Arabia: Clinical and molecular genetic findings in 22 patients. Semin Arthritis Rheum 2013; 43:292-6. [DOI: 10.1016/j.semarthrit.2012.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 10/24/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
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Murphy JM, Vanderhave KL, Urquhart AG. Total hip arthroplasty in adolescents with severe hip arthropathy and dysplasia associated with camptodactyly-arthropathy-coxa vara-pericarditis syndrome. J Arthroplasty 2012; 27:1581.e5-8. [PMID: 22386609 DOI: 10.1016/j.arth.2012.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 01/12/2012] [Indexed: 02/01/2023] Open
Abstract
Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a rare disorder. Patients with this syndrome experience early symptomatic arthropathy of the hips. We report a case of adolescent siblings with bilateral arthropathy associated with CACP syndrome in which total hip arthroplasty was performed as treatment of severe associated disability. Postoperative Harris Hip Scores for patient 1 were 86 for the right at 18 months and 96 for the left at 12 months. Postoperative Harris Hip Score at 6 months for patient 2 was 53; however, he had good range of motion and lacked deformity. Based on our limited experience and the limited available clinical data, we feel that total hip arthroplasty is a reasonable treatment option for adolescents with debilitating hip arthropathy associated with CACP syndrome.
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Affiliation(s)
- Joshua M Murphy
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Al-Mayouf SM. Familial Arthropathy in Saudi Arabian Children: Demographic, Clinical, and Biochemical Features. Semin Arthritis Rheum 2007; 36:256-61. [DOI: 10.1016/j.semarthrit.2006.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 07/25/2006] [Accepted: 08/12/2006] [Indexed: 11/26/2022]
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Offiah AC, Woo P, Prieur AM, Hasson N, Hall CM. Camptodactyly-Arthropathy-Coxa Vara-Pericarditis Syndrome Versus Juvenile Idiopathic Arthropathy. AJR Am J Roentgenol 2005; 185:522-9. [PMID: 16037531 DOI: 10.2214/ajr.185.2.01850522] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our article was to highlight the important clinical and radiographic features of camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome. In particular, we emphasize those features that allow differentiation of CACP syndrome from juvenile idiopathic arthropathy. CONCLUSION CACP syndrome should be considered in all patients who present with a noninflammatory arthropathy or with "atypical juvenile idiopathic arthritis," particularly if radiographs reveal an absence of erosions. In the correct clinical setting, large acetabular cysts on pelvic radiographs may be considered pathognomonic of CACP syndrome.
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Affiliation(s)
- Amaka C Offiah
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond St., London WC1N 3JH, UK
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Abstract
This article reviews the current use of the wide variety of imaging modalities now available, presenting the imaging features of common and important causes of acute and chronic rheumatic disorders including juvenile idiopathic arthritis, spondyloarthropathies/enthesitis-related arthritis, sepsis, autoimmune diseases, vasculitis, and osteoporosis.
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Affiliation(s)
- Paul Babyn
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada.
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Shayan K, Ho M, Edwards V, Laxer R, Thorner PS. Synovial pathology in camptodactyly-arthropathy-coxa vara-pericarditis syndrome. Pediatr Dev Pathol 2005; 8:26-33. [PMID: 15702367 DOI: 10.1007/s10024-004-3035-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Accepted: 10/06/2004] [Indexed: 10/25/2022]
Abstract
At least 25 families with camptodactyly-arthropathy-coxa vara-pericarditis (CACP syndrome) have been reported, with descriptions of a distinctive synovial pathology based largely on light microscopy. Although described as "proliferative," with numerous multinucleated giant cells, the natures of proliferating cells and giant cells have not been determined. To clarify the pathogenesis of this disorder, we studied 3 patients who had CACP syndrome and underwent synovial biopsy. Cells in the biopsies were studied by immunohistochemistry and electron microscopy. Giant cells were identified as macrophage in origin based on CD68 expression and electron microscopic features of macrophages. Most cells in the synovium were CD68 positive, in keeping with macrophages. The degree of proliferation in synovial biopsies was estimated by MIB1 immunostaining, which showed that up to 30% of cells were cycling compared with fewer than 10% in control synovial biopsies. None of the giant cells was cycling. By double immunostaining, proliferating cells were determined to be fibroblastic synoviocytes rather than macrophages. Thus the proliferative synovitis in this CACP syndrome can be more accurately thought of as hypercellularity by infiltrating macrophages with a contribution by proliferating fibroblastic synoviocytes. The synoviocyte proliferation is likely a response to the underlying genetic mutations involving the proteoglycan-4 (or CACP) gene. The encoded protein normally acts as a lubricant and possibly controls cell proliferation. Loss of one or another of these functions may be a possible mechanism that leads to synoviocyte proliferation in this disease, but the exact pathophysiology leading to this change requires further study.
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Affiliation(s)
- Katayoon Shayan
- Division of Pathology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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Choi BR, Lim YH, Joo KB, Paik SS, Kim NS, Lee JK, Yoo DH. Camptodactyly, arthropathy, coxa vara, pericarditis (CACP)syndrome: a case report. J Korean Med Sci 2004; 19:907-10. [PMID: 15608409 PMCID: PMC2816297 DOI: 10.3346/jkms.2004.19.6.907] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The camptodactyly-arthropathy-coxa vara-pericarditis syndrome (CACP) is characterized by congenital or early-onset camptodactyly, childhood-onset noninflammatory arthropathy associated with synovial hyperplasia. Some patients have progressive coxa vara deformity and/or noninflammatory pericardial effusion. CACP is inherited as an autosomal recessive mode and the disease gene is assigned to a 1.9-cM interval on human chromosome 1q25-31. We describe a 10-yr-old boy who has typical features of CACP without familial association.
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Affiliation(s)
- Byung-Ryul Choi
- The Hospital of Rheumatic Diseases, Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Young-Hyo Lim
- The Hospital of Rheumatic Diseases, Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Kyung-Bin Joo
- Department of Diagnostic Radiology, Hanyang University, Seoul, Korea
| | - Seung Sam Paik
- Department of Pathology, Hanyang University, Seoul, Korea
| | - Nam Su Kim
- Department of Pediatrics, Hanyang University, Seoul, Korea
| | | | - Dae-Hyun Yoo
- The Hospital of Rheumatic Diseases, Department of Internal Medicine, Hanyang University, Seoul, Korea
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Faivre L, Prieur AM, Le Merrer M, Hayem F, Penet C, Woo P, Hofer M, Dagoneau N, Sermet I, Munnich A, Cormier-Daire V. Clinical variability and genetic homogeneity of the camptodactyly-arthropathy-coxa vara-pericarditis syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 2000; 95:233-6. [PMID: 11102929 DOI: 10.1002/1096-8628(20001127)95:3<233::aid-ajmg9>3.0.co;2-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The camptodactyly-arthropathy-coxa vara-pericarditis syndrome (CACP) is an autosomal recessive condition characterized by the association of congenital or early onset camptodactyly and noninflammatory arthropathy with synovial hyperplasia. Progressive coxa vara deformity and/or noninflammatory pericardial or pleural effusions have been observed in some patients. Recently, the disease gene has been assigned to human chromosome region 1q25-q31, and truncating mutations have been identified in the megakaryocyte stimulating factor gene. Studying 12 patients from 8 unrelated families, we emphasized hip and spine involvement, particularly in the course of the disease as shown in a 58-year-old patient. Despite clinical variability, linkage studies support genetic homogeneity of the disease.
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Affiliation(s)
- L Faivre
- Département de Génétique, Hôpital des Enfants Malades, Paris, France
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Bahabri SA, Suwairi WM, Laxer RM, Polinkovsky A, Dalaan AA, Warman ML. The camptodactyly-arthropathy-coxa vara-pericarditis syndrome: clinical features and genetic mapping to human chromosome 1. ARTHRITIS AND RHEUMATISM 1998; 41:730-5. [PMID: 9550484 DOI: 10.1002/1529-0131(199804)41:4<730::aid-art22>3.0.co;2-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To delineate the clinical features in patients with the autosomal recessive camptodactyly-arthropathy-coxa vara-pericarditis syndrome (CACP) and to determine the location of the involved gene. METHODS Eight affected individuals (ages 2-15 years) with CACP from 4 consanguineous kindreds were clinically evaluated. Four patients are newly described and 4 have been reported previously. Findings were compared with those in 21 other previously reported cases. DNA obtained from the 8 affected patients and their available siblings and parents was used in a genome-wide search for linkage. RESULTS Congenital camptodactyly and childhood-onset noninflammatory arthropathy were present in all affected patients. Seven patients developed bilateral coxa vara deformity, and 1 developed coxa magna with cystic erosions. Two of the patients also had symptoms or signs of pericarditis. A genome-wide search for linkage identified homozygosity for a series of genetic markers on human chromosome 1q in all affected patients. The marker D1S191 yielded a maximum logarithm of the odds ratio (LOD score) of 3.3 at theta = 0. The CACP gene lies within a 1.9-cM candidate interval defined by the markers D1S2107 and D1S222. CONCLUSION The principal features of the CACP syndrome are congenital or early-onset camptodactyly and childhood-onset noninflammatory arthropathy. Coxa vara deformity or other dysplasia associated with progressive hip disease may develop over time. Clinical pericarditis may also occur. A locus responsible for causing CACP syndrome is assigned to a 1.9-cM interval on human chromosome 1q25-31 by homozygosity mapping. This now facilitates the identification of the responsible gene and permits testing for locus homogeneity in other CACP kindreds.
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Affiliation(s)
- S A Bahabri
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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