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Maatallah K, Boussaa H, Lassoued Ferjani H, Kaffel D, Hamdi W. Progressive pseudorheumatoid dysplasia: A rare entity mimicking juvenile idiopathic arthritis. Clin Case Rep 2021; 9:e04670. [PMID: 34430024 PMCID: PMC8365860 DOI: 10.1002/ccr3.4670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 11/24/2022] Open
Abstract
Progressive pseudorheumatoid dysplasia can be confused with juvenile idiopathic arthritis. Treatment is mainly symptomatic and the prescription of immunosupressive agents is unnecessary. Surgery may be indicated at advanced stages of the disease.
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Affiliation(s)
- Kaouther Maatallah
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
| | - Hiba Boussaa
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
| | - Hanene Lassoued Ferjani
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
| | - Dhia Kaffel
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
| | - Wafa Hamdi
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
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Feng B, Xiao K, Ren Y, Xia Z, Jin J, Wu Z, Qiu G, Weng X. Mid-Term Outcome of Total Hip Arthroplasty in Patients With Progressive Pseudorheumatoid Dysplasia. J Clin Rheumatol 2021; 27:156-160. [PMID: 31876842 DOI: 10.1097/rhu.0000000000001248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Progressive pseudorheumatoid dysplasia (PPD) is a rare disease that causes musculoskeletal deformities. There has been no detailed report on the outcome of PPD patients who undergo total hip arthroplasty (THA). The aim of this study was to investigate the clinical and radiological outcome of PPD patients undergoing THA after middle-term follow-up. METHODS This was a medical records review study. Patients with the diagnosis of PPD who underwent THA were enrolled. The PPD diagnosis was confirmed by genetic sequencing. Baseline clinical data were retrieved. The patients were followed for the Harris Hip Score, visual analogue score, range of hip motion, and postoperative complication. Life quality was evaluated with the Short Form 36. Plain x-ray films were used for radiographic evaluation. RESULTS Four cases were identified from the patient database in our institute. All the patients presented arthropathy of both hips and underwent 1-stage bilateral THA. All the patients had WISP3 mutation after genetic sequencing. The cases were followed at average 47.9 months (range, 18-93 months). Harris Hip Score increased from 39.67 ± 9.73 points preoperatively to 91.67 ± 4.32 points postoperatively (p < 0.05); Short Form 36 increased from 19.67 ± 1.53 points preoperatively to 71.33 ± 3.06 postoperatively (p < 0.05). The hip range of hip motion was significantly improved after operation. X-ray films showed no obvious radiolucent lines or aseptic loosening at the latest follow-up. CONCLUSIONS This study indicated that THA was effective to treat the PPD patients complicated with hip arthropathy with satisfactory clinical and radiological outcome after mid-term follow-up.
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Affiliation(s)
- Bin Feng
- From the Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing
| | - Ke Xiao
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu
| | - Yi Ren
- From the Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing
| | - Zenan Xia
- From the Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing
| | - Jin Jin
- From the Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing
| | - Zhihong Wu
- Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Guixing Qiu
- From the Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing
| | - Xisheng Weng
- From the Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing
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Pomeranz CB, Reid JR. Progressive pseudorheumatoid dysplasia: a report of three cases and a review of radiographic and magnetic resonance imaging findings. Skeletal Radiol 2019; 48:1323-1328. [PMID: 30712121 DOI: 10.1007/s00256-019-3165-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 02/02/2023]
Abstract
Progressive pseudorheumatoid dysplasia (PPD) is a rare disorder of postnatal skeletal and cartilage development that often presents with similar clinical findings to juvenile idiopathic arthritis. Patients with PPD display findings of progressive cartilage loss and secondary osteoarthritis over serial imaging studies and have an absence of elevation of inflammatory markers. Awareness of the imaging features of PPD on radiographs and magnetic resonance imaging (MRI) may be important for early diagnosis and surveillance of the disease.
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Affiliation(s)
- Christy B Pomeranz
- Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., F631E, New York, NY, 10065, USA.
| | - Janet R Reid
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Torreggiani S, Torcoletti M, Campos-Xavier B, Baldo F, Agostoni C, Superti-Furga A, Filocamo G. Progressive pseudorheumatoid dysplasia: a rare childhood disease. Rheumatol Int 2018; 39:441-452. [PMID: 30327864 DOI: 10.1007/s00296-018-4170-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/04/2018] [Indexed: 01/13/2023]
Abstract
Progressive pseudorheumatoid dysplasia (PPRD) is a genetic bone disorder characterised by the progressive degeneration of articular cartilage that leads to pain, stiffness and joint enlargement. As PPRD is a rare disease, available literature is mainly represented by single case reports and only a few larger case series. Our aim is to review the literature concerning clinical, laboratory and radiological features of PPRD. PPRD is due to a mutation in Wnt1-inducible signalling protein 3 (WISP3) gene, which encodes a signalling factor involved in cartilage homeostasis. The disease onset in childhood and skeletal changes progresses over time leading to significant disability. PPRD is a rare condition that should be suspected if a child develops symmetrical polyarticular involvement without systemic inflammation, knobbly interphalangeal joints of the hands, and gait abnormalities. A full skeletal survey, or at least a lateral radiograph of the spine, can direct towards a correct diagnosis that can be confirmed molecularly. More than 70 WISP3 mutations have so far been reported. Genetic testing should start with the study of genomic DNA extracted from blood leucocytes, but intronic mutations in WISP3 causing splicing aberrations can only be detected by analysing WISP3 mRNA, which can be extracted from cultured skin fibroblasts. A skin biopsy is, therefore, indicated in patients with typical PPRD findings and negative mutation screening of genomic DNA.
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Affiliation(s)
- Sofia Torreggiani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy.
| | - Marta Torcoletti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy
| | - Belinda Campos-Xavier
- Division of Genetic Medicine, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Francesco Baldo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy
| | - Andrea Superti-Furga
- Division of Genetic Medicine, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Giovanni Filocamo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy
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Xiao K, Li T, Jiang Y, Li Z, Zhu Q, Wu Z, Weng X. Ilizarov technique in an adolescent patient with progressive pseudorheumatoid dysplasia: A case report. Medicine (Baltimore) 2018; 97:e11375. [PMID: 30075503 PMCID: PMC6081158 DOI: 10.1097/md.0000000000011375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Progressive pseudorheumatoid dysplasia (PPD) is a rare autosomal recessive inherited disease that causes severe systemic joint deformity and articular dysfunction in young patients. PATIENT CONCERNS Ilizarov technique treatment in PPD patients has never been reported before. DIAGNOSES A 17-year-old male patient presented with a 10-year history of polyarthritis and 4-year history of progressive hip and knee pain and stiffness. Genetic testing for the WISP3 gene was done and showed compound heterozygous mutations: NM_198239.1 (WISP3):c.1064_1065dupGT (p.Gln356ValfsTer33) and NM_198239.1 (WISP3):c.643+2T > C. INTERVENTIONS Taking his young age into consideration, the Ilizarov external fixation technique was adopted for the treatment of the deformity in knees. OUTCOMES One year after the operation, the improvement of joint deformity was satisfactory. LESSONS The Ilizarov technique is economical and less invasive, and most importantly, it can delay the possible arthroplasty. It gives young PPD patients with arthropathy an alternative treatment.
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Affiliation(s)
- Ke Xiao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing Department of Orthopaedic Surgery Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Taspinar O, Kelesoglu F, Keskin Y, Uludag M. Progressive Pseudorheumatoid Dysplasia Misdiagnosed as Seronegative Juvenile Idiopathic Arthritis. Ethiop J Health Sci 2017; 26:397-400. [PMID: 27587938 PMCID: PMC4992780 DOI: 10.4314/ejhs.v26i4.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Progressive pseudorheumatoid dysplasia (PPD) is a rare spondylo-epi-metaphyseal dysplasia (SEMD). It can be confused with juvenile idiopathic arthritis (JIA), both clinically and radiologically. Early detection and diagnosis of PPD are important in helping to relieve the pain and disability associated with this disease and in avoiding unnecessary investigations and anti-rheumatic interventions. Case Details We report the case of a 15-year-old girl with PPD who was misdiagnosed with JIA. Conclusion In conclusion, PPD is a rare SEMD and can be confused with JIA, both clinically and radiologically. Early detection and diagnosis of PPD are important in helping to relieve the pain and disability associated with this disease and in avoiding unnecessary investigations and anti-rheumatic interventions.
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Affiliation(s)
- Ozgur Taspinar
- Department of Pyhisical Therapy and Rehabilitation, Cinarcik State Hospital, Yalova, Turkey
| | - Fatih Kelesoglu
- Department of Pediatric Rheumatology, Istanbul University Capa Medical Faculty, Istanbul, Turkey
| | - Yasar Keskin
- Department of Pyhisical Therapy and Rehabilitation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Murat Uludag
- Department of Pyhisical Therapy and Rehabilitation, Cinarcik State Hospital, Yalova, Turkey
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Novel WISP3 mutations causing progressive pseudorheumatoid dysplasia in two Chinese families. Hum Genome Var 2016; 3:16041. [PMID: 28018607 PMCID: PMC5143363 DOI: 10.1038/hgv.2016.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/30/2016] [Accepted: 09/30/2016] [Indexed: 02/06/2023] Open
Abstract
Progressive pseudorheumatoid dysplasia (PPD) is a rare disease caused by mutations in the gene for Wnt1-inducible signaling pathway protein 3 (WISP3). Here, we report the clinical and radiographic manifestations of two Chinese PPD patients. We performed whole-exome sequencing for one patient and sequenced the WISP3 for the other. Three WISP3 mutations (c.396T>G, c.721T>G and c.679dup) were identified; the two missense mutations were novel. Our study expanded the WISP3 mutation spectrum.
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Madhuri V, Santhanam M, Rajagopal K, Sugumar LK, Balaji V. WISP3 mutational analysis in Indian patients diagnosed with progressive pseudorheumatoid dysplasia and report of a novel mutation at p.Y198. Bone Joint Res 2016; 5:301-6. [PMID: 27436824 PMCID: PMC4957178 DOI: 10.1302/2046-3758.57.2000520] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 05/09/2016] [Indexed: 01/12/2023] Open
Abstract
Objectives To determine the pattern of mutations of the WISP3 gene in clinically identified progressive pseudorheumatoid dysplasia (PPD) in an Indian population. Patients and Methods A total of 15 patients with clinical features of PPD were enrolled in this study. Genomic DNA was isolated and polymerase chain reaction performed to amplify the WISP3 gene. Screening for mutations was done by conformation-sensitive gel electrophoresis, beginning with the fifth exon and subsequently proceeding to the remaining exons. Sanger sequencing was performed for both forward and reverse strands to confirm the mutations. Results In all, two of the 15 patients had compound heterozygous mutations: one a nonsense mutation c.156C>A (p.C52*) in exon 2, and the other a missense mutation c.677G>T (p.G226V) in exon 4. All others were homozygous, with three bearing a nonsense mutation c.156C>A (p.C52*) in exon 2, three a missense mutation c.233G>A (p.C78Y) in exon 2, five a missense mutation c.1010G>A (p.C337Y) in exon 5, one a nonsense mutation c.348C>A (p.Y116*) in exon 3, and one with a novel deletion mutation c.593_597delATAGA (p.Y198*) in exon 4. Conclusion We identified a novel mutation c.593_597delATAGA (p.Y198*) in the fourth exon of the WISP3 gene. We also confirmed c.1010G>A as one of the common mutations in an Indian population with progressive pseudorheumatoid dysplasia. Cite this article: V. Madhuri, M. Santhanam, K. Rajagopal, L. K. Sugumar, V. Balaji. WISP3 mutational analysis in Indian patients diagnosed with progressive pseudorheumatoid dysplasia and report of a novel mutation at p.Y198* Bone Joint Res 2016;5:301–306. DOI: 10.1302/2046-3758.57.2000520.
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Affiliation(s)
- V Madhuri
- Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India and Adjunct Scientist, Centre for Stem Cell Research (a unit of inStem, Bengaluru), Christian Medical College, Vellore, Tamil Nadu, 632002, India
| | - M Santhanam
- Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - K Rajagopal
- Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - L K Sugumar
- Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - V Balaji
- Paediatric Orthopaedics Unit, Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, 632004, India
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An Unusual Coexistence of Progressive Pseudorheumatoid Dysplasia and Relapsing Polychondritis. Arch Rheumatol 2016; 31:290-294. [PMID: 29900963 DOI: 10.5606/archrheumatol.2016.5994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/01/2016] [Indexed: 01/31/2023] Open
Abstract
Progressive pseudorheumatoid dysplasia is a rare hereditary skeletal disease characterized by bone and cartilage dysplasia, progressive arthropathy without sign of systemic or synovial inflammation. Relapsing polychondritis (RP) is a rare autoimmune disease associated with inflammation in cartilaginous and other proteoglycan rich structures. An associated autoimmune and/or hematologic disorder is seen in over 30% of patients with RP. To our knowledge, coexistence of progressive pseudorheumatoid dysplasia and RP has not been previously reported. In this article, we describe an unusual case of coexisting progressive pseudorheumatoid dysplasia with RP. Physicians should be aware of this possible association.
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Nassar K, Rachidi W, Janani S, Mkinsi O. [Destructive polyepiphyseal dysplasia pseudorhumatoid]. Presse Med 2015; 44:961-4. [PMID: 26049910 DOI: 10.1016/j.lpm.2015.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/08/2015] [Accepted: 03/10/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kawtar Nassar
- CHU, service de rhumatologie, 33, avenue du 2-Mars, résidence Youssef, appartement 2, 1(er) étage, 20500 Casablanca, Maroc.
| | - Wafae Rachidi
- CHU, service de rhumatologie, 33, avenue du 2-Mars, résidence Youssef, appartement 2, 1(er) étage, 20500 Casablanca, Maroc
| | - Saadia Janani
- CHU, service de rhumatologie, 33, avenue du 2-Mars, résidence Youssef, appartement 2, 1(er) étage, 20500 Casablanca, Maroc
| | - Ouafa Mkinsi
- CHU, service de rhumatologie, 33, avenue du 2-Mars, résidence Youssef, appartement 2, 1(er) étage, 20500 Casablanca, Maroc
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Yang X, Song Y, Kong Q. Diagnosis and surgical treatment of progressive pseudorheumatoid dysplasia in an adult with severe spinal disorders and polyarthropathy. Joint Bone Spine 2013; 80:650-2. [DOI: 10.1016/j.jbspin.2013.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/07/2013] [Indexed: 01/13/2023]
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Total Hip Arthroplasty in a 17-Year-Old Girl With Progressive Pseudorheumatoid Dysplasia. J Clin Rheumatol 2013; 19:138-41. [DOI: 10.1097/rhu.0b013e318289bf35] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garcia Segarra N, Mittaz L, Campos-Xavier AB, Bartels CF, Tuysuz B, Alanay Y, Cimaz R, Cormier-Daire V, Di Rocco M, Duba HC, Elcioglu NH, Forzano F, Hospach T, Kilic E, Kuemmerle-Deschner JB, Mortier G, Mrusek S, Nampoothiri S, Obersztyn E, Pauli RM, Selicorni A, Tenconi R, Unger S, Utine GE, Wright M, Zabel B, Warman ML, Superti-Furga A, Bonafé L. The diagnostic challenge of progressive pseudorheumatoid dysplasia (PPRD): A review of clinical features, radiographic features, and WISP3 mutations in 63 affected individuals. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2012; 160C:217-29. [DOI: 10.1002/ajmg.c.31333] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Temiz F, Ozbek MN, Kotan D, Sangun O, Mungan NO, Yuksel B, Topaloglu AK. A homozygous recurring mutation in WISP3 causing progressive pseudorheumatoid arthropathy. J Pediatr Endocrinol Metab 2011; 24:105-8. [PMID: 21528827 DOI: 10.1515/jpem.2011.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
WISP3 is a member of the CCN (for CTGF, CYR61, and NOV) gene family, which encodes cysteine-rich secreted proteins with roles in cell growth and differentiation. Mutations in the WISP3 gene are associated with the autosomal recessive skeletal disorder, also known as progressive pseudorheumatoid arthropathy of childhood (PPAC). We diagnosed three siblings from a non-consanguineous family with PPAC. The patients were asymptomatic in early childhood. Signs and symptoms of disease that include progressive joint stiffness, swelling of the finger joints, and osteopenia, and slow linear growth developed between 2 and 8 years of age. PCR amplification and direct sequencing of the WISP3 gene revealed a homozygous mutation at nucleotide 156 of the WISP3 gene, resulting in a Cys52-to-ter substitution. This mutation has previously been reported in French, Italian, and Arab families. Interestingly, the C52X mutation was found to be associated with a c.248G-->A (G83E) variation, suggesting the existence of a founder effect. By contrast, the presence of the same aberration in three different ethnic groups could imply that this particular site is prone to mutation. Basal fasting concentrations of growth hormone, insulin-like growth factor-1, and insulin-like growth factor binding protein-3, as well as glucose and insulin levels revealed no aberrations. In conclusion, consideration of this rare disease that causes significant morbidity with short stature, osteopenia and arthritic complaints would prevent unnecessary examinations and treatment attempts. Testing for this specific mutation in suspected cases could provide a rapid and definitive diagnosis.
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Affiliation(s)
- Fatih Temiz
- Department of Pediatric Endocrinology and Metabolism, Cukurova University Faculty of Medicine, Balcali, Adana, Turkey.
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Spondyloepiphyseal dysplasia tarda: four cases from two families. Rheumatol Int 2008; 29:699-702. [PMID: 18932001 DOI: 10.1007/s00296-008-0746-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 10/05/2008] [Indexed: 10/21/2022]
Abstract
Spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA) is an autosomal recessively inherited skeletal dysplasia. We present four patients (three patients-a brother and a sister and their third cousin-in a family and one patient in another family) with SEDT-PA. All patients had short stature and stubby hands and feet. Their radiographs revealed typical changes for SEDT-PA including platyspondyly, severe osteopenia and dysplastic bone changes. Physical therapy and exercises were performed to all patients in order to decrease in pain and increase or at least maintain joint motion and mobility. Symptomatic relief was achieved in all patients for about a couple of months. The major clinical importance of this rather rare disorder is its similarity to juvenile idiopathic arthritis which has rather different treatment protocol.
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Bennani L, Amine B, Ichchou L, Lazrak N, Hajjaj-Hassouni N. Progressive pseudorheumatoid dysplasia: Three cases in one family. Joint Bone Spine 2007; 74:393-5. [PMID: 17596985 DOI: 10.1016/j.jbspin.2006.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 11/29/2006] [Indexed: 11/29/2022]
Abstract
UNLABELLED Progressive pseudorheumatoid dysplasia is an inherited skeletal dysplasia with autosomal recessive transmission. Radiographs of the spine show abnormalities similar to those seen in spondyloepiphyseal dysplasia tarda. The clinical presentation, but not the imaging study findings, suggest juvenile idiopathic arthritis. We report 3 cases of progressive pseudorheumatoid dysplasia in the same family. CASE-REPORTS A 4-year-old girl had been receiving follow-up for 3 years for seronegative, polyarticular juvenile idiopathic arthritis progressing by flares and remissions. The disease was unresponsive to anti-inflammatory medications. Findings at admission included inflammatory joint pain, joint swelling, range-of-motion limitation, and joint deformities in the hands, wrists, ankles, and knees. The hips were normal. Normal values were found for the erythrocyte sedimentation rate and C-reactive protein level. Synovial fluid removed from one of the knees exhibited mechanical properties. Plain radiographs of the hands and forefeet showed no evidence of joint destruction. Bilateral hip dysplasia was noted on a radiograph of the pelvis. The diagnosis of juvenile idiopathic arthritis was reconsidered. A study of the family identified two similar cases, in a brother and paternal uncle. The brother, who was 14 years old, had similar manifestations without laboratory evidence of inflammation; radiographs disclosed dysplasia of the hips and metacarpophalangeal epiphyses. Manifestations in a paternal uncle consisted of spinal stiffness, thoracic kyphosis, and motion-range limitation at the hips; radiographs showed normal sacroiliac joints and bilateral hip dysplasia. A diagnosis of progressive pseudorheumatoid dysplasia with polyarticular involvement was given. DISCUSSION Progressive pseudorheumatoid dysplasia is an autosomal recessive disease characterized by abnormal cartilage homeostasis. It should be included among the differential diagnoses of juvenile idiopathic arthritis.
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Affiliation(s)
- Loubna Bennani
- Rheumatology Department, El-Ayachi Hospital, Rabat-Salé Teaching Hospital, Rabat-Salé, Morocco.
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Zhou HD, Bu YH, Peng YQ, Xie H, Wang M, Yuan LQ, Jiang Y, Li D, Wei QY, He YL, Xiao T, Ni JD, Liao EY. Cellular and molecular responses in progressive pseudorheumatoid dysplasia articular cartilage associated with compound heterozygous WISP3 gene mutation. J Mol Med (Berl) 2007; 85:985-96. [PMID: 17483925 DOI: 10.1007/s00109-007-0193-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Revised: 03/03/2007] [Accepted: 03/06/2007] [Indexed: 10/23/2022]
Abstract
Progressive pseudorheumatoid dysplasia (PPD) is characterized by continuous degeneration and loss of articular cartilage, which has been attributed to mutations in the gene encoding WISP3. We collected a PPD family and analyzed their WISP3 genes mutation. Articular chondrocytes (ACs) were purified from the femurs of a PPD patient after hip replacement surgery. Cell growth, proliferation, and viability were examined. Gene expression profiling and analyses of matrix metalloproteinases (MMP)-1, -3, and -13 proteins were carried out using cDNA differential microarrays, real-time reverse transcriptase-polymerase chain reaction (RT-PCR), immunohistochemistry, and Western blot analysis. We found that two probands carried a deletion (840delT) mutation in maternal allele, which leads to truncated WISP3 protein missing 43 residues in C terminus; and a 1000T>C substitution in paternal allele, which was also passed on to four other members in the PPD kindred. PPD ACs were heterogeneous in size with an enhanced rate of cell proliferation and viability compared with the normal ACs. MMP-1, -3, and -13 mRNA expressions were dereased in PPD ACs. MMP-1, -3, and -13 protein levels, however, were increased in cell lysates from PPD ACs, but markedly decreased in the supernatants from cultured ACs. WISP3 mRNA expression in PPD ACs was also decreased. Our results show, for the first time, a compound heterozygous mutation of WISP3 and a series of cellular and molecular changes disturbing the endochondral ossification in this PPD patient.
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Affiliation(s)
- Hou-De Zhou
- Institute of Endocrinology and Metabolism, The Second Xiang-Ya Hospital of Central South University, 139# Mid-RenMin Road, Changsha, Hunan, 410011, China
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Cefle A, Cefle K, Tunaci M, Ozturk S, Palanduz S. A case of progressive pseudorheumatoid arthropathy of 'childhood' with the diagnosis delayed to the fifth decade. Int J Clin Pract 2006; 60:1306-9. [PMID: 16981975 DOI: 10.1111/j.1742-1241.2005.00662.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Progressive pseudorheumatoid arthropathy of childhood (PPAC) is a rare single gene disorder which is frequently misdiagnosed as juvenile rheumatoid arthritis. It is characterised with arthralgia, joint contractures, bony swelling of metacarpophalangeal and interphalangeal joints and platyspondyly. Clinical and laboratory signs of joint inflammation such as synovitis, a high erythrocyte sedimentation rate and an elevated C-reactive protein level are usually absent. Although the disease begins early in life (usually between 3 and 8 years of age), the diagnosis may be delayed. In the present case report, we describe a male patient diagnosed with PPAC at the age of 46 years, although he had been exhibiting the typical radiological and clinical features of the disease since the age of 7 years.
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Affiliation(s)
- A Cefle
- Division of Rheumatology, Department of Internal Medicine, Kocaeli University, Medical Faculty, Kocaeli, Istanbul University, Istanbul, Turkey
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Kaya A, Ozgocmen S, Kiris A, Ciftci I. Clinical and radiological diagnosis of progressive pseudorheumatoid dysplasia in two sisters with severe polyarthropathy. Clin Rheumatol 2005; 24:560-4. [PMID: 15877179 DOI: 10.1007/s10067-005-1086-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Accepted: 12/20/2004] [Indexed: 11/26/2022]
Abstract
The aim of this case report is to describe unusual cases of progressive pseudorheumatoid dysplasia (PPD) affecting the axial skeleton and peripheral joints and to stress the importance of examining the entire skeleton for definite diagnosis and the importance of rehabilitation interventions. PPD is a rare familial disease characterized by generalized bone-cartilage dysplasia, progressive arthropathy, and platyspondyly. PPD presents as spondyloepiphyseal dysplasia (SED) tarda with progressive arthropathy and progressive pseudorheumatoid arthritis of childhood and is described as a specific autosomal recessive subtype of SED. Two sisters, 18 and 16 years old, with low back pain and polyarthritis are presented. Radiographic and magnetic resonance imaging of the cases revealed typical features characteristic for PPD-like platyspondyly, multiple intravertebral herniations, changes in metaphyses and epiphysis, and mega os trigonum. Consequently, PPD is a rare disease of childhood and should be kept in mind in the differential diagnosis of juvenile idiopathic arthritis to prevent delayed diagnosis and to begin rehabilitation interventions early. It is essential to carefully examine the entire body, particularly the axial skeleton, and to perform radiological evaluation of the spine. These illustrative cases serve to remind physicians to examine the entire skeleton and not to concentrate only on "branches" but also on the "trunk."
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Affiliation(s)
- Arzu Kaya
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Firat University, Firat Tip Merkezi, Fiziksel Tip ve Reh. ABD, Romatoloji BD, 23119, Elazig, Turkey
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Sen M, Cheng YH, Goldring MB, Lotz MK, Carson DA. WISP3-dependent regulation of type II collagen and aggrecan production in chondrocytes. ACTA ACUST UNITED AC 2004; 50:488-97. [PMID: 14872491 DOI: 10.1002/art.20005] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE WISP3 (Wnt-1-inducible secreted protein 3) is a member of the CCN (connective tissue growth factor, cysteine-rich 61, nephroblastoma overexpressed) family of connective tissue growth factors. WISP3 mutations have been linked to progressive pseudorheumatoid dysplasia (PPRD). The present study was conducted to investigate whether WISP3 is responsible for the expression of cartilage-specific molecules. METHODS WISP3 expression in human cartilage was assessed by immunostaining with anti-WISP3 antibody. The effect of WISP3 on chondrocyte-specific gene regulation was determined by transfecting human chondrocyte lines C-28/I2 and T/C-28a2 with a WISP3 expression vector. Alterations in WISP3-mediated messenger RNA and protein expression of cartilage-specific molecules were assessed by reverse transcriptase-polymerase chain reaction and immunoblotting. RESULTS Immunohistochemistry experiments demonstrated that WISP3 protein is expressed in the midzone chondrocytes of normal adult articular cartilage, in chondrocyte clusters of osteoarthritic cartilage, and in the zone of proliferating chondrocytes of fetal growth cartilage. Human chondrocyte lines C-28/I2 and T/C-28a2 transfected with a WISP3 expression vector produced increased amounts of the cartilage-specific matrix molecules type II collagen and aggrecan, in part via activation of the sex-determining region Y-type high mobility group box (SOX) family of transcription factors. In contrast, a mutant WISP3, previously found to be associated with PPRD, had impaired effects on cartilage-specific gene expression. CONCLUSION Our experimental results suggest that WISP3 supports cartilage integrity by regulating the expression of type II collagen and aggrecan, and mutations linked with PPRD can compromise this function and produce cartilage loss.
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Affiliation(s)
- Malini Sen
- University of California, San Diego, CA 92093-0663, USA.
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