Eicosanoid profiling in patients with complete form of pachydermoperiostosis carrying SLCO2A1 mutations

A Case Study of a Female Infant With Primary Hypertrophic Osteoarthropathy Demonstrates That Early Initiation of Celecoxib Slows but Does Not Prevent Symptom Progression

Primary Hypertrophic Osteoarthropathy (PHOAR1) is characterized by autosomal recessive loss of function variants in 15-hydroxyprostaglandin dehydrogenase (HPGD) leading to digital clubbing, periostosis, pachydermia, and severe hyperhidrosis. HPGD catalyzes the first step of prostaglandin E2 (PGE2) degradation. Selective COX-2 inhibitors have proved beneficial in adults, though it is unknown if early initiation of COX-2 inhibitors can alter the natural history of PHOAR1. This individual was diagnosed with PHOAR1 at 3.5 months of age due to homozygous HPGD c.218-1G>A variants. At presentation, she had a diffuse erythematous rash secondary to hyperhidrosis, mild symmetric clubbing of her fingertips, and mildly decreased mobility of her knees and wrists. By 20 months of age, she had more significant clubbing, mild flexion contractures, joint pain, and fatigue. She started celecoxib at 26 months of age. ResultsAfter 7 months of celecoxib, she had stable digital clubbing, improved hyperhidrosis and contractures, and resolution of her joint pain and fatigue. COX-2 inhibition appears to be a safe and effective intervention in young children with PHOAR1. More investigation is needed to assess safety and long-term impact on the natural history of PHOAR1 after COX-2 inhibition is initiated in early childhood.

Acetaminophen as a possible treatment option for pachydermoperiostosis carrying mutated SLCO2A1: Case series

Pachydermoperiostosis (PDP) is a genetic disease characterized by digital clubbing, periostosis, and pachydermia. PDP with these three features, along with cutis verticis gyrata (CVG), is categorized as the "complete form," whereas cases without CVG are categorized as the "incomplete form." The condition is linked to elevated levels of systemic prostaglandin E2 (PGE2). About half of PDP patients experience arthralgia. The standard treatment for PDP is selective cyclooxygenase (COX)-2 inhibitors, but long-term usage can cause gastrointestinal side effects. Additionally, mutations in the SLCO2A1 can lead to chronic enteropathy associated with the SLCO2A1 gene (CEAS), making the use of selective COX-2 inhibitors particularly risky for PDP patients with CEAS. This has prompted the search for alternative treatments. In this study, five PDP patients-three with the complete form and two with the incomplete form-were treated with acetaminophen. The PGE-major urinary metabolite (PGE-MUM) was monitored as a biomarker of disease activity, reflecting systemic PGE2 levels. Before treatment, PGE-MUM levels were significantly elevated in patients with complete form and mildly elevated in those with incomplete form. Following acetaminophen, PGE-MUM levels decreased in patients with complete form, and all patients reported improvement in arthralgia without developing gastrointestinal symptoms. In conclusion, acetaminophen shows promise as an alternative treatment for PDP, effectively reducing PGE-MUM levels in certain patients and alleviating arthralgia while avoiding the gastrointestinal side effects associated with long-term COX-2 inhibitor usage.

Primary pachydermoperiostosis associated with pigmented villonodular synovitis: An unknown association?

Primary pachydermoperiostosis is a rare genetic disease affecting the skin and musculoskeletal system. In contrast to secondary hypertrophic osteoarthropathy, primary pachydermoperiostosis is considered a benign condition. While a variety of associated abnormalities have been described in this form, any association with tumors was previously reported in the literature. We hereby describe the first case of a 20-year-old man with primary pachydermoperiostosis revealed by a knee synovial tumor.