{"id":61,"date":"2022-12-14T22:03:01","date_gmt":"2022-12-14T22:03:01","guid":{"rendered":"https:\/\/mpsdsehcp-dev-001.azurewebsites.net\/en\/mucopolysaccharidosis-mps\/?page_id=61"},"modified":"2023-12-04T09:13:01","modified_gmt":"2023-12-04T09:13:01","slug":"assessing-mps","status":"publish","type":"page","link":"https:\/\/hcp.biomarin.com\/en-gb\/mps\/assessing-mps\/","title":{"rendered":"Assessing MPS"},"content":{"rendered":"<div id=\"acf-block-63fdfdce16e32\" class=\"hero hero-no-overlay hero-large-first-para\">\n            <div class=\"hero-background-image hero-background-image-desktop\" style=\"background-image: url(https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2023\/04\/MPS-IVA-Annalena-2000x423.jpg);\"><\/div>\n\t    <div class=\"hero-background-image hero-background-image-mobile\" style=\"background-image: url(https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2023\/12\/Blue.jpg?v=0.26);\"><\/div>\n    \t<div class=\"overlay\"><\/div>\n\t<div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t\t<div class=\"hero-content\">\n\t\t\t    \t\t\t\t\t\t\t\t\t\t\t\t    <h1>Assessing MPS\n<\/h1>\n\t\t\t\t\t\t\t\t\t\t\t\t    <p>Often mischaracterised as either purely a childhood disorder or a musculoskeletal disease, MPS might not be as uncommon as you think<\/p>\n\t\t\t\t\t\t\t\t\n                <p class=\"inline-buttons\">\n                                                        <\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n<div id=\"Prevalence-of-MPS\" class=\"block wrapped-content block-tight-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce16f06\" class=\"block-wysiwyg\">\n            <h2>Is there a rare genetic disease hiding in your department?<\/h2>\n<h3>Often mischaracterised as either purely a childhood disorder or a musculoskeletal disease, MPS might not be as uncommon as you think<\/h3>\n<p>Mucopolysaccharidosis (MPS) disorders are a group of inherited enzyme deficiencies with heterogeneous presentation and variable disease progression that are suspected to affect 1 in 22,500 live births worldwide.<sup>1,2<\/sup><\/p>\n<p>Similar clinical manifestations and rates of progression are seen across MPS disorders. The images below illustrate patterns of MPS disease progression as seen in a patient with MPS VI.<\/p>\n<p><strong>Variable disease progression in patients with MPS VI<\/strong><\/p>\n    <\/div>\n\n<figure id=\"acf-block-63fdfdce16f1c\">\n    <div class=\"image image-rounded image-align-left\">\n                    <img decoding=\"async\" class=\"\" src=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2023\/01\/Rate-of-Progression-.jpg?v=0.26\" alt=\"Images showing photos of the rate of progression\" \/>            <\/div>\n            <figcaption><p>All patients, regardless of initial presentation, are at risk for end-organ damage.<\/p>\n<\/figcaption>\n    <\/figure>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"Delay-in-diagnosis\" class=\"block wrapped-content block-tight-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce16f3e\" class=\"block-wysiwyg\">\n            <h2>Delay in diagnosis is common and can be devastating for patients<sup>3<\/sup><\/h2>\n<p>Perceived disease rarity, variability in disease progression and presentation and the myriad of nonspecific symptoms associated with MPS make diagnosis challenging. Time to diagnosis from first symptom manifestation can range from six months to decades.<sup>3<\/sup><\/p>\n<p><strong>Time to diagnosis in a series of patients with slowly progressing MPS VI<sup>4<\/sup><\/strong><\/p>\n    <\/div>\n\n<figure id=\"acf-block-63fdfdce16f54\">\n    <div class=\"image image-rounded image-align-left\">\n                    <img decoding=\"async\" class=\"\" src=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2022\/12\/time_to_diagnosis_graph.svg\" alt=\"time to diagnosis graph\" \/>            <\/div>\n            <figcaption><p>In a small group of patients with MPS VI, median delay in diagnosis was found to be 17.5 years. Common among these patients was the lack of classic dysostosis multiplex.<\/p>\n<\/figcaption>\n    <\/figure>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"Early-diagnosis\" class=\"block wrapped-content\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce17138\" class=\"block-wysiwyg\">\n            <h2>Early diagnosis is essential to optimise patient outcomes<sup>3,5<\/sup><\/h2>\n<p>Early diagnosis can enable improved patient outcomes through access to disease-specific management and enzyme replacement therapy (ERT).<sup>3,5\u20138<\/sup><\/p>\n<p>For many MPS disorders, there is an ERT either already available or in development. The best way to diagnose MPS and, in turn, initiate treatment, is to refer any patient you suspect to a geneticist or metabolic centre familiar with testing for it.<sup>9<\/sup><\/p>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"acf-block-6450298c93caf\" class=\"block call-to-action block-tight-bottom\">\n    <div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t\t<div class=\"box\" style=\"\">\n\t\t\t\t<div class=\"overlay\"><\/div>\n\t\t\t\t<div class=\"cta-content\">\n\t\t\t\t    \t\t\t\t\t<div class=\"cta-content-main\">\n                        <div class=\"content-block\">\n\t\t\t\t\t        \t\t\t\t\t        \t\t\t\t\t\t        <h2 class=\"h3\">Stay informed about emerging research in MPS\n<\/h2>\n\t\t\t\t\t\t    \t\t\t\t\t\t    \t\t\t\t\t    <\/div>\n\t\t\t\t\t                                <div class=\"content-block\">\n                                <p><a class=\"button button-ghost button-arrow\" href=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/stay-updated\/\" target=\"_self\">Register<\/a><\/p>\n                            <\/div>\n\t\t\t\t\t                        <\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n<div id=\"acf-block-63fdfdce1715a\" class=\"block cards cards-2-col bg-band block-tight-top block-zero-bottom\">\n\t<div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t\t<div class=\"cards-title\">\n\t\t\t    \t\t\t\t    <h2>Look for early signs and symptoms of MPS:<sup>3,10\u201312<\/sup>\n<\/h2>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<div class=\"cards-wrapper\">\n\t\t\t    \n<div id=\"acf-block-63fdfdce17187\" class=\"card\" data-muted-autoplay=\"false\">\n        <div class=\"card-content\">\n                            <h4>Classical\n<\/h4>\n        \n                                                                                                            <ul>\n<li>Hernias<\/li>\n<li>Joint and skeletal abnormalities<\/li>\n<li>Short stature<\/li>\n<li>Any gradual, progressive changes in physical appearance<\/li>\n<\/ul>\n                                                                                    <\/div>\n<\/div>\n\n<div id=\"acf-block-63fdfdce171a4\" class=\"card\" data-muted-autoplay=\"false\">\n        <div class=\"card-content\">\n                            <h4>Non-classical\n<\/h4>\n        \n                                                                                                            <ul>\n<li>Subtle expressions of skeletal abnormalities, including thickened ribs or clavicles, subtle genu valgum, and joint abnormalities or pain<\/li>\n<li>Reduced exercise capacity and\/or unexplained cardiovascular involvement, especially heart murmur in paediatric patients<\/li>\n<li>Unexplained hearing or visual impairment (corneal clouding)<\/li>\n<\/ul>\n                                                                                    <\/div>\n<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n<div id=\"acf-block-63fdfdce171b7\" class=\"block wrapped-content block-zero-top block-zero-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce171c7\" class=\"block-wysiwyg\">\n            <p><em>A constellation of suggestive findings is especially significant, but the absence of a particular finding or characteristic does not necessarily rule out an MPS diagnosis.<sup>10<\/sup><\/em><\/p>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"When-should-you-suspect-MPS\" class=\"block wrapped-content block-zero-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce171ed\" class=\"block-wysiwyg\">\n            <p><strong>When you see any number or pattern of signs that span multiple body systems and are indicative of MPS, don\u2019t delay; refer to a geneticist or metabolic specialist.<\/strong><\/p>\n<p><strong>Symptomatology for MPS:<\/strong><\/p>\n<ul>\n<li>Spans multiple body systems<sup>8<\/sup><\/li>\n<li>May be either overt or discoverable through speciality-specific assessments<\/li>\n<\/ul>\n<p>Overt symptoms are those that can be observed during any routine office visit or physical examination. Investigate the key visual features of MPS that are listed below.<\/p>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"acf-block-6463887d49d91\" class=\"block wrapped-content\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-646386b133362\" class=\"block-wysiwyg\">\n            <h3>General features and overt signs that should raise suspicion of MPS<sup>3,4,8,10,11,13-26<\/sup><\/h3>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"acf-block-63fdfdce1726e\" class=\"block accordion\">\n\t<div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t                                                                                <div class=\"accordion-item\">\n                        <div class=\"accordion-title\">\n                            <div class=\"accordion-trigger\">\n                                <span><\/span>\n                                <span><\/span>\n                            <\/div>\n                            <h2>Musculoskeletal\n<\/h2>\n                        <\/div>\n                        <div class=\"accordion-content\">\n                                                            <h4><em>General features<\/em><\/h4>\n<ul>\n<li>Abnormal gait<\/li>\n<li>Bone dysplasia<\/li>\n<li>Claw hands<\/li>\n<li>Coarse facial features<\/li>\n<li>Joint pain<\/li>\n<li>Macrocephaly<\/li>\n<li>Pectus carinatum<\/li>\n<li>Reduced endurance\/exercise intolerance<\/li>\n<li>Short stature\/growth retardationa<\/li>\n<\/ul>\n<h4><em>Features revealed by speciality- specific assessment<\/em><\/h4>\n<ul>\n<li>Abnormal gait<\/li>\n<li>Bone deformities<\/li>\n<li>Dysostosis multiplex<\/li>\n<li>Genu valgum<\/li>\n<li>Joint involvement (contractures, joint laxity) without inflammation<\/li>\n<li>Spinal subluxation<\/li>\n<\/ul>\n                                                    <\/div>\n                    <\/div>\n                                                                            <div class=\"accordion-item\">\n                        <div class=\"accordion-title\">\n                            <div class=\"accordion-trigger\">\n                                <span><\/span>\n                                <span><\/span>\n                            <\/div>\n                            <h2>Rheumatological\n<\/h2>\n                        <\/div>\n                        <div class=\"accordion-content\">\n                                                            <h4><em>General features<\/em><\/h4>\n<ul>\n<li>Decreased joint mobility<\/li>\n<li>Hip stiffness and pain<\/li>\n<li>Joint pain<\/li>\n<li>Joint stiffness or laxity<\/li>\n<\/ul>\n<h4><em>Features revealed by speciality- specific assessment<\/em><\/h4>\n<ul>\n<li>Carpal tunnel syndrome<\/li>\n<li>Joint involvement without joint swelling or erosive bone lesions<\/li>\n<\/ul>\n                                                    <\/div>\n                    <\/div>\n                                                                            <div class=\"accordion-item\">\n                        <div class=\"accordion-title\">\n                            <div class=\"accordion-trigger\">\n                                <span><\/span>\n                                <span><\/span>\n                            <\/div>\n                            <h2>Ear, nose and throat\n<\/h2>\n                        <\/div>\n                        <div class=\"accordion-content\">\n                                                            <h4><em>General features<\/em><\/h4>\n<ul>\n<li>Conductive and\/or sensorineural hearing loss<\/li>\n<li>Enlarged tongue<\/li>\n<li>Otitis media<\/li>\n<\/ul>\n<h4><em>Features revealed by speciality- specific assessment<\/em><\/h4>\n<ul>\n<li>Abnormal epiglottis<\/li>\n<li>Depressed nasal bridge<\/li>\n<li>Hypertrophic adenoids<\/li>\n<li>Hypertrophic tonsils<\/li>\n<li>Middle ear mucus<\/li>\n<li>Narrowing of supraglottic and infraglottic airway<\/li>\n<li>Ossicular malformation<\/li>\n<li>Recurrent and excessive rhinorrhea<\/li>\n<li>Recurrent otitis media<\/li>\n<li>Tracheal thickening\/compression<\/li>\n<li>Tubular obstruction<\/li>\n<li>Tympanic membrane thickening<\/li>\n<\/ul>\n                                                    <\/div>\n                    <\/div>\n                                                                            <div class=\"accordion-item\">\n                        <div class=\"accordion-title\">\n                            <div class=\"accordion-trigger\">\n                                <span><\/span>\n                                <span><\/span>\n                            <\/div>\n                            <h2>Ophthalmological\n<\/h2>\n                        <\/div>\n                        <div class=\"accordion-content\">\n                                                            <h4><em>General features<\/em><\/h4>\n<ul>\n<li>Cataracts<\/li>\n<li>Diffuse corneal clouding<\/li>\n<li>Glaucoma<\/li>\n<\/ul>\n<h4><em>Features revealed by speciality- specific assessment<\/em><\/h4>\n<ul>\n<li>Amblyopia<\/li>\n<li>Corneal clouding with characteristic \u2018ground glass\u2019 appearance<\/li>\n<li>High hyperopia<\/li>\n<li>Hypertelorism<\/li>\n<li>Optic nerve abnormalities (swelling and atrophy)<\/li>\n<li>Peripheral vascularisation of the cornea<\/li>\n<li>Progressive pseudo \u2013 exophthalmos<\/li>\n<li>Reduction in visual acuity<\/li>\n<li>Retinopathy<\/li>\n<li>Strabismus<\/li>\n<\/ul>\n                                                    <\/div>\n                    <\/div>\n                                                                            <div class=\"accordion-item\">\n                        <div class=\"accordion-title\">\n                            <div class=\"accordion-trigger\">\n                                <span><\/span>\n                                <span><\/span>\n                            <\/div>\n                            <h2>Neurological\n<\/h2>\n                        <\/div>\n                        <div class=\"accordion-content\">\n                                                            <h4><em>General features<\/em><\/h4>\n<ul>\n<li>Behavioural abnormalities (typically not present in MPS IVA and VI)<\/li>\n<li>Developmental delay (typically not present in MPS IVA and VI)<\/li>\n<li>Hearing impairment<\/li>\n<li>Seizures (typically not present in MPS IVA and VI)<\/li>\n<\/ul>\n<h4><em>Features revealed by speciality- specific assessment<\/em><\/h4>\n<ul>\n<li>Arachnoid cysts (typically not present in MPS IVA and VI)<\/li>\n<li>Brain atrophy (typically not present in MPS IVA and VI)<\/li>\n<li>Carpal tunnel syndrome<\/li>\n<li>Cervical cord compression\/myelopathy\/subluxation<\/li>\n<li>Enlarged perivascular spaces<\/li>\n<li>Hydrocephalus<\/li>\n<li>Odontoid dysplasia<\/li>\n<li>Pachymeningitis cervicalis<\/li>\n<li>Papilledema\/optic atrophy<\/li>\n<li>Sensorineural deafness<\/li>\n<li>Signal-intensity abnormalities<\/li>\n<li>Spinal canal stenosis<\/li>\n<li>Ventriculomegaly<\/li>\n<\/ul>\n                                                    <\/div>\n                    <\/div>\n                                                                            <div class=\"accordion-item\">\n                        <div class=\"accordion-title\">\n                            <div class=\"accordion-trigger\">\n                                <span><\/span>\n                                <span><\/span>\n                            <\/div>\n                            <h2>Cardiovascular\n<\/h2>\n                        <\/div>\n                        <div class=\"accordion-content\">\n                                                            <h4><em>General features<\/em><\/h4>\n<ul>\n<li>Reduced endurance\/exercise intolerance<\/li>\n<\/ul>\n<h4><em>Features revealed by speciality- specific assessment<\/em><\/h4>\n<ul>\n<li>Pulmonary hypertension<\/li>\n<li>Thickened, regurgitant or stenotic mitral or aortic valves in presence of left ventricular hypertrophy<\/li>\n<li>Tricuspid regurgitation<\/li>\n<\/ul>\n                                                    <\/div>\n                    <\/div>\n                                                                            <div class=\"accordion-item\">\n                        <div class=\"accordion-title\">\n                            <div class=\"accordion-trigger\">\n                                <span><\/span>\n                                <span><\/span>\n                            <\/div>\n                            <h2>Pulmonary\n<\/h2>\n                        <\/div>\n                        <div class=\"accordion-content\">\n                                                            <h4><em>General features<\/em><\/h4>\n<ul>\n<li>Reduced endurance\/exercise intolerance<\/li>\n<li>Sleep apnoea<\/li>\n<\/ul>\n<h4><em>Features revealed by speciality- specific assessment<\/em><\/h4>\n<ul>\n<li>Obstructed upper and lower airways (bronchial narrowing, narrowing of supraglottic and infraglottic airway)<\/li>\n<li>Progressive reduction in lung volume<\/li>\n<li>Respiratory infections<\/li>\n<li>Sleep disorders (obstructive sleep apnoea\/hypopnoea syndrome and upper airway resistance syndrome)<\/li>\n<\/ul>\n                                                    <\/div>\n                    <\/div>\n                                                                            <div class=\"accordion-item\">\n                        <div class=\"accordion-title\">\n                            <div class=\"accordion-trigger\">\n                                <span><\/span>\n                                <span><\/span>\n                            <\/div>\n                            <h2>Gastrointestinal\n<\/h2>\n                        <\/div>\n                        <div class=\"accordion-content\">\n                                                            <h4><em>General features<\/em><\/h4>\n<ul>\n<li>Abdominal pain<\/li>\n<li>Constipation<\/li>\n<li>Hepatosplenomegaly<\/li>\n<li>Hernias<\/li>\n<li>Loose stools<\/li>\n<\/ul>\n<h4><em>Features revealed by speciality- specific assessment<\/em><\/h4>\n<ul>\n<li>Hepatosplenomegaly<\/li>\n<\/ul>\n                                                    <\/div>\n                    <\/div>\n                                                                            <div class=\"accordion-item\">\n                        <div class=\"accordion-title\">\n                            <div class=\"accordion-trigger\">\n                                <span><\/span>\n                                <span><\/span>\n                            <\/div>\n                            <h2>Dental\n<\/h2>\n                        <\/div>\n                        <div class=\"accordion-content\">\n                                                            <h4><em>General features<\/em><\/h4>\n<ul>\n<li>Abnormal buccal surfaces<\/li>\n<li>Dentinogenesis imperfecta<\/li>\n<li>Hypodontia<\/li>\n<li>Pointed cusps<\/li>\n<li>Spade-shaped incisors<\/li>\n<li>Thin enamel<\/li>\n<\/ul>\n<h4><em>Features revealed by speciality- specific assessment<\/em><\/h4>\n<ul>\n<li>Abnormal buccal surfaces<\/li>\n<li>Thin enamel<\/li>\n<\/ul>\n                                                    <\/div>\n                    <\/div>\n                            \t\t<\/div>\n\t<\/div>\n<\/div>\n\n<div id=\"prevelence-of-symtoms\" class=\"block wrapped-content block-tight-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce18385\" class=\"block-wysiwyg\">\n            <h2>Prevalence of symptoms in patients with Morquio A<sup>27,a<\/sup><\/h2>\n    <\/div>\n\n<figure id=\"acf-block-63fdfdce1839f\">\n    <div class=\"image image-rounded image-align-left\">\n                    <img decoding=\"async\" class=\"\" src=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2022\/12\/prevalence_of_symptoms_graph.svg\" alt=\"prevalence of symptoms graph\" \/>            <\/div>\n            <figcaption><p><small>Adapted from Harmatz, <em>Mol Genet Metab<\/em>, 2013.<br \/>\nAbbreviation: ENT, Ear, Nose and Throat.<br \/>\n<sup>a<\/sup>25% of patients with Morquio A are classified as nonclassical.<br \/>\n<sup>b<\/sup>Percentages reflect prevalence of symptoms in 325 patients as reported in the Morquio A Clinical Assessment Program (MorCAP) study.<br \/>\n<sup>c<\/sup>The range indicated refers to the incidence of cardiac valve regurgitation in adult patients (n=69; 28% mitral, 32% tricuspid, 39% aortic).<br \/>\n<sup>d<\/sup>The range indicated refers to the incidence of reported spinal abnormalities (65% odontoid dysplasia, 49% cervical spine instability).<br \/>\n<em>Slower walking speed, reduced cadence and lower than average stride length should trigger your suspicion of MPS.<sup>28<\/sup><\/em><\/small><\/p>\n<\/figcaption>\n    <\/figure>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"short-statuture\" class=\"block wrapped-content block-tight-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce1840a\" class=\"block-wysiwyg\">\n            <h3>Short stature, while common in MPS, may not present in all MPS patients<\/h3>\n<ul>\n<li>As evidenced by a natural history study of patients with Morquio A, the majority of patients present with short stature and corresponding short trunk and neck<sup>16<\/sup><\/li>\n<li>Heights can range due to variability of disease progression; however, patients with slowly progressing or non-classical forms of MPS may not present with short stature<sup>13,14<\/sup><\/li>\n<\/ul>\n<p>The chart below, representative of the growth trajectory that is typical of individuals with MPS, is taken from a cohort of 326 patients with Morquio A who participated in The International Morquio A registry.<sup>13<\/sup><\/p>\n<p><strong>Growth trajectory in patients with Morquio A (MPS IVA)<sup>13,a<\/sup><\/strong><\/p>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"acf-block-6404a80902dfd\" class=\"block split-content equal-bias block-tight-top block-zero-bottom\" data-muted-autoplay=\"false\">\n\t<div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t                                                                <div class=\"content-block first-block\">\n                                                                                                <p>Boys growth curve in cm (n=167)<br \/>\nAverage: 122.5 cm (over 18 years old, n=45)<\/p>\n                                                                                                                                                                                                                                                                                                                    \n                                    \n                                                                                                                \n                                    \n                                    <figure>\n                                        <div class=\"image image-rounded\">\n                                                                                            <img decoding=\"async\" class=\"\" src=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2022\/12\/growth_trajectory_boys_graph.svg\" alt=\"growth trajectory boys graph\" \/>                                                                                    <\/div>\n                                                                            <\/figure>\n                                                                                    <\/div>\n                    \n                                            <div class=\"content-block second-block\">\n                                                                                                <p>Girls growth curve in cm (n=145)<br \/>\nAverage: 117 cm (over 18 years old, n=62)<\/p>\n                                                                                                                                                                                                                                                                                                                    \n                                    \n                                                                                                                \n                                    \n                                    <figure>\n                                        <div class=\"image image-rounded\">\n                                                                                            <img decoding=\"async\" class=\"\" src=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2022\/12\/growth_trajectory_girls_graph.svg\" alt=\"growth trajectory girls graph\" \/>                                                                                    <\/div>\n                                                                            <\/figure>\n                                                                                    <\/div>\n                                                \t\t<\/div>\n\t<\/div>\n<\/div>\n\n<div id=\"acf-block-63fdfdce1845a\" class=\"block wrapped-content block-zero-top block-zero-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce18472\" class=\"block-wysiwyg\">\n            <p><small>Adapted from Monta\u00f1o, <em>J Inherit Metab Dis<\/em>, 2007.<br \/>\nAbbreviation: CDC, Centers for Disease Control and Prevention.<\/small><br \/>\n<small><sup>a<\/sup>Weight-for-age (kg) in patients with Morquio A (0 &#8211; 20 years) compared with normal growth chart from the CDC. These data correspond to all the participating patients who have data for the parameter. The data trend line and the 5th, 10th, 25th and 50th centile values for CDC standard weight curve are depicted.<\/small><br \/>\n<small><em>Young patients who fall off the growth curve should raise your suspicion of MPS.<\/em><\/small><\/p>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"clinical-suspicion\" class=\"block wrapped-content block-tight-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce18497\" class=\"block-wysiwyg\">\n            <h3>Any number or pattern of signs should increase your clinical suspicion<\/h3>\n<p>MPS disorders can present in any number of ways, often with a cluster of seemingly unrelated multisystemic symptoms. However, isolated symptoms also merit referral to a geneticist or metabolic centre.<sup>3,9<\/sup><\/p>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"surgical-history\" class=\"block wrapped-content\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-63fdfdce184bc\" class=\"block-wysiwyg\">\n            <h3>A patient\u2019s surgical history and need should also alert you to the possibility of MPS<\/h3>\n<p>Surgical need is high among patients with MPS. Representative of this need, &gt;70% of patients \u22655 years participating in MorCAP, a natural history study, had at least one surgical procedure.<sup>27<\/sup><\/p>\n<p><strong>Common surgical procedures for MPS as seen in the Morquio A population<sup>27,a<\/sup><\/strong><\/p>\n    <\/div>\n\n<figure id=\"acf-block-63fdfdce184d2\">\n    <div class=\"image image-rounded image-align-left\">\n                    <img decoding=\"async\" class=\"\" src=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2022\/12\/common_surgical_procedures_graph.svg\" alt=\"common surgical procedures graph\" \/>            <\/div>\n    <\/figure>\n\n<div id=\"acf-block-63fdfdce184e3\" class=\"block-wysiwyg\">\n            <p><small>Adapted from Harmatz, Mol Genet Metab, 2013.<\/small><br \/>\n<small><sup>a<\/sup>Incidence of surgical procedures in patients (n=325) participating in the MorCAP study.<\/small><\/p>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"acf-block-63fdfdce1901e\" class=\"block split-content equal-bias bg-band block-tight-top block-tight-bottom\" data-muted-autoplay=\"false\">\n\t<div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t                                                                <div class=\"content-block first-block\">\n                                                                                                <h2>Take a closer look at the systems affected by MPS<\/h2>\n<p>Presentation and disease progression are unpredictable, multisystemic and variable across and within MPS disorders, making diagnosis challenging.<sup>3<\/sup><\/p>\n<p>Delayed diagnosis is common and it can have devastating consequences for your patients. Early identification of <a href=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/signs-and-symptoms\/\">signs and symptoms<\/a> across systems can be critical to early and accurate diagnosis.<sup>3,7,8<\/sup> Become familiar with the diverse <a href=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/signs-and-symptoms\/\">signs and symptoms of MPS<\/a> that may present in your department.<\/p>\n                                                                                                                                                                                                                                                                                                                                                                                                                                                                        <p><a class=\"button button-arrow\" href=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/signs-and-symptoms\/\" target=\"_self\">Learn more about signs and symptoms<\/a><\/p>\n                                                                                                                        <\/div>\n                    \n                                            <div class=\"content-block second-block\">\n                                                                                                                                                                                                                                                                                    \n                                    \n                                                                                                                \n                                    \n                                    <figure>\n                                        <div class=\"image image-rounded\">\n                                                                                            <img decoding=\"async\" class=\"\" src=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2022\/12\/signs_symptoms_promo-sq.jpg?v=0.26\" alt=\"signs symptoms promo\" \/>                                                                                    <\/div>\n                                                                            <\/figure>\n                                                                                    <\/div>\n                                                \t\t<\/div>\n\t<\/div>\n<\/div>\n\n<div id=\"Disorders-that-may-look-like-MPS\" class=\"block wrapped-content block-tight-top block-tight-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-6404a809045fe\" class=\"block-wysiwyg\">\n            <h2>Disorders that may look like MPS<\/h2>\n<p>As MPS treatment can have a life-changing impact, early and accurate diagnosis is critical.<sup>8,29<\/sup> If there is any suspicion of MPS, consider referring to a geneticist or local metabolic centre.<sup>3<\/sup><\/p>\n<p>MPS presents as a diverse array of signs and symptoms, leading to a long list of potential misdiagnoses.<sup>8<\/sup> Most common misdiagnoses include spondyloepiphyseal dysplasia congenita (SED), multiple epiphyseal dysplasia (MED), and Legg-Calv\u00e9-Perthes disease.<sup>14<\/sup><\/p>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"new-3\" class=\"block wrapped-content block-tight-top block-tight-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-6404a80904ed0\" class=\"block-wysiwyg\">\n            <p>A review of medical records of presenting signs and symptoms in 18 patients with Morquio A identified several misdiagnoses and other clinical diagnoses, shown in the list below.<\/p>\n<p><strong>Commonly misdiagnosed conditions prior to Morquio A diagnosis<sup>30<\/sup><\/strong><\/p>\n    <\/div>\n\n<figure id=\"acf-block-63fdfdce190b7\">\n    <div class=\"image image-rounded image-align-left\">\n                    <img decoding=\"async\" class=\"\" src=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2022\/12\/misdiagnosed_conditions_table.svg\" alt=\"misdiagnosed conditions table\" \/>            <\/div>\n            <figcaption><p><small>Adapted from Bhattacharaya, <em>Orphanet J Rare Dis<\/em>, 2014.<\/small><\/p>\n<\/figcaption>\n    <\/figure>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"Disorders-that-may-look-like-MPS\" class=\"block wrapped-content block-tight-bottom\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n                \n<div id=\"acf-block-64062bf7422ce\" class=\"block-wysiwyg\">\n            <p>Similarly, as the table below describes, an analysis of 18 patients with MPS VI conducted by managing physicians identified common misdiagnoses associated with this subtype.<\/p>\n<p><strong>Reported misdiagnoses in a cohort of 18 patients with MPS VI<sup>31<\/sup><\/strong><\/p>\n    <\/div>\n\n<figure id=\"acf-block-63fdfdce19103\">\n    <div class=\"image image-rounded image-align-left\">\n                    <img decoding=\"async\" class=\"\" src=\"https:\/\/hcp.biomarin.com\/en-gb\/mps\/wp-content\/uploads\/sites\/2\/2022\/12\/reported_misdiagnoses_table.svg\" alt=\"reported misdiagnoses table\" \/>            <\/div>\n    <\/figure>\n\n<div id=\"acf-block-63fdfdce19116\" class=\"block-wysiwyg\">\n            <p><em>The advancement of specific treatments for MPS highlights the importance of early intervention and referral of patients with suspected SED, MED, or Legg-Calv\u00e9-Perthes disease to a geneticist or metabolic centre.<\/em><sup>3,14,29<\/sup><\/p>\n    <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<div id=\"acf-block-6435d44128f3d\" class=\"block call-to-action\">\n    <div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t\t<div class=\"box\" style=\"\">\n\t\t\t\t<div class=\"overlay\"><\/div>\n\t\t\t\t<div class=\"cta-content\">\n\t\t\t\t    \t\t\t\t\t<div class=\"cta-content-main\">\n                        <div class=\"content-block\">\n\t\t\t\t\t        \t\t\t\t\t        \t\t\t\t\t\t        <h2 class=\"h3\">When in doubt over differential diagnoses, refer patients to a geneticist or local metabolic center.<sup>3<\/sup>\n<\/h2>\n\t\t\t\t\t\t    \t\t\t\t\t\t    \t\t\t\t\t    <\/div>\n\t\t\t\t\t                        <\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n<div id=\"new-2\" class=\"block cards cards-2-col block-tight-top block-tight-bottom\">\n\t<div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t\t<div class=\"cards-title\">\n\t\t\t    \t\t\t\t    <h2>Differential diagnosis to rule out MPS<sup>8<\/sup>\n<\/h2>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<div class=\"cards-wrapper\">\n\t\t\t    \n<div id=\"acf-block-6404a80904dc8\" class=\"card\" data-muted-autoplay=\"false\">\n        <div class=\"card-content\">\n                \n                                                                                                            <ul>\n<li>Autoimmune disease<\/li>\n<li>Muscular dystrophy<\/li>\n<li>Connective tissue disease<\/li>\n<li>Osteogenesis imperfecta<\/li>\n<li>Polymyositis<\/li>\n<li>Dermatomyositis<\/li>\n<li>Polyneuropathy<\/li>\n<li>Fibromyalgia<\/li>\n<\/ul>\n                                                                                    <\/div>\n<\/div>\n\n<div id=\"acf-block-6404a80904e4a\" class=\"card\" data-muted-autoplay=\"false\">\n        <div class=\"card-content\">\n                \n                                                                                                            <ul>\n<li>Rheumatoid arthritis<\/li>\n<li>Growing pains<\/li>\n<li>Scleroderma<\/li>\n<li>Juvenile idiopathic arthritis<\/li>\n<li>Spondyloarthritis<\/li>\n<li>Legg-Calv\u00e9-Perthes disease<\/li>\n<li>Other systemic rheumatic disorder<\/li>\n<\/ul>\n                                                                                                <p><small>Adapted from Hendriksz, <em>Br J Hosp Med (Lond)<\/em>, 2011.<\/small><\/p>\n                                                                                    <\/div>\n<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n<div id=\"acf-block-63fdfdce192cb\" class=\"block call-to-action block-tight-top block-tight-bottom\">\n    <div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t\t<div class=\"box\" style=\"\">\n\t\t\t\t<div class=\"overlay\"><\/div>\n\t\t\t\t<div class=\"cta-content\">\n\t\t\t\t    \t\t\t\t\t<div class=\"cta-content-main\">\n                        <div class=\"content-block\">\n\t\t\t\t\t        \t\t\t\t\t        \t\t\t\t\t\t        <h2 class=\"h3\">Register for access\n<\/h2>\n\t\t\t\t\t\t    \t\t\t\t\t\t    \t\t\t\t\t\t        <p>Get access to the latest webinars, meetings and events about MPS; registration is quick and easy.<\/p>\n\t\t\t\t\t\t    \t\t\t\t\t    <\/div>\n\t\t\t\t\t                                <div class=\"content-block\">\n                                <p><a class=\"button button-ghost button-arrow\" href=\"http:\/\/www.mpsmeetings.com\/register\/\" target=\"_blank\">Register Now<\/a><\/p>\n                            <\/div>\n\t\t\t\t\t                        <\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n<div id=\"acf-block-63fdfdce1923c\" class=\"block references\">\n    <div class=\"wrapper\">\n\t\t<div class=\"inner-wrapper\">\n\t\t    \t\t\t    <h4>References:\n<\/h4>\n\t\t\t\t\t\t                <ol>\n                                                                                                                        <li><span>1. Kakkis ED, Neufeld EF. The mucopolysaccharidoses. In: Berg BO, ed. Principles of child neurology. New York, NY: McGraw-Hill; 1996:1141\u20131166.\n<\/span><\/li>\n                                                                                                                                                <li><span>Coman DJ <em>et al.<\/em> Enzyme replacement therapy and extended newborn screening for mucopolysaccharidoses: opinions of treating physicians. <em>JIMD Rep<\/em>. 2011;1:9\u201315.\n<\/span><\/li>\n                                                                                                                                                <li><span>Lehman TJA <em>et al.<\/em> Diagnosis of the mucopolysaccharidoses. <em>Rheumatology<\/em>. 2011;50(suppl 5):v41\u2013v48.\n<\/span><\/li>\n                                                                                                                                                <li><span>Jurecka A <em>et al.<\/em> Attenuated osteoarticular phenotype of type VI mucopolysaccharidosis: a report of four patients and a review of the literature. <em>Clin Rheumatol.<\/em> 2014;33(5):725\u2013731.\n<\/span><\/li>\n                                                                                                                                                <li><span>Muenzer J, Beck M, Eng CM, et al.<em>Genet Med.<\/em> 2011;13(2):95\u2013101. doi:10.1097\/GIM.0b013e3181fea459.\n<\/span><\/li>\n                                                                                                                                                <li><span>Clarke LA. Pathogenesis of skeletal and connective tissue involvement in the mucopolysaccharidoses: glycosaminoglycan storage is merely the instigator. <em>Rheumatology (Oxford)<\/em> 2011;50(suppl 5):v13\u201318. d\n<\/span><\/li>\n                                                                                                                                                <li><span>Morishita K, Petty RE. Musculoskeletal manifestations of mucopolysaccharidoses. <em>Rheumatology<\/em> 2011;50(suppl 5):v19\u2013v25.\n<\/span><\/li>\n                                                                                                                                                <li><span>Hendriksz C. Improved diagnostic procedures in attenuated mucopolysaccharidosis. <em>Br J Hosp Med<\/em> 2011;72(2):91\u201395.\n<\/span><\/li>\n                                                                                                                                                <li><span>Wood TC <em>et al.<\/em> Diagnosing mucopolysaccharidosis IVA. <em>J Inherit Metab Dis<\/em> 2013;36(2):293\u2013307.\n<\/span><\/li>\n                                                                                                                                                <li><span>Muenzer J. The mucopolysaccharidoses: a heterogeneous group of disorders with variable pediatric presentations. <em>J Pediatr<\/em> 2004;144(suppl 5):S27\u2013S34.\n<\/span><\/li>\n                                                                                                                                                <li><span>Th\u00fcmler A <em>et al.<\/em> Clinical characteristics of adults with slowly progressing mucopolysaccharidosis VI: a case series. <em>J Inherit Metab Dis<\/em> 2012;35(6):1071\u20131079.\n<\/span><\/li>\n                                                                                                                                                <li><span>Valayannopoulos V <em>et al.<\/em> Mucopolysaccharidosis VI. <em>Orphanet J Rare Dis<\/em> 2010;5:5.\n<\/span><\/li>\n                                                                                                                                                <li><span>Monta\u00f1o AM <em>et al.<\/em> International Morquio A Registry: clinical manifestation and natural course of Morquio A disease. <em>J Inherit Metab Dis<\/em> 2007;30(2):165\u2013174.\n<\/span><\/li>\n                                                                                                                                                <li><span>Lachman RS <em>et al.<\/em> Mucopolysaccharidosis IVA (Morquio A syndrome) and VI (Maroteaux-Lamy syndrome): under-recognized and challenging to diagnose. <em>Skeletal Radiol<\/em> 2014;43(3):359\u2013369. \n<\/span><\/li>\n                                                                                                                                                <li><span>Kinirons MJ, Nelson J. Dental findings in mucopolysaccharidosis type IV A (Morquio\u2019s disease type A). <em>Oral Surg Oral Med Oral Pathol<\/em> 1990;70(2):176\u2013179. \n<\/span><\/li>\n                                                                                                                                                <li><span>Hendriksz CJ <em>et al.<\/em>  International guidelines for the management and treatment of Morquio A syndrome. <em>Am J Med Genet Part A<\/em> 2014;9999A:1-15.  \n<\/span><\/li>\n                                                                                                                                                <li><span>Lachman R <em>et al.<\/em> Radiologic and neuroradiologic findings in the mucopolysaccharidoses. <em>J Pediatr Rehabil Med<\/em> 2010;3(2):109\u2013118.\n<\/span><\/li>\n                                                                                                                                                <li><span>Cimaz R <em>et al.<\/em> Joint contractures in the absence of inflammation may indicate mucopolysaccharidosis [hypothesis]. <em>Pediatr Rheumatol Online J<\/em>\n<\/span><\/li>\n                                                                                                                                                <li><span>Fahnehjelm KT<em>et al.<\/em> Clinical guidelines for diagnosing and managing ocular manifestations in children with mucopolysaccharidosis. <em>Acta Ophthalmol<\/em> 2012;90(7):595\u2013602. \n<\/span><\/li>\n                                                                                                                                                <li><span>Zafeiriou DI, Batzios SP. Brain and spinal MR imaging findings in mucopolysaccharidoses: a review. <em>AJNR Am J Neuroradiol<\/em> 2013;34(1):5\u201313.  \n<\/span><\/li>\n                                                                                                                                                <li><span>Braunlin EA <em>et al.<\/em> Cardiac disease in patients with mucopolysaccharidosis: presentation, diagnosis and management. <em>J Inherit Metab Dis<\/em> 2011;34(6):1183\u20131197. \n<\/span><\/li>\n                                                                                                                                                <li><span>Braunlin E <em>et al.<\/em> Unexpected coronary artery findings in mucopolysaccharidosis. Report of four cases and literature review. <em>Cardiovasc Pathol<\/em> 2014;23(3):145\u2013151. \n<\/span><\/li>\n                                                                                                                                                <li><span>Mesolella M <em>et al.<\/em> Management of otolaryngological manifestations in mucopolysaccharidoses: our experience. <em>Acta Otorhinolaryngol Ital<\/em> 2013;33(4):267\u2013272. \n<\/span><\/li>\n                                                                                                                                                <li><span>Berger KI <em>et al.<\/em> Respiratory and sleep disorders in mucopolysaccharidosis. <em>J Inherit Metab Dis<\/em> 2013;36(2):201\u2013210. \n<\/span><\/li>\n                                                                                                                                                <li><span>Martins AM <em>et al.<\/em> Guidelines for the management of mucopolysaccharidosis type I. <em>J Pediatr<\/em> 2009;155(4)(suppl 2):S32-S46.\n<\/span><\/li>\n                                                                                                                                                <li><span>Clarke LA <em>et al.<\/em> Biomarkers for the mucopolysaccharidoses: discovery and clinical utility. <em>Mol Genet Metab<\/em> 2012;106(4):396\u2013402.  \n<\/span><\/li>\n                                                                                                                                                <li><span>Harmatz P <em>et al.<\/em> The Morquio A clinical assessment program: baseline results illustrating progressive, multisystemic clinical impairments in Morquio A subjects. <em>Mol Genet Metab<\/em> 2013;109(1):54\u201361. \n<\/span><\/li>\n                                                                                                                                                <li><span>Dhawale AA <em>et al.<\/em> Gait pattern and lower extremity alignment in children with Morquio syndrome. <em>J Pediatr Orthop B<\/em> 2013;22(1):59\u201362. doi:10.1097\/BPB.0b013e32835a0e6d. \n<\/span><\/li>\n                                                                                                                                                <li><span>Muenzer J. Early initiation of enzyme replacement therapy for the mucopolysaccharidoses. <em>Mol Genet Metab<\/em> 2014;111(2):63\u201372. \n<\/span><\/li>\n                                                                                                                                                <li><span>Bhattacharya K <em>et al.<\/em> Overcoming the barriers to diagnosis of Morquio A syndrome. <em>Orphanet J Rare Dis<\/em> 2014;9:192. doi:10.1186\/s13023-014-0192-7. \n<\/span><\/li>\n                                                                                                                                                <li><span>Choy YS <em>et al.<\/em> Identifying the need for a multidisciplinary approach for early recognition of mucopolysaccharidosis VI (MPS VI). <em>Mol Genet Metab<\/em> 2015;115(1):41\u201347. \n<\/span><\/li>\n                                                                                                                                                <li><span>Data on file. Biomarin Pharmaceutical, Inc. \n<\/span><\/li>\n                                                                                                                                                <li><span>Drummond JC <em>et al.<\/em> Paraplegia after epidural-general anesthesia in a Morquio patient with moderate thoracic spinal stenosis. <em>Can J Anesth<\/em> 2015;62(1):45\u201349. \n<\/span><\/li>\n                                                                                                                                                <li><span>Sharkia R<em>et al.<\/em> Sanfilippo type A: new clinical manifestations and neuro-imaging findings in patients from the same family in Israel: a case report. <em>J Med Case Rep<\/em> 2014;8:78.\n<\/span><\/li>\n                                                            <\/ol>\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-61","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - 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