{"id":63,"date":"2022-12-14T22:03:37","date_gmt":"2022-12-14T22:03:37","guid":{"rendered":"https:\/\/mpsdsehcp-dev-001.azurewebsites.net\/en\/mucopolysaccharidosis-mps\/?page_id=63"},"modified":"2023-12-04T09:14:44","modified_gmt":"2023-12-04T09:14:44","slug":"signs-and-symptoms","status":"publish","type":"page","link":"https:\/\/hcp.biomarin.com\/en-gb\/mps\/signs-and-symptoms\/","title":{"rendered":"Signs and Symptoms"},"content":{"rendered":"
Explore the multisystemic manifestations of MPS, what you see may surprise you<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n
Regardless of the clinical setting, there are overt and generally observable signs that should raise your suspicion of mucopolysaccharidosis (MPS) disorders, including:1<\/sup><\/p>\n Consideration of MPS based on suspicious patterns of signs and symptoms is the first step to arriving at a definitive diagnosis of a specific MPS disorder. Of particular importance, recognition of the heterogeneous nature of slowly progressive disease is essential to reduce time to diagnosis for many patients.2<\/sup><\/p>\n <\/div>\n \n Classically, mucopolysaccharidosis (MPS) is associated with a cluster of signs and symptoms referred to as dysostosis multiplex, with the exception of MPS III. However, recognition of early and non-classical skeletal symptoms prior to more robust skeletal progression can enable early recognition, and should prompt referral to a geneticist or metabolic centre.1,2<\/sup><\/p>\n Most MPS types are characterised by skeletal abnormalities and joint disease with hallmark features of dysostosis multiplex.1,2<\/sup><\/p>\n Radiograph image showing dysostosis multiplex manifestations in the pelvis and hips of a patient with MPS. Rounded iliac wings, double-contoured ileal lateral walls (arrows) and elongated femoral necks.<\/strong><\/p>\n Reproduced with permission from Lachman, J Pediatr Rehabil Med, 2010.<\/em><\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Radiograph of the chest of a patient with MPS showing paddle-shaped ribs and short thickened clavicles (arrows).<\/strong><\/p>\n Reproduced with permission from Lachman, J Pediatr Rehabil Med, 2010.<\/em><\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Radiograph of anterposterior pelvis and hips in a 27-year-old patient with Morquio A showing mildly dysplastic capital femoral epiphysis with joint space narrowing and sclerosis (degenerative arthrosis).<\/strong><\/p>\n Source: Skeletal Radiology, volume 43, issue 3. Lachman RS, Burton BK, Clarke LA, Hoffinger S, Ikegawa S, Jin D-K, Kano H, Kim O-H, Lampe C, Mendelsohn NJ, Shediac R, Tanpaiboon P, White KK. Mucopolysaccharidosis IVA (Morquio A syndrome) and VI (Maroteaux-Lamy syndrome): under-recognized and challenging to diagnose. Pages 359\u2013369. Copyright (C) Lachman RS, Burton BK, Clarke LA, Hoffinger S, Ikegawa S, Jin D-K, Kano H, Kim O-H, Lampe C, Mendelsohn NJ, Shediac R, Tanpaiboon P, White KK 2014. <\/em><\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Cardiac involvement is commonly seen in individuals with mucopolysaccharidosis (MPS) and leads to extensive morbidity and, potentially, premature mortality. Early suspicion is therefore critical, regardless of whether cardiac symptoms are seen alone or in combination with other symptoms.5<\/sup><\/p>\n The most common cardiac findings in MPS, as reported in an evaluation of 28 patients aged 2 to 14 years were:5<\/sup><\/p>\n Along with the preceding common cardiac signs, the following signs should raise your index of suspicion for MPS:<\/p>\n Mitral valve involvement in a patient with MPS at 6 months.<\/strong><\/p>\n Courtesy of Dr. Russo P. and Dr. Parini R. (Monza).<\/em><\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Aortic valve disease in a patient with advanced MPS. Note the retraction of the valve leaflets.<\/strong><\/p>\n Courtesy of Dr. Russo P. and Dr. Parini R. (Monza).<\/em><\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Pseudohypertrophy of the interventricular septum in a patient with MPS.<\/strong><\/p>\n Courtesy of Dr. Russo P. and Dr. Parini R. (Monza). <\/em><\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Bone- and joint-related features are common from a very early stage of disease in patients with most types of mucopolysaccharidosis (MPS) disorders. Patients with these types of musculoskeletal manifestations often present to a rheumatologist, and often before MPS is diagnosed.8<\/sup><\/p>\n Rheumatological involvement is uniformly progressive, with incidence and severity increasing over time. Although patients with MPS typically present with a wide range or cluster of symptoms, isolated symptoms may be sufficient to merit referral to a geneticist or metabolic centre.8,9<\/sup><\/p>\n Signs and symptoms may be subtle or overt. Common bone and joint features suggestive of MPS include:1<\/sup><\/p>\n Rheumatologists should additionally consider an MPS referral in patients with any of the following:<\/p>\n Manifestations of dysostosis multiplex in the hands. Radiograph showing hands of a patient with MPS in early childhood, with moderately severe proximal pointing and expanded metacarpals with thin cortices.<\/strong><\/p>\n Reproduced with permission from Lachman, J Pediatr Rehabil Med<\/em>, 2010.<\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Radiograph of anteroposterior pelvis and hips in a 27-year old patient with Morquio A showing mildly dysplastic capital femoral epiphysis with joint space narrowing and sclerosis (degenerative arthrosis).<\/strong><\/p>\n Source: Skeletal Radiology, volume 43, issue 3. Lachman RS, Burton BK, Clarke LA, Hoffinger S, Ikegawa S, Jin D-K, Kano H, Kim O-H, Lampe C, Mendelsohn NJ, Shediac R, Tanpaiboon P, White KK. Mucopolysaccharidosis IVA (Morquio A syndrome) and VI (Maroteaux-Lamy syndrome): under-recognized and challenging to diagnose. Pages 359-369. Copyright (C) Lachman RS, Burton BK, Clarke LA, Hoffinger S, Ikegawa S, Jin D-K, Kano H, Kim O-H, Lampe C, Mendelsohn NJ, Shediac R, Tanpaiboon P, White KK 2014.<\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Radiograph of a patient with MPS showing valgus knee.<\/strong><\/p>\n Courtesy of BioMarin.<\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Ocular manifestations often arise prior to other features of mucopolysaccharidosis (MPS) and vary by type and severity among the MPS disorders. Corneal clouding is a hallmark feature of MPS.13<\/sup><\/p>\n Ocular features often leading to visual impairment, have been described in all types of MPS and should raise suspicion of MPS.<\/p>\n Common ocular manifestations include:14<\/sup><\/p>\n Hypotransparent cornea due to deposits of mucopolysaccharides in a patient with MPS.<\/strong><\/p>\n Courtesy of Dr. Magalh\u00e3es A. (Porto).<\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Optic nerve atrophy in a patient with MPS.<\/strong><\/p>\n Courtesy of Dr. Magalh\u00e3es A. (Porto).<\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Papilloedema in a patient with MPS.<\/strong><\/p>\n Courtesy of Dr. Magalh\u00e3es A. (Porto).<\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n Ear, nose and throat (ENT) manifestations are commonly seen in individuals with mucopolysaccharidosis (MPS) and are often among the first symptoms to appear. Common manifestations include but are not limited to adenotonsillar hypertrophy, frequent infections of the upper airway and hearing loss.15,16<\/sup><\/p>\n Any number of ENT symptoms, especially if coupled with other systemic signs and symptoms, should prompt referral to a geneticist or metabolic centre.8,17<\/sup> Along with the common ENT and respiratory signs, these additional features should also raise your index of suspicion for MPS:18<\/sup><\/p>\n Macroglossia in a patient with MPS.<\/strong><\/p>\n Courtesy of Dr. Lampe C. (Wiesbaden).<\/small><\/p>\n <\/div>\n \t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n
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Musculoskeletal manifestations<\/h2>\n
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Cardiovascular manifestations<\/h2>\n
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Rheumatological manifestations<\/h2>\n
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Ophthalmological manifestations<\/h2>\n
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Ear, nose and throat manifestations<\/h2>\n
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