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FOP in South Africa: awareness leads to diagnosis

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Introduction

Fibrodysplasia Ossificans Progressiva (FOP) is a genetic disorder (autosomal dominant)in which there is progressive ossification of skeletal muscle. The majority of affected persons represent new mutations for the determinant gene, ACVR1 the protein product of which acts to regultae Bone Morphogenic Protein expression.(1)FOP presents in early childhood, with painful , hard areas of ossification in the muscles of the back/neck and progressive limitation leading to immbobilisation of all joints by adulthood.Previously there were few reports of FOP from Africa.We recently reported on 3 patients from South Africa(2) and have in the last 18months diagnosed a further 6 patients.

Methods

We document 9 affected individuals in the Xhosa, Afrikaner and mixed ancestry community.

Results

Two were reported in childhoodalmost three decades ago, five are young children, and two presented in their teens. All have the typical features of heterotopic ossification as well as the characteristic halluxvalgus. Two patients underwent unnecessary and harmful biopsies and one patient sustained a fracture of one of the areas of heterotopic bone during positioning for diagnostic xrays. In these three cases the tissue trauma exacerbated and stimulated heterotopic bone formation.

Conclusion

FOP is a devastating condition with no known cure, but early diagnosis is essential to prevent unnecessary and directly harmful special investigations.In our experience an increased awareness has led to a flurry of new diagnoses, leading to early referral and appropriate counselling and management. Paediatric rheumatologists should be aware of this condition, in order to facilitate patient diagnosis and avoid harmful procedures.

References

  1. 1.

    Kaplan FS, Shen Q, Lounev V, Seemann P, Groppe J, Katagiri T: Skeletal metamorphosis in fibrodysplasia ossificans progressiva (FOP). J Bone Miner Metab. 2008, 26 (6): 521-30. 10.1007/s00774-008-0879-8.

  2. 2.

    Scott C, Urban M, Arendse R, Dandara C, Beighton P: Fibrodysplasia ossificans progressiva in South Africa: difficulties in management in a developing country. J Clin Rheumatol. 2011, 17 (1): 37-41.

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Author information

Correspondence to Christiaan Scott.

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cite this article

Scott, C. FOP in South Africa: awareness leads to diagnosis. Pediatr Rheumatol 9, P31 (2011) doi:10.1186/1546-0096-9-S1-P31

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Keywords

  • Bone Formation
  • Affected Individual
  • Heterotopic Ossification
  • Bone Morphogenic Protein
  • Paediatric Rheumatologist