Nail-patella syndrome

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Nail-patella syndrome
Nailpatellakleur1fotojanwij.jpg
Nail of a patient the nail-patella syndrome
ICD-10 Q87.2
ICD-9 756.89
OMIM 161200
DiseasesDB 8773
MeSH C05.550.629

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Synonyms and Keywords: Iliac Horn syndrome; hereditary osteoonychodysplasia; Fong disease; Turner-Kiser syndrome

Overview

Nail-patella syndrome (NPS) is a genetic disorder that results in small, poorly developed nails and kneecaps, but can also affect many other areas of the body, such as the elbows, chest, and hips. The name "nail-patella" can be very misleading because the syndrome often affects many other areas of the body, including even the production of certain proteins.[1]:666 It is also referred to as iliac horn syndrome, hereditary onychoosteodysplasia, Fong disease or Turner–Kieser syndrome.[2].

Historical Perspective

Chatelain first described the syndrome in 1820, and its genetics was first documented by Little in 1897.

Pathophysiology

Genetics

Nail-patella syndrome is inherited in an autosomal dominant pattern.

The Nail-Patella syndrome is inherited via autosomal dominancy (see autosomal dominant) linked to aberrancy on human chromosome 9's q arm (q stands for longer arm), 9q34. This autosomal dominancy means that only a single copy, instead of both, is sufficient for disorder to be expressed in the offspring, meaning that the chance of getting the disorder from an affected parent is 50%. The frequency of the occurrence is 1/50,000. The disorder is linked to the ABO blood group locus.

Differentiating Nail-patella syndrome from Other Diseases

Epidemiology and Demographics

The prevalence of nail-patella syndrome is estimated to be 1 in 50,000 individuals.

Diagnosis

Symptoms

  • Poorly developed fingernails, toenails, and patellae (kneecaps).
  • The nails may be absent, pitted, rigged, discolored or a small piece of a thumbnail may be found on the edge of the thumb. The area at the base of the nail is triangular instead of usual crescent shape.
  • Elbow deformities
  • Some patients are unable to keep their elbow extended or keep their palms up with elbow extended
  • Abnormally shaped pelvis bone (hip bone) or outgrowths causing no symptoms
  • Knee may be small, deformed or absent
  • Some research shows that people with NPS are more prone to glaucoma and scoliosis, due to poorly developed spines.

Physical Examination

Appearance of the Patient

  • May have pronounced skeletal deformities

Skin

  • Nail changes:
    • Presentation varies from no thumbnail or small piece of a thumb nail at the edge of the finger to minor pitting or discoloration

Eyes

Extremities

  • Patellar apalsia may be seen
  • Unstable knees from patellar subluxation
  • Limited range of motion of elbow joint
  • Arthodysplasia of the elbow joint may be present
  • General hyper-extension of the elbow noted
  • Exostosis from the iliac bones : pathognomic feature of the syndrome
  • Scoliosis
  • Scapular apalsia
  • Cervical ribs may be present
  • Subluxation of radial head

Laboratory Findings

Blood tests

Urinalysis

Treatment

  • Medical treatment:
  • Surgical treatment:
    • Orthopedic correction for knee deformities

References

  1. Freedberg, et. al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  2. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 786-7. ISBN 0-7216-2921-0.

See also

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