Rheumatoid Arthritis and CLOVES Syndrome: A Tricky Diagnosis
The PI3K/AKT/mTOR signaling pathway is significantly activated in rheumatoid arthritis. In addition, somatic activating mutations of the PI3K/AKT/mTOR pathway may result in <i>PIK3CA</i>-related overgrowth spectrum diseases, including CLOVES (Congenital Lipomatous Overgrowth, Vascular ma...
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doaj-c44b06bad7e3425589f096104bb8128c2020-11-25T03:42:46ZengMDPI AGDiagnostics2075-44182020-07-011046746710.3390/diagnostics10070467Rheumatoid Arthritis and CLOVES Syndrome: A Tricky DiagnosisLaura Damian0Andrei Lebovici1Cristina Pamfil2Cristina Belizna3Romana Vulturar4Cab. Reumatologie Dr. Damian, 6-8 Petru Maior St, 400002 Cluj-Napoca, RomaniaRadiology Department, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj, 8 Victor Babeș St, 400023 Cluj-Napoca, RomaniaCenter for Rare Musculoskeletal Autoimmune and Autoinflammatory Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj, 8 Victor Babeș St, 400023 Cluj-Napoca, RomaniaVascular and Coagulation Department, University Hospital Angers, 49100 Angers, FranceDepartment of Molecular Sciences, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj, 6, Pasteur St., 400349 Cluj-Napoca, RomaniaThe PI3K/AKT/mTOR signaling pathway is significantly activated in rheumatoid arthritis. In addition, somatic activating mutations of the PI3K/AKT/mTOR pathway may result in <i>PIK3CA</i>-related overgrowth spectrum diseases, including CLOVES (Congenital Lipomatous Overgrowth, Vascular malformation, Epidermal nevi, Skeletal abnormalities/Scoliosis) syndrome. We describe the case of a young female patient, with anti-citrullinated peptide antibodies-positive rheumatoid arthritis, referred for persistent finger pain and stiffness. Examination revealed discrete macrodactyly involving two fingers, scoliosis, asymmetrical calves, venectasias, a shoulder nevus and triangular feet with a “sandal gap” between two toes. These mild dysmorphic features with early-onset and the history of surgeries for thoracic lipoma and venous malformation were strongly suggestive of CLOVES syndrome. Confirmatory mutation analysis was not performed, as blood or saliva testing is not contributive for tissue-specific localized effects in the <i>PIK3CA</i>-related overgrowth spectrum. Nevertheless, lack of detection of a <i>PIK3CA</i> mutation does not exclude the diagnosis in patients fulfilling clinical criteria. Due to the patient’s wish to plan a pregnancy, therapy consisted in sulfasalazine and hydroxychloroquine, along with orthotic correction of leg length discrepancy. Overgrowth syndromes and arthritis may share common pathways. Mild macrodactyly should be differentiated from dactylitis. Diagnosing patients with minimal dysmorphic features within the PI3K-related overgrowth spectrum may help design better care strategies, in the quest for personalized medicine.https://www.mdpi.com/2075-4418/10/7/467CLOVES syndromerheumatoid arthritismacrodactylyPIK3/AKT/mTOR pathway<i>PIK3CA</i>-related overgrowth spectrum |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Laura Damian Andrei Lebovici Cristina Pamfil Cristina Belizna Romana Vulturar |
spellingShingle |
Laura Damian Andrei Lebovici Cristina Pamfil Cristina Belizna Romana Vulturar Rheumatoid Arthritis and CLOVES Syndrome: A Tricky Diagnosis Diagnostics CLOVES syndrome rheumatoid arthritis macrodactyly PIK3/AKT/mTOR pathway <i>PIK3CA</i>-related overgrowth spectrum |
author_facet |
Laura Damian Andrei Lebovici Cristina Pamfil Cristina Belizna Romana Vulturar |
author_sort |
Laura Damian |
title |
Rheumatoid Arthritis and CLOVES Syndrome: A Tricky Diagnosis |
title_short |
Rheumatoid Arthritis and CLOVES Syndrome: A Tricky Diagnosis |
title_full |
Rheumatoid Arthritis and CLOVES Syndrome: A Tricky Diagnosis |
title_fullStr |
Rheumatoid Arthritis and CLOVES Syndrome: A Tricky Diagnosis |
title_full_unstemmed |
Rheumatoid Arthritis and CLOVES Syndrome: A Tricky Diagnosis |
title_sort |
rheumatoid arthritis and cloves syndrome: a tricky diagnosis |
publisher |
MDPI AG |
series |
Diagnostics |
issn |
2075-4418 |
publishDate |
2020-07-01 |
description |
The PI3K/AKT/mTOR signaling pathway is significantly activated in rheumatoid arthritis. In addition, somatic activating mutations of the PI3K/AKT/mTOR pathway may result in <i>PIK3CA</i>-related overgrowth spectrum diseases, including CLOVES (Congenital Lipomatous Overgrowth, Vascular malformation, Epidermal nevi, Skeletal abnormalities/Scoliosis) syndrome. We describe the case of a young female patient, with anti-citrullinated peptide antibodies-positive rheumatoid arthritis, referred for persistent finger pain and stiffness. Examination revealed discrete macrodactyly involving two fingers, scoliosis, asymmetrical calves, venectasias, a shoulder nevus and triangular feet with a “sandal gap” between two toes. These mild dysmorphic features with early-onset and the history of surgeries for thoracic lipoma and venous malformation were strongly suggestive of CLOVES syndrome. Confirmatory mutation analysis was not performed, as blood or saliva testing is not contributive for tissue-specific localized effects in the <i>PIK3CA</i>-related overgrowth spectrum. Nevertheless, lack of detection of a <i>PIK3CA</i> mutation does not exclude the diagnosis in patients fulfilling clinical criteria. Due to the patient’s wish to plan a pregnancy, therapy consisted in sulfasalazine and hydroxychloroquine, along with orthotic correction of leg length discrepancy. Overgrowth syndromes and arthritis may share common pathways. Mild macrodactyly should be differentiated from dactylitis. Diagnosing patients with minimal dysmorphic features within the PI3K-related overgrowth spectrum may help design better care strategies, in the quest for personalized medicine. |
topic |
CLOVES syndrome rheumatoid arthritis macrodactyly PIK3/AKT/mTOR pathway <i>PIK3CA</i>-related overgrowth spectrum |
url |
https://www.mdpi.com/2075-4418/10/7/467 |
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