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Jaime F. Bravo
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Should we worry about health
problems in Marfanoids?
After returning to Santiago, Chile in 1998, after 30
years in Denver, Colorado, USA., I noticed that many of
the adolescents here now, males and females are tall
(Marfanoids), which was not the case before. The
emergence of tall people has been noted lately all
around the world. Many come to my office, because of
arthralgias, recurrent sprains, tendinitis, bursitis
and/or back pain. Some have tall parents , but most do
not. As I was studying patients with Benign Joint
Hypermobility Syndrome (BJHS), I soon realized that
these Marfanoids were suffering from BJHS too. Later I
was gladdly surprised, when I came across the Brighton
Criteria for BJHS (1), to note that Marfanoid features
were included as a minor criteria.
Since patients with this syndrome can have not only
musculo-skeletal problems but also problems derived from
fragile tissues, is that we need to be aware of
potential complications in Marfanoids.
BJHS appears to be a genetic alteration of the collagen
fibers which renders tissues rich in collagen fibers, to
be weak. Because of this, besides the recurrent symptoms
from the musculo-skeletal system (arthralgias, bursitis,
tendinitis, sub-luxations, back pain, etc) they may get
problems from other tissues : uterine or rectal
prolapse, hernias, varicose veins, lax skin, transparent
(show readily the veins), with striae, capilar fragility
and poor cicatrization, mitral valve prolapse, miopia,
retinal detachment, blepharoptosis, etc. Due to weak
cartilages and bones, we have seen early osteoarthritis
and early osteoporosis in these patients too, including
young males. As we see in true Marfans, occasional cases
of spontaneous pneumothorax are seen, due to poor lung
elasticity.
In summary: It appears that due to genetic mutations,
cause unknown, the percentage of tall people
(Marfanoids) has increased all around the world.
Tall adolescents need to be evaluated carefully not only
for musculo-skeletal complaints, but specially looking
for more serious problems affecting the skin, blood
vessels, cardiac valves, ocular and lung problems.
(1) Grahame R. Brighton Diagnosis Criteria for the
Benign Joint Hypermobility Syndrome. Br J Rheumatol
2000; 27: 1777-9
My E-Mail Address is : jbravos@ctcinternet.cl
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