title: Pediatric granulomatous arthritis: an international registry.
abstract: OBJECTIVE
  Blau syndrome and its sporadic counterpart, early-onset sarcoidosis, share an identical phenotype featuring the classic triad of arthritis, dermatitis, and uveitis and are associated with mutations of CARD15 in 50-90% of cases. We chose the term "pediatric granulomatous arthritis" to refer to both. An international registry was established in the spring of 2005 to define the phenotype spectrum and establish the mutation frequency and variants.
  
  
  METHODS
  Histologically confirmed granuloma and arthritis were required for inclusion. Probands and relatives were genotyped for CARD15. Deidentified clinical information was collected.
  
  
  RESULTS
  One year after the inception of the registry, 61 individuals from 22 pedigrees had been entered. Seven pedigrees with 19 individuals (8 affected, 11 unaffected) had clinical disease that was atypical, and none of the individuals in those pedigrees showed mutations. There were 9 classic simplex pediatric granulomatous arthritis pedigrees including 19 individuals (9 affected, 10 unaffected) and 6 classic multiplex pedigrees with 22 individuals (17 affected, 5 unaffected). Cutaneous presentation was the most common. Arthritis was polyarticular in 96% of patients. Isolated eye disease was never the presenting symptom, but significant/severe visual impairment was observed in 41% of patients. Eye disease was bilateral in 21 of 22 patients and was complicated by glaucoma in 6 of 22 patients and by cataracts in 50% of patients. Skin biopsy was the best diagnostic approach (because of accuracy and low invasiveness).
  
  
  CONCLUSIONS
  In this series, the first combining familial and sporadic pedigrees and, to our knowledge, the largest, we further defined the phenotype and showed that all affected classic (and no nonclassic) pedigrees carry a mutation and that there is no asymptomatic carriage. If these data are confirmed, mutation analysis rather than tissue sampling may prove to be the most efficient diagnostic procedure.
authors.affiliation: duPont Children's Hospital, Wilmington, Delaware 19899, USA. crose@nemours.org
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Rosé
authors.forename: Carine H
authors.initials: CH
authors.lastname: Wouters
authors.forename: Silvia
authors.initials: S
authors.lastname: Meiorin
authors.forename: Trudy M
authors.initials: TM
authors.lastname: Doyle
authors.forename: Michael P
authors.initials: MP
authors.lastname: Davey
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D001168:Arthritis / Q000235:genetics / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003872:Dermatitis / Q000235:genetics / Q000473:pathology; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D053473:Nod2 Signaling Adaptor Protein / Q000235:genetics*; D010375:Pedigree; D010641:Phenotype; D012042:Registries / Q000706:statistics & numerical data*; D012507:Sarcoidosis / Q000235:genetics / Q000473:pathology; D013577:Syndrome; D014605:Uveitis / Q000235:genetics / Q000473:pathology; D020293:Vasculitis, Central Nervous System / Q000145:classification / Q000235:genetics* / Q000473:pathology*
chemical_list: C429018:NOD2 protein, human; D053473:Nod2 Signaling Adaptor Protein