title: The diagnostic journey of patients with mucopolysaccharidosis I: A real-world survey of patient and physician experiences.
abstract: Mucopolysaccharidosis type I (MPS I) is an inherited lysosomal storage disease. Affected individuals have disease ranging from attenuated to severe with significant disease burden, disability, and premature death. Early treatment with enzyme replacement therapy and/or stem cell transplantation can reduce disease progression and improve outcomes. However, diagnosis is often delayed, particularly for patients with attenuated phenotypes. We conducted a survey of 168 patients and 582 physicians to explore health care seeking patterns and familiarity of physicians with MPS I symptoms. Patients with attenuated MPS I typically first presented with stiff joints or hernia/bulging abdomen, and patients with severe disease with noisy/difficult breathing, or hernia/bulging abdomen. There was a mean delay from time of symptom presentation to diagnosis of 2.7 years for patients with attenuated disease, with a mean of 5 physicians consulted before receiving a correct diagnosis. MPS I was most commonly misidentified by physicians as rheumatoid arthritis (48-72%), with a wide variety of suspected diseases, including lupus.
  
  
  CONCLUSIONS
  Patient and physician real-world surveys show that MPS I is under-recognized and diagnosis of MPS I remains delayed, particularly in patients with attenuated disease. Across regions and specialties, physicians require differential diagnosis education in order to improve early detection and early treatment initiation of MPS I.
authors.affiliation: Sanofi Genzyme, Strada Scaglia Est 136, 41126 Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bruni
authors.affiliation: Society for Mucopolysaccharide Diseases, MPS House, Repton Place, White Lion Road, Amersham, Buckinghamshire HP7 9LP, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Lavery
authors.affiliation: Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Broomfield
keywords: Card, cardiologist; Diagnosis; ENT, ear nose and throat; ERT, enzyme replacement therapy; EU, Europe; Education; GAG, glycosaminoglycan; Gen Pract, general practitioner; Gen/Met Dis, geneticist/metabolic disease specialist; HSCT, hematopoietic stem cell transplant; IDUA, α-l-iduronidase; LA, Latin America; MPS I; MPS I, mucopolysaccharidosis Type I; Neuro, neurologist; Ophth, ophthalmologist; Ortho, orthopedist; Ped or P, pediatrician; Pulm, pulmonologist; Rheum or R, rheumatologist; Treatment; US, United States