Camurati–Engelmann disease

"Engelmann syndrome" redirects here. For the neuro-genetic disorder, see Angelman syndrome.

Rare genetic disorder affecting bones and muscles

Autosomal dominant

Camurati–Engelmann disease (CED) is a rare genetic disorder that primarily affects the bones and muscles, leading to progressive bone thickening, muscle weakness, and chronic pain. The condition is characterized by abnormal bone remodeling, particularly in the long bones and skull, resulting in excessive bone growth (hyperostosis) and increased bone density (osteosclerosis).

CED is an autosomal dominant disorder caused by mutations in the TGFB1 gene, which encodes the transforming growth factor-beta 1 (TGF-β1) protein. This protein plays a crucial role in bone formation, inflammation, and tissue repair.

Causes and Genetic Basis

Camurati–Engelmann disease is caused by mutations in the TGFB1 gene, which disrupts the normal function of TGF-β1, a cytokine involved in:

• Bone growth and remodeling
• Regulation of inflammation
• Tissue repair and immune system function

The disease follows an autosomal dominant inheritance pattern, meaning that an affected individual has a 50% chance of passing it on to their offspring. Some cases, however, may arise from spontaneous mutations rather than being inherited.

Clinical Features and Symptoms

The symptoms of CED vary among individuals and worsen with age. The most common symptoms include:

Bone Abnormalities

• Thickened bones (hyperostosis) – most notably in the long bones (femur, tibia, humerus) and skull.
• Increased bone density (osteosclerosis) – leading to bone stiffness.
• Pain and tenderness – particularly in the legs, arms, and skull.
• Abnormal gait – due to leg pain and muscle weakness.

Muscle and Neurological Symptoms

• Muscle weakness – especially in the legs and arms.
• Fatigue – due to chronic pain and muscle inefficiency.
• Nerve compression – from thickened bones affecting cranial and peripheral nerves, leading to symptoms such as:
• Headaches
• Hearing loss
• Vision problems

Other Symptoms

• Delayed puberty – Some individuals experience hormonal imbalances.
• Weight loss and failure to thrive – particularly in childhood.
• Joint stiffness – due to bone overgrowth affecting mobility.

Diagnosis and Imaging

Diagnosing Camurati–Engelmann disease requires a combination of clinical evaluation, imaging studies, and genetic testing.

Radiographic Features

X-rays and CT scans typically reveal:

• Thickening of long bones (diaphyseal dysplasia).
• Increased bone density in the skull, pelvis, and vertebrae.
• Narrowing of the bone marrow cavity, which may lead to reduced blood cell production.

Genetic Testing

• Identifies mutations in the TGFB1 gene, confirming the diagnosis.
• Helps in family screening for inherited cases.

Treatment and Management

Currently, there is no cure for Camurati–Engelmann disease, but treatment focuses on symptom management and improving quality of life.

Pain Management

• Nonsteroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen or naproxen, help reduce bone pain.
• Corticosteroids (e.g., prednisone) – can be used for severe cases to decrease inflammation and pain.
• Bisphosphonates – used in some cases to help regulate bone turnover.

Physical Therapy and Supportive Care

• Physical therapy – strengthens muscles and improves mobility.
• Orthopedic interventions – in severe cases, surgery may be needed to correct bone deformities.
• Hearing aids – for those experiencing hearing loss due to skull thickening.

Hormonal and Growth Support

• Growth hormone therapy – may be considered in cases of delayed puberty or stunted growth.
• Dietary support – ensuring adequate calcium and vitamin D for bone health.

Prognosis and Long-Term Outlook

The severity of Camurati–Engelmann disease varies widely. Some individuals experience mild symptoms, while others may have severe mobility restrictions and chronic pain. With proper management, many individuals lead normal lives, but progressive bone thickening can cause increasing complications over time.

See Also

• Bone remodeling
• Hyperostosis
• Osteosclerosis
• TGFB1 gene mutations
• Genetic bone disorders

External Links

• National Organization for Rare Disorders (NORD) - CED
• MedlinePlus - Camurati–Engelmann Disease
• Online Mendelian Inheritance in Man (OMIM) - CED

NIH genetic and rare disease info

• NIH info on Camurati–Engelmann disease

Camurati–Engelmann disease is a rare disease.

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