Background
Costello syndrome (CS) and cardio-facio-cutaneous syndrome (CFCS) belong to the RASopathies, a group of neurodevelopmental disorders with skeletal anomalies. Due to their rarity, the characterization of the musculo-skeletal phenotype in both disorders has been poorly characterized.
Patients and methods
Herein we reported data on orthopedic findings and functional status of a large sample of CS and CFCS patients. Thirty-four patients (CS=17 and CFCS=17) were recruited. Functional and disability evaluations were performed by assessing the 6-minute walking test (6MWT) and Pediatric Outcomes Data Collection Instrument (PODCI). Genotype/phenotype correlation was also provided.
Results
Orthopedic manifestations are highly prevalent in CS and CFCS and overlap in the two disorders. Overall, patients with CS harboring the recurrent HRAS Gly12Ser substitution show a more severe skeletal phenotype compared to patients carrying the Gly12Ala and Gly13Cys variants. Among CFCS patients, those with the MAP2K1/2 variant show different skeletal characteristics compared to BRAF variants, with a higher prevalence of orthopedic abnormalities. Functional assessment showed that patients with CS and CFCS reached lower values compared to the general population, with CFCS patients displaying the lowest scores.
Conclusions
Orthopedic manifestations appear universal features of CS and CFCS and they can evolve across patients’ life. Longitudinal assessment of disability status by using 6MWT and PODCI could be useful to evaluate the functional impact of orthopedic manifestations on patients’ outcome and help planning a tailored treatment of these comorbidities.

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Posted 12 Jan, 2021
On 03 Jan, 2021
On 29 Dec, 2020
On 29 Dec, 2020
On 29 Dec, 2020
On 12 Dec, 2020
Received 06 Dec, 2020
Received 05 Dec, 2020
On 01 Dec, 2020
On 01 Dec, 2020
On 29 Nov, 2020
On 28 Nov, 2020
Received 15 Nov, 2020
Invitations sent on 09 Nov, 2020
On 09 Nov, 2020
On 05 Nov, 2020
On 05 Nov, 2020
On 05 Nov, 2020
On 15 Oct, 2020
Received 14 Oct, 2020
On 29 Sep, 2020
Received 20 Jul, 2020
On 28 Jun, 2020
On 26 Jun, 2020
Invitations sent on 26 Jun, 2020
On 25 Jun, 2020
On 25 Jun, 2020
On 25 Jun, 2020
Posted 12 Jan, 2021
On 03 Jan, 2021
On 29 Dec, 2020
On 29 Dec, 2020
On 29 Dec, 2020
On 12 Dec, 2020
Received 06 Dec, 2020
Received 05 Dec, 2020
On 01 Dec, 2020
On 01 Dec, 2020
On 29 Nov, 2020
On 28 Nov, 2020
Received 15 Nov, 2020
Invitations sent on 09 Nov, 2020
On 09 Nov, 2020
On 05 Nov, 2020
On 05 Nov, 2020
On 05 Nov, 2020
On 15 Oct, 2020
Received 14 Oct, 2020
On 29 Sep, 2020
Received 20 Jul, 2020
On 28 Jun, 2020
On 26 Jun, 2020
Invitations sent on 26 Jun, 2020
On 25 Jun, 2020
On 25 Jun, 2020
On 25 Jun, 2020
Background
Costello syndrome (CS) and cardio-facio-cutaneous syndrome (CFCS) belong to the RASopathies, a group of neurodevelopmental disorders with skeletal anomalies. Due to their rarity, the characterization of the musculo-skeletal phenotype in both disorders has been poorly characterized.
Patients and methods
Herein we reported data on orthopedic findings and functional status of a large sample of CS and CFCS patients. Thirty-four patients (CS=17 and CFCS=17) were recruited. Functional and disability evaluations were performed by assessing the 6-minute walking test (6MWT) and Pediatric Outcomes Data Collection Instrument (PODCI). Genotype/phenotype correlation was also provided.
Results
Orthopedic manifestations are highly prevalent in CS and CFCS and overlap in the two disorders. Overall, patients with CS harboring the recurrent HRAS Gly12Ser substitution show a more severe skeletal phenotype compared to patients carrying the Gly12Ala and Gly13Cys variants. Among CFCS patients, those with the MAP2K1/2 variant show different skeletal characteristics compared to BRAF variants, with a higher prevalence of orthopedic abnormalities. Functional assessment showed that patients with CS and CFCS reached lower values compared to the general population, with CFCS patients displaying the lowest scores.
Conclusions
Orthopedic manifestations appear universal features of CS and CFCS and they can evolve across patients’ life. Longitudinal assessment of disability status by using 6MWT and PODCI could be useful to evaluate the functional impact of orthopedic manifestations on patients’ outcome and help planning a tailored treatment of these comorbidities.

Figure 1

Figure 2

Figure 3
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