Rare Diseases
A rare disease is a condition that affects fewer than one in 2000 people. It is often reported that there are approximately 7000 rare diseases, of which about 80% are genetic. This figure is an underestimate if you include cancers and infectious diseases. A 2020 review counted over 10,000 rare diseases. Over 200 rare diseases are added to OMIM annually.[1] In New Zealand only 24 rare diseases are tested in the Newborn Metabolic Screening Programme.
Key Observations for Rare vs Common disease
| Features | Rare Diseases | Common Diseases |
|---|---|---|
| Age | Young people - Occam's razor more likely to be true | Older people - Hickam's dictum more likely to be true. |
| Pattern of inheritance | Mendelian (because there is one cause) | May cluster in families however none of the common diseases are monogenic (because there are multiple causes) |
| Syndromic? | Often syndromic | Usually non-syndromic |
| Environmental factors | Environmental factors generally play less of a role | Environmental factors play a stronger role |
| Prevalence | 1 in 2000 or less | One thousand to one million times more common |
| Number of diseases | >7000 | <100 |
Common diseases are considered complex diseases. They exhibit a limited set of clinical phenotypes that result from derangement of various pathways. The micro-effects leading to the disease are distinct from each other, but the macro-effect is commonplace. On the other hand, in rare diseases, a specific phenotype is produced due to a single gene mutation activating a particular pathway. Unlike common diseases, the pathways leading to these phenotypes are more defined and distinct.
Family GENES
It is not humanely possible for an individual doctor to attain knowledge and experience with anything more than a tiny fraction of all rare diseases. Therefore, an important cognitive step is suspecting that the patient might have a rare disease of some kind. The following are clinical indicators of a possible undiagnosed rare disease.[2]
Family history: multiple affected siblings or individuals in multiple generations. Remember that lack of a family history does NOT rule out genetic causes.
G: group of congenital anomalies: Common anatomic variations are, well, common; but two or more anomalies are much more likely to indicate the presence of a syndrome with genetic implications.
E: extreme or exceptional presentation of common conditions: Early onset cardiovascular disease, cancer, or renal failure. Unusually severe reaction to infectious or metabolic stress. Recurrent miscarriage. Bilateral primary cancers in paired organs, multiple primary cancers of different tissues
N: neurodevelopmental delay or degeneration: Developmental delay in the paediatric age group carries a very high risk for genetic disorders. Developmental regression in children or early onset dementia in adults should similarly raise suspicion for genetic etiologies
E: extreme or exceptional pathology: Unusual tissue histology, such as pheochromoctyoma, acoustic neuroma, medullary thyroid cancer, multiple colon polyps, plexiform neurofibromas, multiple exostoses, most paediatric malignancies.
S: surprising laboratory values: Markedly abnormal pathology results
Rare Causes of Chronic Pain
Some examples of rare diseases that can cause pain
- Brachial Neuritis
- Facioscapulohumeral Dystrophy
- Myotonic Dystrophy
- Pompe Disease
- McArdle Disease
- Charcot Marie Tooth
- Progressive External Ophthalmoplegia
- Limb Girdle Muscular Dystrophies
- Chronic Inflammatory Demyelinating Polyneuropathy
- Ehlers Danlos Syndrome (note: the hypermobile EDS subtype should not be considered a rare disease because the prevalence is 1 in 500[3])
- SCN9A Neuropathic Pain Syndromes: small fibre neuropathy, erythromelalgia, paroxysmal extreme pain disorder
- Hereditary Hyperekplexia
- Systemic transthyretin (ATTR) amyloidosis
- Fabry Disease
- Porphyrias
- Schwannomatosis
Resources
There are many sources to assist with the diagnostic process.
- Rare Disease 101 course: https://learn.m4rd.org/
- https://www.findzebra.com/: Open access, web-based tool specifically to assist rare disease diagnosis. Start with two most specific terms.
- http://www.omim.org/: The OMIM database is a comprehensive compendium of human genes and genetic phenotypes
- http://www.orpha.net/: Search keywords such as a disease or genes. tutorial
- https://compbio.charite.de/phenomizer/: An open access, web-based tool to assist diagnosis
- https://rarediseases.org/: NORD (national organisation for rare diseases)
- https://www.eurordis.org/: Rare Diseases Europe
- https://www.ncbi.nlm.nih.gov/books/NBK1116/: GeneReviews online textbook
See Also
References
- ā Haendel, Melissa; Vasilevsky, Nicole; Unni, Deepak; Bologa, Cristian; Harris, Nomi; Rehm, Heidi; Hamosh, Ada; Baynam, Gareth; Groza, Tudor; McMurry, Julie; Dawkins, Hugh (2020-02). "How many rare diseases are there?". Nature Reviews. Drug Discovery. 19 (2): 77ā78. doi:10.1038/d41573-019-00180-y. ISSN 1474-1784. PMC 7771654. PMID 32020066. Check date values in:
|date=(help) - ā Whelan, Alison J.; Ball, Susie; Best, Lyle; Best, Robert G.; Echiverri, Susan C.; Ganschow, Pamela; Hopkin, Robert J.; Mayefsky, Jay; Stallworth, James (2004-09). "Genetic red flags: clues to thinking genetically in primary care practice". Primary Care. 31 (3): 497ā508, viii. doi:10.1016/j.pop.2004.04.010. ISSN 0095-4543. PMID 15331244. Check date values in:
|date=(help) - ā Demmler, Joanne C.; Atkinson, Mark D.; Reinhold, Emma J.; Choy, Ernest; Lyons, Ronan A.; Brophy, Sinead T. (2019-11-04). "Diagnosed prevalence of Ehlers-Danlos syndrome and hypermobility spectrum disorder in Wales, UK: a national electronic cohort study and case-control comparison". BMJ open. 9 (11): e031365. doi:10.1136/bmjopen-2019-031365. ISSN 2044-6055. PMC 6858200. PMID 31685485.
