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Uncertain Diagnosis of Fabry Disease in Patients with Neuropathic Pain, Angiokeratoma or Cornea Verticillata: Consensus on the Approach to Diagnosis and Follow-Up.
[fabry disease]
Introduction
:
Individuals
with
neuropathic
pain
,
angiokeratoma
(
AK
)
and
/
or
cornea
verticillata
(
CV
)
may
be
tested
for
Fabry
disease
(
FD
)
.
Classical
FD
is
characterised
by
a
specific
pattern
of
these
features
.
When
a
patient
presents
with
a
non-
specific
pattern
,
the
pathogenicity
of
a
variant
in
the
α-galactosidase
A
(
GLA
)
gene
may
be
unclear
.
This
uncertainty
often
leads
to
considerable
distress
and
inappropriate
counselling
and
treatment
.
We
developed
a
clinical
approach
for
these
individuals
with
an
uncertain
diagnosis
of
FD
.
Materials
and
Methods
:
A
document
was
presented
to
an
FD
expert
panel
with
background
information
based
on
clinical
experience
and
the
literature
,
followed
by
an
online
survey
and
a
written
recommendation
.
Results
:
The
13
experts
agreed
that
the
recommendation
is
intended
for
individuals
with
neuropathic
pain
,
AK
and
/
or
CV
only
,
i
.
e
.
without
kidney
,
heart
or
brain
disease
,
with
an
uncertain
diagnosis
of
FD
.
Only
in
the
presence
of
FD
-
specific
neuropathic
pain
(
small
fibre
neuropathy
with
FD
-
specific
pattern
)
,
AK
(
FD
-
specific
localisations
)
or
CV
(
without
CV
inducing
medication
)
,
FD
is
confirmed
.
When
these
features
have
a
non-
specific
pattern
,
there
is
insufficient
evidence
for
FD
.
If
no
alternative
diagnosis
is
found
,
follow-up
is
recommended
.
Conclusions
:
In
individuals
with
an
uncertain
diagnosis
of
FD
,
the
presence
of
an
FD
-
specific
pattern
of
CV
,
AK
or
neuropathic
pain
is
sufficient
to
confirm
the
diagnosis
of
FD
.
When
these
features
are
non-
specific
,
a
definite
diagnosis
can
not
(
yet
)
be
established
and
follow-up
is
indicated
.
ERT
should
be
considered
only
in
those
patients
with
a
confirmed
diagnosis
of
FD
.
Diseases
Validation
Diseases presenting
"small fibre neuropathy"
symptom
fabry disease
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