What happens in this disease?
A change in the ARSB gene leaves the enzyme arylsulfatase B missing. This enzyme breaks down large sugar molecules called GAGs. GAGs build up in the cells. Tissues and organs grow larger and are damaged over time. Symptoms usually begin in early childhood.
Which symptoms can occur?
How fast the disease progresses varies from person to person.
- Short stature and stiff joints
- Coarse facial features and a large tongue
- Numbness and weakness in the hand, called carpal tunnel (in many children)
- Narrowing of the spinal canal in the neck
- Heart valve problems
- Pauses in breathing during sleep, frequent airway infections
- Clouding of the clear front layer of the eye and hearing loss
- A large liver and spleen, hernia
How is it diagnosed?
GAG levels in the urine may be found to be high. The diagnosis is confirmed when the enzyme arylsulfatase B is low in the blood. A genetic test for the ARSB gene can also be done.
Treatment and care
There is an approved enzyme replacement therapy for this disease. Depending on the symptoms, surgery may be needed: for carpal tunnel, the spine, a hernia, a heart valve or the tonsils. A corneal transplant and hearing aids may also be used. Care is led by a specialist team, and support for the family is important. The doctor who follows the disease decides which treatment is suitable.
For the family: inheritance and genetic counselling
The disease is passed on through recessive inheritance. The mother and father are usually healthy carriers. For a couple who are both carriers, the chance of having an affected child is 1 in 4 in each pregnancy. Diseases of this kind may be more common in marriages between relatives. Genetic counselling guides the family.