RELATIONSHIP OF JOINT HYPERMOBILITY AND MUSCULOSKELETAL PROBLEMS AND FREQUENCY OF BENIGN JOINT HYPERMOBILITY SYNDROME IN CHILDREN
AbstractBackground: The majority of individuals with joint hypermobility remain asymptomatic. However,those associated with Benign Joint Hypermobility Syndrome (BJHS), develop a number of systemicmanifestations. Our objective was to determine the relationship between joint hypermobility andmusculoskeletal problems, and frequency of BJHS in children and adolescents. Method: This crosssectional observational descriptive study was conducted at Outpatient Department, The Children’sHospital, Lahore, Pakistan. A total of 872 individuals (4–18 year) were examined for hypermobilejoints using Beighton score ≥4. A questionnaire was implied to get data regarding demographicprofile, musculoskeletal and extra-articular complaints, family history of joint problems and dailyactivity. Brighton’s criteria were implied for diagnosis of BJHS. Results: The frequency of jointhypermobility was 37.0%; male 39.5%, and female 34.2% (p=0.1). There was a gradual decline inmean Beighton score with age. The female population showed increase in mean Beighton scorearound 16–17 year age. Arthralgias and back pains 7.7% vs. 1.6%, (p<0.001), and hernias 2.5%(p=0.03) were significantly higher in individuals with joint hypermobility. History of joint problemsin the family was also significantly higher in children with joint hypermobility (p=0.01). BJHS wasdetected in 4.8% children (male 3.6% and female 6.3%, p=0.06). Arthralgias (51.0%), hernias(16.3%), joint dislocations (8.2%) and varicose veins (8.2%) were the most common presentations.Conclusion: BJHS is common among children. Arthralgias, back pains and hernias are significantlyhigher in these individuals.Keywords: Joint hypermobility, Benign Joint Hypermobility Syndrome, musculoskeletalproblems, Children
Remvig L, Jensen DV, Ward RC. Epidemiology of general joint
hypermobility and basis for the proposed criteria for benign joint
hypermobility syndrome: review of the literature. J Rheumatol
Murray KJ. Hypermobility disorders in children and adolescents.
Best Pract Res Clin Rheumatol 2006;20:329–51.
Grahame R, Bird HA, Child A. The revised (Brighton 1998)
criteria for the diagnosis of benign joint hypermobility syndrome
(BJHS). J Rheumatol 2000;27:1777–9.
Qvindesland A, Jonsson H. Articular hypermobility in Icelandic
year olds. Rheumatology 1999;38:1014–6.
Birrell FN, Adebajo AO, Hazleman BL, Silman AJ. High
prevalence of joint laxity in West Africans. Br J Rheumatol
Klemp P, William SM, Stansfield SA. Articular mobility in
Maori and European New Zealanders. Rheumatology (Oxford)
Russek LN. Hypermobility syndrome. Phys Ther 1999;79:591–9.
Jansson A, Saartok T, Werner S, Renstrom P. General joint laxity
in 1845 Swedish school children of different ages: age-and
gender-specific distributions. Acta Paediatr 2004;93:1202–6.
Beynnon BD, Bernstein IM, Belisle A, Brattbakk B, Devanny P,
Risinger R, et al. The effect of estradiol and progesterone on knee
and ankle joint laxity. Am J Sports Med 2005;33:1298–304.
Gedalia A, Brewer EJ Jr. Joint hypermobility in pediatric
practice: a review. J Rheumatol 1993;20:371–4.
Larsson LG, Baum J, Mudholkar GS. Hypermobility: features
and differential incidence between the sexes. Arthritis Rheum
el-Shahaly HA, el-Sherif AK. Is the benign joint hypermobility
syndrome benign? Clin Rheumatol 1991;10:302–7.
Denko CW, Boja B. Growth hormone, insulin, and insulin-like
growth factor-1 in hypermobility syndrome. J Rheumatol
Adib N, Davies K, Grahame R, Woo P, Murray KJ. Joint
hypermobility syndrome in childhood. A not so benign
multisystem disorder? Rheumatology (Oxford) 2005;44:744–50.
Didia BC, Dapper DV, Boboye SB. Joint hypermobility
syndrome among undergraduate students. East Afr Med J
Mogren IM, Pohjanen AI. Low back pain and pelvic pain during
pregnancy: prevalence and risk factors. Spine 2005;30:983–91.
Ferrell WR, Tennant N, Sturrock RD, Ashton L, Creed G,
Brydson G et al. Amelioration of symptoms by enhancement of
J Ayub Med Coll Abbottabad 2010;22(4)
proprioception in patients with joint hypermobility syndrome.
Arthritis Rheum 2004;50:3323–8.
Ofluoglu D, Gunduz OH, Ozaras N, Kayhan O. Early-onset
hemochromatic arthropathy in a patient with idiopathic
hypermobility syndrome. Rheumatol Int 2003;23:305–8.
Zapata AL, Moraes AJ, Leone C, Doria-Filho U, Silva CA. Pain
and musculoskeletal pain syndromes in adolescents. J Adolesc
Manning J, Korda A, Benness C, Solomon M. The association of
obstructive defecation, lower urinary tract dysfunction and the
benign joint hypermobility syndrome: a case-control study. Int
Urogynecol J Pelvic Floor Dysfunct 2003;14:128–32.
Skoumal M, Haberhauer G, Mayr H. Concomitant diseases in
primary joint hypermobility syndrome. Med Klin (Munich)
El-Garf AK, Mahmoud GA, Mahgoub EH. Hypermobility
among Egyptian children: prevalence and features. J Rheumatol
van der Giessen LJ, Liekens D, Rutgers KJ, Hartman A, Mulder
PG, Oranje AP. Validation of Beighton score and prevalence of
connective tissue signs in 773 Dutch children. J Rheumatol
Rikken-Bultman DG, Wellink L, van Dongen PW.
Hypermobility in two Dutch school populations. Eur J Obstet
Gynecol Reprod Biol 1997;73:189–92.