Hypermobility spectrum disorder

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Hypermobility spectrum disorder
Other namesHypermobility syndrome
Joint hypermobility syndrome
Hypermobility-11.jpg
Hypermobile thumb
Specialty Rheumatology, genetics   OOjs UI icon edit-ltr-progressive.svg
Symptoms Joint hypermobility, musculoskeletal pain, fatigue [1]
Causes Genetic [2]

Hypermobility spectrum disorder (HSD), related to earlier diagnoses such as hypermobility syndrome (HMS), and joint hypermobility syndrome (JHS) is a heritable connective tissue disorder [3] that affects joints and ligaments. Different forms and sub-types have been distinguished, but it does not include asymptomatic joint hypermobility, sometimes known as double-jointedness.

Contents

Symptoms can include the inability to walk properly or for long distances, and pain in affected areas. Some people with HSD have hypersensitive nerves and a weaker immune system. It can also cause severe fatigue and some cases cause depressive episodes. It is somewhat similar to other genetic connective tissue disorders such as Ehlers–Danlos syndromes. There is a strong association between HSD and neurodevelopmental disorders such as ADHD (attention deficit/hyperactivity disorder) and ASD (autism spectrum disorder). [4]

Classification

Hypermobility spectrum disorders are diagnosed when individuals have symptomatic joint hypermobility but do not meet the criteria for other connective tissue disorders, such as Ehlers–Danlos syndrome. [5]

The term "hypermobility spectrum disorder" was coined in 2017 after criteria for hypermobile Ehlers–Danlos syndrome were made more restrictive. In part, this classification change was designed to address the overlap between joint hypermobility syndrome and what was then known as Ehlers–Danlos syndrome, hypermobility type (EDS-HT), which some researchers believed were the same condition. [6] [7] [8] While hypermobility spectrum disorders are most analogous to JHS, the 2017 diagnostic criteria for hypermobile Ehlers–Danlos syndrome excludes many people who fit the old criteria, who would instead be diagnosed with hypermobility spectrum disorders. [9]

Hypermobility syndrome and hypermobility spectrum disorders do not include people with asymptomatic hypermobility or people with double-jointedness but no other symptoms. Hypermobile Ehlers–Danlos syndrome and hypermobility spectrum disorders may be equally severe. [5] [8]

Signs and symptoms

Some common symptoms of hypermobility spectrum disorder include:

Other symptoms can appear and not everyone affected experiences the same symptoms.

Diagnosis

Beighton score Hypermobility Beighton Score.png
Beighton score

Being diagnosed with hypermobility syndrome can be a difficult task. There is a lack of wide understanding of the condition and it can be considered a zebra condition. As hypermobility syndrome can be easily mistaken for being double-jointed or categorised as nothing more than perhaps an achy body from lack of exercise, medical professionals may diagnose those affected incorrectly and not adequately investigate the symptoms. Due to these circumstances many affected individuals can live not knowing they have it. As a result, those affected without a proper diagnosis can easily injure themselves and not take proper care to ensure they go about working safely.

The Beighton Score can be used to determine generalised joint hypermobility (GJH) related to hypermobility syndrome. [10] The newer term "generalised hypermobility spectrum disorder" includes people with generalised joint hypermobility, often determined using the Beighton Score, and other symptoms. Those who do not meet the Beighton Score criteria may be diagnosed with historical joint hypermobility spectrum disorder, peripheral hypermobility spectrum disorder, or localised hypermobility spectrum disorder. [8]

In comparison to the diagnostic criteria of hypermobile Ehlers–Danlos syndrome, the criteria for hypermobile spectrum disorder are less strict. However, these criteria are differentiated from criteria of other EDS types and therefore its less-strict criteria are only comparable to the criteria of hEDS. As those with HSD experience a considerable amount of discomfort, it is important to focus on the treatment, not the labels. The severity of each condition can be equivalent. In particular, musculoskeletal involvement is a requirement for diagnosis with any form of hypermobility spectrum disorder but not for hypermobile Ehlers–Danlos syndrome. Like hypermobile Ehlers–Danlos syndrome, hypermobility spectrum disorders are associated with orthostatic tachycardia, gastrointestinal disorders, and pelvic and bladder dysfunction. [11]

Treatment

Treating hypermobility syndrome can be difficult. The condition has no direct cure, but its symptoms can be treated. Physiotherapy, particularly exercise, is the main treatment for the condition, although there is only limited evidence for its effectiveness. [12]

Treatments for pain include:

Prevalence

Prevalence of the condition is unknown, but can be high in those attending musculoskeletal services. [7] [13]

Related Research Articles

<span class="mw-page-title-main">Marfan syndrome</span> Genetic disorder involving connective tissue

Marfan syndrome (MFS) is a multi-systemic genetic disorder that affects the connective tissue. Those with the condition tend to be tall and thin, with long arms, legs, fingers, and toes. They also typically have exceptionally flexible joints and abnormally curved spines. The most serious complications involve the heart and aorta, with an increased risk of mitral valve prolapse and aortic aneurysm. The lungs, eyes, bones, and the covering of the spinal cord are also commonly affected. The severity of the symptoms is variable.

<span class="mw-page-title-main">Ehlers–Danlos syndromes</span> Group of genetic connective tissues disorders

Ehlers–Danlos syndromes (EDS) are a group of 13 genetic connective-tissue disorders in the current classification, with the latest type discovered in 2018. Symptoms often include loose joints, joint pain, stretchy velvety skin, and abnormal scar formation. These may be noticed at birth or in early childhood. Complications may include aortic dissection, joint dislocations, scoliosis, chronic pain, or early osteoarthritis.

Rheumatology is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, collectively known as rheumatic diseases, which includes many forms of arthritis as well as lupus and Sjögren's syndrome. Doctors who have undergone formal training in rheumatology are called rheumatologists.

<span class="mw-page-title-main">Dysautonomia</span> Any disease or malfunction of the autonomic nervous system

Dysautonomia, autonomic failure or autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly. This may affect the functioning of the heart, bladder, intestines, sweat glands, pupils, and blood vessels. Dysautonomia has many causes, not all of which may be classified as neuropathic. A number of conditions can feature dysautonomia, such as Parkinson's disease, multiple system atrophy, dementia with Lewy bodies, Ehlers–Danlos syndromes, autoimmune autonomic ganglionopathy and autonomic neuropathy, HIV/AIDS, pure autonomic failure, and postural orthostatic tachycardia syndrome.

Autism spectrum disorders (ASD) are neurodevelopmental disorders that begin in early childhood, persist throughout adulthood, and affect three crucial areas of development: communication, social interaction and restricted patterns of behavior. There are many conditions comorbid to autism spectrum disorders such as attention-deficit hyperactivity disorder and epilepsy.

A connective tissue disease (collagenosis) is any disease that has the connective tissues of the body as a target of pathology. Connective tissue is any type of biological tissue with an extensive extracellular matrix that supports, binds together, and protects organs. These tissues form a framework, or matrix, for the body, and are composed of two major structural protein molecules: collagen and elastin. There are many different types of collagen protein in each of the body's tissues. Elastin has the capability of stretching and returning to its original length—like a spring or rubber band. Elastin is the major component of ligaments and skin. In patients with connective tissue disease, it is common for collagen and elastin to become injured by inflammation (ICT). Many connective tissue diseases feature abnormal immune system activity with inflammation in tissues as a result of an immune system that is directed against one's own body tissues (autoimmunity).

<span class="mw-page-title-main">Ligamentous laxity</span> Looseness of the ligaments

Ligamentous laxity, or ligament laxity, is a cause of chronic body pain characterized by loose ligaments. When this condition affects joints in the entire body, it is called generalized joint hypermobility, which occurs in about ten percent of the population, and may be genetic. Loose ligaments can appear in a variety of ways and levels of severity. It also does not always affect the entire body. One could have loose ligaments of the feet, but not of the arms.

<span class="mw-page-title-main">Hypermobility (joints)</span> Human condition: joints that stretch further than normal

Hypermobility, also known as double-jointedness, describes joints that stretch farther than normal. For example, some hypermobile people can bend their thumbs backwards to their wrists and bend their knee joints backwards, put their leg behind the head or perform other contortionist "tricks". It can affect one or more joints throughout the body.

<span class="mw-page-title-main">Kyphoscoliosis</span> Medical condition

Kyphoscoliosis describes an abnormal curvature of the spine in both the coronal and sagittal planes. It is a combination of kyphosis and scoliosis. This musculoskeletal disorder often leads to other issues in patients, such as under-ventilation of lungs, pulmonary hypertension, difficulty in performing day-to-day activities, psychological issues emanating from anxiety about acceptance among peers, especially in young patients. It can also be seen in syringomyelia, Friedreich's ataxia, spina bifida, kyphoscoliotic Ehlers–Danlos syndrome (kEDS), and Duchenne muscular dystrophy due to asymmetric weakening of the paraspinal muscles.

<span class="mw-page-title-main">Sack–Barabas syndrome</span> Medical condition

Sack–Barabas syndrome is an older name for the medical condition vascular Ehlers–Danlos syndrome (vEDS). It affects the body's blood vessels and organs, making them prone to rupture.

<span class="mw-page-title-main">Hitchhiker's thumb</span> Condition in which the thumbs can bend backwards 90°

Hitchhiker's thumb, also known as distal hyperextensibility of the thumb, is the condition of having a thumb that has a distal phalange that bends backwards in an angle of 90°. This condition is benign and does not cause pain or affect the thumb with the trait negatively.

<span class="mw-page-title-main">Winchester syndrome</span> Rare hereditary connective tissue disease

Winchester syndrome is a rare hereditary connective tissue disease described in 1969, of which the main characteristics are short stature, marked contractures of joints, opacities in the cornea, coarse facial features, dissolution of the carpal and tarsal bones, and osteoporosis. Winchester syndrome was once considered to be related to a similar condition, multicentric osteolysis, nodulosis, and arthropathy (MONA). However, it was discovered that the two are caused by mutations found in different genes; however they mostly produce the same phenotype or clinical picture. Appearances resemble rheumatoid arthritis. Increased uronic acid is demonstrated in cultured fibroblasts from the skin and to a lesser degree in both parents. Despite initial tests not showing increased mucopolysaccharide excretion, the disease was regarded as a mucopolysaccharidosis. Winchester syndrome is thought to be inherited as an autosomal recessive trait.

Basilar invagination is invagination (infolding) of the base of the skull that occurs when the top of the C2 vertebra migrates upward. It can cause narrowing of the foramen magnum. It also may press on the lower brainstem.

Marfanoid is a constellation of signs resembling those of Marfan syndrome, including long limbs, with an arm span that is at least 1.03 of the height of the individual, and a crowded oral maxilla, sometimes with a high arch in the palate, arachnodactyly, and hyperlaxity.

<span class="mw-page-title-main">Genu recurvatum</span> Orthopedic deformity

Genu recurvatum is a deformity in the knee joint, so that the knee bends backwards. In this deformity, excessive extension occurs in the tibiofemoral joint. Genu recurvatum is also called knee hyperextension and back knee. This deformity is more common in women and people with familial ligamentous laxity. Hyperextension of the knee may be mild, moderate or severe.

<span class="mw-page-title-main">De Barsy syndrome</span> Medical condition

De Barsy syndrome is a rare autosomal recessive genetic disorder. Symptoms include cutis laxa as well as other eye, musculoskeletal, and neurological abnormalities. It is usually progressive, manifesting side effects that can include clouded corneas, cataracts, short stature, dystonia, or progeria.

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<span class="mw-page-title-main">Ehlers-Danlos Society</span> International patient advocacy and support organization

The Ehlers–Danlos Society is an international nonprofit organization dedicated to patient support, scientific research, advocacy, and increasing awareness for the Ehlers–Danlos syndromes (EDS) and hypermobility spectrum disorder (HSD). The society has organized multiple events around the world in an attempt to raise awareness for EDS and HSD. These events include a rally in Baltimore's Inner Harbor, and a conference in India. The society also organizes symposiums dedicated to research on EDS and HSD. The 2016 symposium resulted in the reclassification of Ehlers–Danlos subtypes.

Craniocervical instability (CCI) is a medical condition where there is excessive movement of the vertebrae at the atlanto-occipital joint and the atlanto-axial joint, that is, between the skull and the top two vertebrae. This can cause neuronal injury and compression of nearby structures including the spinal cord, brain stem, vertebral artery or vagus nerve, causing a constellation of symptoms. It is frequently co-morbid with atlanto-axial instability, Chiari malformation and tethered cord syndrome.

<span class="mw-page-title-main">Amplified musculoskeletal pain syndrome</span> Condition characterized by amplified and chronic pain

Amplified musculoskeletal pain syndrome (AMPS) is a long-term condition characterized by amplified pain without an identifiable physical cause. Other common symptoms include changes in the skin texture, color, and temperature; changes in hair and nail growth; skin sensitivity to touch, also known as allodynia; and dizziness, especially when going to a standing position after sitting. In up to 80% of cases, symptoms are caused by psychological trauma or psychological stress. AMPS is also commonly caused by physical injury or illness. Other possible causes of AMPS include Ehlers-danlos syndrome, myositis, arthritis, and other rheumatologic diseases. Due to the nature of the condition, AMPS is often not diagnosed when it first presents. AMPS is diagnosed through a review of a patient's medical history, as well as multiple tests to rule out the diagnosis of other conditions, such as bone fracture.

References

  1. "What Is HSD?". The Ehlers–Danlos Society. Retrieved 30 May 2018.
  2. Hakim, Alan. "Hypermobility Disorders- An Update for Clinicans". Hypermobility Syndromes Association. Retrieved 30 May 2018.
  3. "Hypermobile Ehlers–Danlos syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 19 June 2017.
  4. Kindgren, Erik; Perez, Antonia Quiñones; Knez, Rajna (10 February 2021). "Prevalence of ADHD and Autism Spectrum Disorder in Children with Hypermobility Spectrum Disorders or Hypermobile Ehlers–Danlos Syndrome: A Retrospective Study". Neuropsychiatric Disease and Treatment. 17: 379–388. doi: 10.2147/NDT.S290494 . PMC   7882457 . PMID   33603376.
  5. 1 2 "What are the hypermobility spectrum disorders?". The Ehlers Danlos Society. Retrieved 20 October 2020.
  6. B.T. Tinkle, Issues and Management of Joint Hypermobility. A Guide for the Ehlers–danlos Syndrome Hypermobility Type and the Hypermobility Syndrome, Left Paw Press, USA (2008)
  7. 1 2 Palmer et al., 2017
  8. 1 2 3 Castori, Marco; Tinkle, Brad; Levy, Howard; Grahame, Rodney; Malfait, Fransiska; Hakim, Alan (March 2017). "A framework for the classification of joint hypermobility and related conditions". American Journal of Medical Genetics. Part C, Seminars in Medical Genetics. 175 (1): 148–157. doi: 10.1002/ajmg.c.31539 . ISSN   1552-4876. PMID   28145606.
  9. Castori, Marco; Tinkle, Brad; Levy, Howard; Grahame, Rodney; Malfait, Fransiska; Hakim, Alan (2017). "A framework for the classification of joint hypermobility and related conditions". American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 175 (1): 148–157. doi: 10.1002/ajmg.c.31539 . ISSN   1552-4876. PMID   28145606.
  10. "Assessing Joint Hypermobility". The Ehlers–Danlos Society. Retrieved 30 May 2018.
  11. Ehlers–Danlos Society. "Hypermobile Ehlers–Danlos syndrome (hEDS) vs. hypermobility spectrum disorders (HSD): What's the difference?" (PDF). Ehlers–Danlos Society. Retrieved 31 January 2019.
  12. Palmer et al., 2014
  13. E. Connelly, A. Hakim, S. Davenport, J. Simmonds. "A study exploring the prevalence of joint hypermobility syndrome in patients attending a musculoskeletal triage clinic." Physiother. Pract. Res., 36 (1) (2015), pp. 43-53