An exploration of the prevalence of hypermobility and joint hypermobility syndrome in Omani women attending a hospital physiotherapy service

Background and Objectives. Joint hypermobility syndrome (JHS) is an inherited disorder of connective tissue. It presents as a condition in which there are neuromusculoskeletal signs and symptoms, including pain, without the inflammatory component of a joint disease such as rheumatoid arthritis. Re‐attendance in rheumatology clinics, re‐injury and prolonged rehabilitation are also features of JHS. The primary aims of this study were to establish the prevalence of hypermobility and JHS in those attending physiotherapy clinics with neuromusculoskeletal disorders in Oman. Methods. A cross‐sectional case control study design was used. The participant population included Omani women, aged 18–50 years, attending physiotherapy services for musculoskeletal complaints. The comparison population comprised women of a similar age and ethnic origin who were staff at the hospital. The primary outcome measures were the Beighton Score and the Brighton Criteria. Results. A total of 184 subjects were recruited into the study. These consisted of 94 in the participant group and 90 in the comparison group. Hypermobility was recorded in 51% of the participant group and 30% of the comparison group. The number of participants with JHS was 55%, while 21% of the comparison group exhibited features of the JHS phenotype without pain. A significant number of participants with JHS were re‐attending for treatment compared with those without JHS. Conclusions. This study confirms a high prevalence of JHS among subjects with musculoskeletal signs and symptoms and that re‐attendance for physiotherapy treatment is more frequent in subjects with JHS than in those without. Copyright © 2010 John Wiley & Sons, Ltd.     

Symptomatic joint hypermobility

Joint hypermobility is relatively common and has many influences such as age, gender, training, and ethnicity among many. Joint hypermobility may be asymptomatic or symptomatic. It may also be non-syndromic or syndromic. However, “asymptomatic” joint hypermobility may result in repetitive use injury, alter biomechanics of joints at other body sites, or become symptomatic later in life. Symptomatic joint hypermobility can result from soft-tissue rheumatism (e.g. bursitis, tendonitis, etc.) or muscular tension pain due to muscular imbalance. Generalized joint hypermobility (GJH) can be easily assessed using a standardized, quick, in-office examination. Management is relatively straight forward once joint hypermobility is recognized using neuromuscular re-training. It is important to recognize that GJH may also be a feature of a heritable connective tissue disorder with other systemic findings. Therefore, assessing joint hypermobility in those with musculoskeletal complaints may lead to recognizing systemic manifestations and allow the appropriate management.     

Is joint hypermobility important in prepubertal children?

The purpose of this study was to investigate serum prolidase activity and its relationship with collagen metabolism and joint hypermobility, and to determine the prevalence and characteristics of joint hypermobility in prepubertal children. Serum prolidase activity was measured spectrophotometrically. Joint hypermobility was defined using Beighton criteria. The children underwent complete history and physical examination. Serum levels of prolidase were lower in the hypermobile group compared with controls and no statistical difference (1,598.61 ± 54.99, 1,741.89 ± 57.54; P > 0.05). However, there was significant negative correlation between prolidase level and Beighton score (r = −0.295, P = 0.002). The prevalence of hypermobility was distributed as follows: ≥4, 39.3%; ≥5, 22.7%; ≥6, 13.3%. There was correlation between joint hypermobility and pes planus (P = 0.006), arthralgia (P = 0.042), and musculoskeletal disorders in mother and/or father (P < 0.001). The decrease in prolidase activity may be related with collagen metabolism in joint hypermobility Therefore, joint hypermobility appeared to warrant further investigation due to concomitant signs and symptoms.     

The relationship between benign joint hypermobility syndrome and carpal tunnel syndrome

Benign joint hypermobility syndrome (BJHS) is defined as the presence of musculoskeletal symptoms in persons with generalized joint laxity in the absence of systemic rheumatologic disease. There is an association between soft tissue rheumatism, entrapment neuropathies, and BJHS. The purpose of the study was to identify the relationship between BJHS and carpal tunnel syndrome (CTS). Ninety patients were included in the prospective controlled study. All selected participants were referred to our electrophysiological laboratory with clinical diagnosis of CTS. Subsequently, subjects were divided into two groups as group I and II. Group I included patients with CTS and group II had patients without CTS based on electrophysiological findings. All subjects were assessed for existing BJHS by using the Brighton 1998 criteria. Fifty-five patients were recruited into group I (CTS) and 35 subjects were in group II. The mean age in group I and II was 49.5 +/- 10.8 and 40 +/- 9.9 years, respectively. The subjects in group II were younger than those in group I (p < 0.05). The mean Beighton score was 2.04 +/- 2.7 and 1 +/- 1.68 in groups I and II, respectively. In patients with CTS, BJHS rate was markedly higher than those in patients without CTS with respect to Brighton 1998 criteria (p < 0.0001). There was a positive correlation between CTS and BJHS (r = 0.59, p = 0.0001). Consequently, we suggested that BJHS could be a predisposing factor for CTS or vice versa.     

Joint hypermobility in patients with fibromyalgia syndrome

Objective. To test the hypothesis that joint hyperlaxity can play some role in the pathogenesis of pain in primary fibromyalgia. Methods. A total of 66 women with fibromyalgia (according to the 1990 American College of Rheumatology criteria) and 70 women with other rheumatic diseases were examined for joint laxity based on 5 criteria (The Non-Dominant Spanish modification). Individuals meeting 4 or 5 criteria were considered to be hyperlax. Results. Joint hyperlaxity was detected in 18 (27.3%) of the patients with fibromyalgia and 8 (11.4%) of those with another rheumatic disorder. The statistical analysis revealed significant differences (p < 0.05) between both groups. Conclusion. The results of this study suggest that joint hypermobility and fibromyalgia are associated. Joint hyperlaxity may play a prominent role in the pathogenesis of pain in fibromyalgia.     

Joint hypermobility

Joint hypermobility is an area of neglect in rheumatology. That is not to say it is overlooked by rheumatologists. It is spotted when sought, but for many unfortunate patients, here the story ends. The act of recognition becomes the goal in itself rather than the medium through which effective therapy can be provided. This chapter serves to reinforce the clinical and epidemiological importance of a common disorder whose significance is under-appreciated and impact largely ignored. In contradistinction to our earlier chapter, published in 2000, which took for its remit the heritable disorders of connective tissue in general, the current one focuses on the commonly encountered (so-called benign) joint hypermobility syndrome, its recognition, epidemiology, clinical features and management according to the most recent literature.     

Joint hypermobility

Patients with joint hypermobility, perhaps the mildest of the various inherited abnormalities of connective tissue, may present to a rheumatologist or general practitioner although a large proportion are recognized by health professionals, particularly physiotherapists. Hypermobility may be generalized or extreme at a small number of joints. Sometimes it is associated with involvement of other organs because of abnormal inherited collagen structure elsewhere. A small proportion of patients will have one of the more serious conditions such as Ehlers-Danlos syndrome, Marfan's syndrome or osteogenesis imperfecta. Management is multidisciplinary requiring a team including physicians, physiotherapists, occupational therapists and podiatrists, among others. Patients often wait a long time before receiving their definitive diagnosis and are sometimes dismissed as malingerers. Patients often have a lot of queries about their condition unrelated to their joints. Among these are whether there will be problems in pregnancy, whether the condition will be passed on to their children, whether symptoms arising from organs other than the joints are related and whether they might have been incorrectly accused of battering their children.     

Relationship of Q angle and joint hypermobility and Q angle values in different positions

Patellar malalignment is the most important reason for anterior knee pain. Patellar alignment is commonly determined by the measurement of the quadriceps (Q) angle. In this study, our primary aim was to investigate the Q angle difference between healthy individuals with and without joint hypermobility. The other objectives were to compare the Q angle values, which were measured in supine and upright positions, to determine hypermobility frequency among healthy males in a certain population, and to investigate the correlation between the existent skeletal deformities and Beighton score levels. Two hundred fifty-three healthy male college students were examined for hypermobility and skeletal deformities. According to the Beighton scoring system, three groups (n=20) were formed, and Q angle measurements were performed on the 60 individuals in both supine and upright positions. In the comparison of the groups, the mean Q angle values in healthy hypermobile individuals were found to be significantly higher than that of the nonhypermobile ones (p<0.05). No statistical difference was found between Q angle values in supine and upright positions (p>0.05). The frequency of joint hypermobility (Beighton score 4 or more) was found to be 29.25% in this population. No correlation was determined between existent skeletal deformities and Beighton score values (p>0.05). In conclusion, the Q angle evaluation among healthy hypermobile individuals may have a prognostic value for probable knee pathologies that may appear in the future.     

The frequency of hypermobility and its relationship with clinical findings of fibromyalgia patients

The etiology and pathogenic mechanisms of fibromyalgia (FM) are unknown. A number of studies have suggested that there was a link between hypermobility and FM. In this study, we aimed to expose the frequency of hypermobility in FM patients and its relation with clinical findings. For this reason, 236 women (118 FM women as study group and 118 healthy women as control group) were enrolled in the study. Joint hypermobility was evaluated in the participants by using Beighton scoring system. The rate of joint hypermobility among FM patients (Beighton score of at least 4 or more) was found to be higher than the control group (46.6 vs 28.8%). This result was also statistically meaningful (p<0.05). In addition, the mean Beighton score of FM group was observed to be higher than the control (3.68 vs 2.55, p<0.001). Although not reaching statistical difference (p>0.05), more severe clinical findings were observed in FM patients with hypermobility when compared with ones without.     

Smoking among high school students

INTRODUCTION: There are no recent data on smoking habits of high-school students in Greece. The primary objective of the study was to determine these epidemiological factors. METHODS: The smoking habits of 927 high-school students (471 boys and 456 girls), aged between 15-18 years, in four regions of a Greek area (the island of Cos), were examined. Study data were collected using a questionnaire. RESULTS: It was found that 32.48% of boys and 27.19% of girls are smokers; 43.3% had started smoking before the age of 14. The mean age for starting smoking was 14.4 +/- 1.9 years for the boys and 14.9 +/- 1.6 years for the girls. As many as 22.8% of the students smoke 6 to 10 cigarettes per day and 21.5% 16 to 20 cigarettes per day; 40.2% reported that they smoke out of spite. Students reported that their parents are aware that their offspring smoke in a proportion of 36.7%. Social standards and parental example were found to be the main determinants for starting smoking. The majority of the students (95.2%) stated that they are aware of the hazards associated with smoking. DISCUSSION: Our findings highlight the need for smoking control interventions aimed at young people. Smoking is a major, yet preventable cause of morbidity and mortality. For these reasons, we view that adolescents should be targeted with a well-planned integrated anti-smoking policy and not just an initiative for raising awareness of smoking hazards.     

Drinking and driving among high school students

A questionnaire survey of high school students conducted in 1983 provided information on their self-reported drinking and driving practices. By age 15 the majority reported drinking alcoholic beverages. By age 17 half or more of the males and one-third of the females reported driving after drinking at least once in the past month. About one-quarter of the students estimated that six or more cans of beer would be required to make someone an unsafe driver. Reported frequency of driving after drinking was associated with less time spent on homework and poorer academic performance, working part time, greater participation in social activities, less perceived parental influence regarding their travel, owning a car, driving high mileage, speeding, and having crashes and violations.     

Classic Ehlers-Danlos syndrome and cardiac transplantation - Is there a connection?

Ehlers-Danlos syndrome (EDS) is a heterogeneous group of connective tissue disorders comprised of several types. Classic EDS is an autosomal dominant disorder with stretchable skin, delayed wound healing with poor scarring, joint hypermobility with subluxations or dislocations, easy bruisability, hernias, aneurysms and cardiac abnormalities. Advances in genomics technology using next-generation sequencing has led to the discovery of causative genes for connective tissue disorders, hereditary cardiomyopathies and cardiovascular diseases including several genes for connective tissue disorders. A 55 year-old male exhibited thin stretchable skin, atrophic scars, easy bruising, joint pain and dislocations requiring multiple knee surgeries and a Beighton hyperflexibility score of 6 out of 7. He was found to have a heterozygous missense COL5A1 gene variant involving exon 3 at nucleotide c:305T>A with an amino acid position change at p.lle102Asn consistent with classic EDS. He had a heart transplant at 43 years of age due to cardiac failure of unknown cause. This patient with classic EDS is brought to medical attention and should be of interest to cardiologists, heart transplant specialists and surgeons, particularly in individuals with unexplained cardiac failure and then diagnosed prior to surgical intervention to avoid poor wound healing, scarring and other tissue involvement (e.g., vascular anomalies, blood pressure instability, aneurysms) as components of EDS.     

Lifetime inhalant use among alternative high school students in Texas: prevalence and characteristics of users

This cross-sectional study describes the prevalence of lifetime inhalant use and identifies demographic, psychosocial, and other risk behavior characteristics of students reporting lifetime inhalant use. The sample consisted of 354 students attending alternative high schools (dropout prevention/recovery schools) in Texas. The prevalence of lifetime inhalant use was 27.7%. After controlling for potentially confounding factors, students reporting lifetime inhalant use were less likely to be financially supported by their parents/guardians, more likely to use alcohol/tobacco, marijuana, and cocaine, and more likely to carry weapons and consider suicide. Study results may allow school officials, parents, researchers, and health care providers to gain a better understanding of inhalant use among students at risk for dropping out of school, a group which has not been extensively studied by previous researchers.     

汕头市高三学生肠易激综合征流行病学的调查分析

目的了解汕头市高三学生肠易激综合征（irrita blebowel syndrome,IBS）的患病率和依从性情况。方法采用整群随机抽样方法对汕头市3300名高三学生进行流行病学问卷调查,估算符合罗马Ⅲ标准IBS的期间患病率、依从性和危险因素。结果 IBS的患病率为13.39%,女性患病率显著高于男性（17.0%vs10.3%,P〈0.05）;在符合罗马Ⅲ标准的IBS患者中,38.01%（168例）为腹泻型;26.70%（118例）为便秘型;15.61%（69例）为混合型;19.68%（87例）为不定型;肠道感染史和进食辛辣食物等可能是危险因素。结论 IBS是高三学生的常见病及多发病但大多数没有专科诊治,依从性差。