Chronic widespread pain and neurophysiological symptoms in joint hypermobility syndrome (JHS)

Abstract

Background Joint Hypermobility Syndrome (JHS) is a multisystemic connective tissue disorder characterised by pain, tissue fragility and laxity. This study aims to investigate the prevalence of chronic widespread pain (CWP) and the extended neurophysiological features reported by a group of patients with JHS. Methods Ninety patients with JHS (mean age 34.7 ± 9.9 years), which was diagnosed in accordance with the Brighton criteria, and 113 healthy volunteers (mean age 35.7 ± 12.9) with no musculoskeletal pain participated in the study. A self-report questionnaire and pain chart were employed to collect data. Results CWP was reported by 86% of patients with JHS. The mean number of pain sites in this group was 9.8/17 ± 4.2. Fibromyalgia was reported by 19% of this group. Patients with JHS were significantly more likely to report the following than healthy volunteers: autonomic symptoms (70%, 12%); gastrointestinal symptoms (71%, 9%); and chronic fatigue syndrome (31%, 1%). Patients with JHS reported significantly higher mean functional difficulties scores (22.28 ± 4.90) than healthy volunteers (17.96 ± 3.73) (P<0.001), indicative of functional difficulties associated with developmental coordination disorder/dyspraxia. Conclusion Patients with JHS reported a wide range of neurophysiological symptoms of which CWP was a salient feature. There is a need to acknowledge and understand the extended symptoms associated with CWP in order to address the holistic needs of patients with JHS. Further studies and discussion are required to identify the complex inter-related multifactorial neurophysiological mechanisms in those with JHS.

The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome

“…Although not all of those patients would have been referred for symptoms directly attributed to JHS, it does suggest that there is a large population of potential JHS patients being referred to physiotherapy services. Clark et al 101 reported that JHS is accompanied by a wide range of concomitant diagnoses such as chronic widespread pain (86%), chronic fatigue syndrome (31%) and fibromyalgia (19%), each of which might form the basis for a referral for physiotherapy. It might therefore be possible to screen all referrals to physiotherapy services to help identify participants with JHS.…”

A humanisation approach for the management of Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobility Type (JHS/EDS-HT)

“…More recently the breadth of symptoms have been found to include: Postural Orthostatic Tachycardic Syndrome, gastrointestinal disorders, fatigue and Development Coordination Disorder (Castori, Morlino, Pascolini, Blundo, & Grammatico, 2015; Clark, Khattab, & Carr, 2014; Farmer & Aziz, 2010). The clinical presentation of JHS/EDS-HT is complex, often impacting on a person’s daily activity, family life, social and employment opportunities.…”

“…This requires HPs to recognise and understand the multifactorial aspects of JHS/EDS-HT and the complex central neurophysiological mechanisms that contribute to this condition (Celletti et al, 2015; Clark et al, 2014). …”

Development and initial validation of the Bristol Impact of Hypermobility questionnaire

“…It may also be associated with a range of autonomic and gastrointestinal symptoms, and functional difficulties indicative of developmental coordination disorder/dyspraxia [6]. Empirical data has shown that, when compared with healthy controls, JHS has a significant impact on outcomes such as exercise endurance, gait, pain, proprioception, strength, function and quality of life both in children [7,8,9,10] and adults [11,12,13,14].…”