Prevalence of Joint Hypermobility and Patterns of Articular Manifestations in Patients with Inflammatory Bowel Disease

Abstract

Objective. The objective is the investigation of Joint Hypermobility (JH) and the Hypermobility Syndrome (HMS) in patients with inflammatory bowel disease (IBD). Methods. We examined 83 patients with IBD and 67 healthy individuals for the presence of JH. Patients were excluded if they were under 18 or over 50 years of age and if they had other conditions which affect joint mobility. The x2 and the Fisher exact test were used appropriately between study groups. Odds ratios (ORs) for the risk of JH and HMS in IBD groups were calculated. Results. A total of 150 individuals (83 IBD patients and 67 healthy controls) participated in the study. 69 IBD patients, 41 with Crohn's Disease (CD) and 28 with ulcerative colitis (UC), were finally eligible. JH was detected in 29 CD patients (70.7%), in 10 UC patients (35.7%), and in 17 healthy control subjects (25.4%). Significant difference was detected on JH in CD patients as compared to UC patients (P = .0063) and controls (P < .0001). The estimated OR for JH was 7.108 (95% CI: 2.98–16.95) in CD and 1.634 (95% CI: 0.63–4.22) in UC patients. HMS was detected in 5 (12.2%) CD and in 1 (3.57%) UC patients. The OR for HMS in CD was 3.75 (95% CI: 0.41–34.007), while 7 (17.1%) CD patients had overlapping symptoms for both HMS and early spondylarthropathy. Conclusions. JH and the HMS are common in CD patients, thus articular manifestations should be carefully interpreted. This implies an involvement of collagen varieties in the pathogenesis of IBD.

Gastrointestinal disorders in joint hypermobility syndrome/Ehlers‐Danlos syndrome hypermobility type: A review for the gastroenterologist

“…No differences were found in the proportion of gJHM between patients with UC and healthy controls ( P =.3). The prevalence of JHS/EDS‐HT was relatively low in both groups although it was higher in patients with Crohn's disease than in patients with UC (12.2% Crohn's disease, 3.57% UC) …”

Gastrointestinal and nutritional issues in joint hypermobility syndrome/ehlers–danlos syndrome, hypermobility type

“…Of the 12 studies with positive results (Table ), four studied adult females only [Norton et al, ; Jha et al, ; Arunkalaivanan et al, ; Lammers et al, ], five adult males and females [Pulliam and Schuster, ; Al‐Rawi et al, ; Reilly et al, ; Vounotrypidis et al, ; Zarate et al, ], two children and adolescents from both sexes [Mohammed et al, ; Kajbafzadeh et al, ], and one children, adolescents and adults from both sexes [Marshman et al, ]. These works differed also for the assessing method for gJHM, which was the Beighton score with a positive cut‐off of >4 four times [Jha et al, ; Reilly et al, ; Arunkalaivanan et al, ; Zarate et al, ], Beighton score with a positive cut‐off of ≥4 twice [Al‐Rawi et al, ; Kajbafzadeh et al, ], Beighton score with an undefined positive cut‐off once [Vounotrypidis et al, ], the self‐reported 5‐point questionnaire once [Mohammed et al, ], and a self‐developed screening method four times [Marshman et al, ; Norton et al, ; Pulliam and Schuster, ; Lammers et al, ]. Association between gJHM and chronic constipation, alternatively termed as chronic intestinal pseudoobstruction [Pulliam and Schuster, ] or slow transit constipation [Mohammed et al, ], appeared the most consistent, being observed four times in both sexes from all ages [Pulliam and Schuster, ; Reilly et al, ; Mohammed et al, ; Kajbafzadeh et al, ].…”

“…A study pointed out a relationship between constipation and a past history of pelvic prolapse in females [Mohammed et al, ]. Three further works highlighted the association between JHM with some upper GI complaints (i.e., gastro‐esophageal reflux and bloating) [Zarate et al, ], hiatus hernia [Al‐Rawi et al, ], and Crohn disease [Vounotrypidis et al, ]. “Functional” nature of constipation and upper GI complaints in individuals with gJHM was envisaged twice by the net prevalence of an absent precipitating factor for both features in these subjects [Mohammed et al, ; Zarate et al, ].…”

“…Summative effects of this process may include influences on pain thresholds and gut motility, both known contributors to various functional GI complaints, such as gastro‐esophageal reflux, abdominal pain, bloating, diarrhea and constipation [Farmer and Aziz, ]. Furthermore, a defect of the extracellular matrix in the lamina propria and secondary alterations of luminal microbiota may affect permeability of gut mucosa, a mechanism which may explain, in part, the associations with celiac disease [Danese et al, ], Crohn disease [Vounotrypidis et al, ] and eosinophilic esophagitis [Abonia et al, ].…”

Gastrointestinal involvement in the Ehlers–Danlos syndromes

“…Only two published studies exist which demonstrate a possible association between hypermobility and organic disorders, and these were done in patients with inflammatory bowel disease (IBD) and celiac disease. The first was performed in a Greek Hospital setting [Vounotrypidis et al, ] which described that the prevalence of hEDS in Crohn's disease (12.2%) was higher than that in UC (3.6%) but this difference was not statistically significant. Fikree et al [] also demonstrated a relatively high prevalence of JHS in Crohn's disease and ulcerative colitis patients (32% and 21%, respectively).…”