Joint Hypermobility in Paediatric Acute-Onset Neuropsychiatric Syndrome—A Preliminary Case-Control Study

Abstract

Background: Individuals with generalised joint hypermobility (GJH, present in 10–20% of the general population) are at increased risk of being diagnosed with a range of psychiatric and rheumatological conditions. It is unknown whether Paediatric acute-onset neuropsychiatric syndrome (PANS), characterised by childhood onset obsessive-compulsive disorder or restricted eating and typically associated with several comorbid neuropsychiatric symptoms, is associated with GJH. It is also unknown whether extensive psychiatric comorbidity is associated with GJH.Method: This is a case-control study including 105 participants. We compared three groups: Individuals with PANS, individuals with other mental disorders and healthy controls. Joint mobility was assessed with the Beighton scoring system, psychiatric comorbidity with the M.I.N.I. or MINI-KID interview and symptoms of PANS with the PsychoNeuroInflammatory related Signs and Symptoms Inventory (PNISSI).Results: Hypermobility was similar across groups, and high rates of psychiatric comorbidity was not associated with higher Beighton scores.Conclusion: Although GJH is associated with several psychiatric conditions, such as ADHD and anxiety, this does not seem to be the case for PANS according to this preliminary study.

Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome

“…Some clinicians have theorized that spooning is a manifestation of joint hypermobility rather than dystonic posturing, given the high prevalence of hypermobility in patients with PANS. 72,73 In our PANS cohort, there was no significant association found between spooning and joint hypermobility, suggesting it may be a relevant dystonic feature in PANS and should be evaluated. Nonetheless, future studies should define whether the prevalence of spooning is associated with other NSS-BG.…”