Need for a consensus on the methods by which to measure joint mobility and the definition of norms for hypermobility that reflect age, gender and ethnic-dependent variation: is revision of criteria for joint hypermobility syndrome and Ehlers-Danlos syndrome hypermobility type indicated?

Remvig, Lars; Engelbert, Raoul; Berglund, Bo; Bulbena, Antonio; Byers, Peter H.; Grahame, Rodney; Juul-Kristensen, Birgit; Lindgren, Karl August; Uitto, Jouni; Wekre, Lena Lande

doi:10.1093/rheumatology/ker140

Cited by 73 publications

(82 citation statements)

References 6 publications

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“…A meta-analysis showed that the sex difference in the 2D:4D length ratio was largest in the right hand and is possibly a better indicator of prenatal androgenization (7). However, the reasons for this side difference are unclear.…”

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confidence: 99%

Need for international consensus on examining for joint laxity: Comment on the article by Clinch et al

Remvig

Juul-Kristensen

2011

Arthritis & Rheumatism

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Two previous studies demonstrated an association between low 2D:4D ratio (as a possible marker for prenatal testosterone) and knee OA (1,2). This observed association could possibly be due to a direct effect of testosterone on the cartilage in the prenatal period (3). Previous studies have also shown that a low 2D:4D ratio is associated with more aggressive and risk-taking behavior and with better athletic skills (4,5), and the association with knee OA could therefore be mediated through a higher risk of knee injuries (which is a well-known risk factor for knee OA). We found an association between 2D:4D and previous self-reported knee injuries in men, but no association with meniscal damage or knee OA. This may be due to low frequency of posttraumatic OA and high frequency of degenerative meniscal lesions (not related to acute injuries) in middle-aged and elderly persons. Our goal was to gain a better understanding of risk factors for OA, and was primarily of academic character. Hence, we see no direct prevention opportunities with respect specifically to the 2D:4D length ratio, because the 2D:4D length ratio is possibly only indirectly and weakly associated with knee OA (no significant association was found in this study).We used logistic regression to examine the association of the 2D:4D length ratio as the independent variable with knee OA, hand OA, meniscal damage, and knee injury as the dependent variables. We apologize if the description of the statistical methodology could be misinterpreted.The participants in the Framingham community cohort were randomly selected from the general population (ages Ͼ50 years). Of those who were contacted, 1,830 of 2,582 expressed initial interest. Of those, 1,039 were examined, and 1,020 were included in this study. Further information about the recruitment and exclusion criteria is detailed in Figure 1 in another article by our group (6). The primary purpose was to establish a cohort representative of the general population in order to investigate the epidemiology of OA.A meta-analysis showed that the sex difference in the 2D:4D length ratio was largest in the right hand and is possibly a better indicator of prenatal androgenization (7). However, the reasons for this side difference are unclear. We divided the participants into tertiles according to their 2D:4D length ratio, and the risk of misclassification of participants with left hand measurements was considered low, due to the use of only 3 categories. Exclusion of the data on these participants yielded similar results.There are no established fixed-value boundaries for the categories with low, equal, and high 2D:4D length ratio. Several studies have relied on a visual classification, which is more prone to misclassification due to deviations of the hand. We therefore divided the participants into tertiles (i.e., the same approach as in earlier studies) (1,2). Mean values for the length ratio of the phalangeal and metacarpal bones in the 3 visual classification groups have previously been reported by Robertson et al ...

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confidence: 99%

Need for international consensus on examining for joint laxity: Comment on the article by Clinch et al

Remvig

Juul-Kristensen

2011

Arthritis & Rheumatism

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“…The spectral disorder of inherent joint hypermobility is a commonly recognized syndrome (20,21), which is genetically determined (33,34). A question therefore arises: can MHT also be differentiated as a constitutional variant?…”

Section: Discussionmentioning

confidence: 99%

“…The resistance an examiner feels on passive stretching could also be attributed to connective tissue elasticity or laxity (16,19). Range of joint mobility varies considerably in the normal population, depending upon age, gender, and ethnic origin (20,21). Correlations occur in the ROMs of different joints studied in individuals.…”

Section: Introductionmentioning

confidence: 99%

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Muscular hypertonicity: a suspected contributor to rheumatological manifestations observed in ambulatory practice

Masi

Kamat²,

Gajdosik

et al. 2015

Eur J Rheumatol

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Objective: The objective of this retrospective study of non-inflammatory rheumatic disease patients was to investigate if the individuals clinically identified with muscular hypertonicity (MHT) had increased clinical manifestations compared with those of age-and gender-matched patients with the same disorders. Material and Methods:The MHT status was clinically identified in the rheumatologist's myofascial protocol examination as relatively increased passive resistance of relaxed muscle on a slow gentle stretch. Clinical and laboratory data were abstracted on a pre-coded form, including symptom and physical examination features, serum assays, and medications.Results: The 19 MHT cases complained of greater subjective stiffness (p=0.010) and tiredness (p=0.018) at initial encounters and increased aching pain (p=0.049) and were prescribed more (p=0.003) mild narcotic analgesics than the 19 comparison patients. The cases had higher (p=0.027) serum creatine kinase levels, and patients with diffuse MHT had greater frequency of heavy (30+pack-years) cigarette smoking (p=0.002) than comparison subjects. Narcotic usage was also greater in cases with diffuse involvement.Conclusion: Non-inflammatory rheumatic disease patients with MHT had an overall similar profile as that of comparison patients but had greater musculoskeletal complaints, and those with diffuse involvement had greater narcotic usage. Further research, including quantitative measurements of muscle stiffness, are required to determine whether MHT is a documented entity associated with increased rheumatological manifestations.

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“…A further set of diagnostic criteria, including common features such as functional bowel disorder, cardiovascular dysautomia, has been proposed [35], but it is not yet validated. The revision of the EDS nosology is required [36], for unifying available diagnostic criteria.…”

Section: Diagnosismentioning

confidence: 99%

Gynecologic and obstetric impact of the ehlers-danlos syndrome : clues from scrutinizing dermal ultrastructural alterations

Hermanns‐Lê¹,

Pierard²,

Piérard-Franchimont³

et al. 2014

Gynecol

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Background: The Ehlers-Danlos syndrome (EDS) represents a heterogenous group of heritable connective tissue disorders chiefly characterized by joint laxity, increased skin distensibility and connective tissue fragility. Each EDS type corresponds to a multisystemic disorder with widespread implications. Physicians evoke the EDS diagnosis in presence of some typical cutaneous signs, such as atrophic scars and frequent hematomas. Methods: To revisit the transmission electron microscopy support from skin biopsies when screening EDS in gynecologyobstetrics. Results: EDS women commonly suffer from a series of gynecologic and obstetric disorders. Dermal ultrastructural changes are keynote features suggesting some EDS types. Conclusion: Gene mutations are mostly identified in the classic and vascular EDS types, but only in sporadic cases of the hypermobile EDS type which apparently represents the most frequent type. Dermal ultrastructural changes represent relevant diagnostic clues for the practitioner. Preconception counseling about possible complications is welcome. Management requires precise diagnosis of the EDS type.

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Need for a consensus on the methods by which to measure joint mobility and the definition of norms for hypermobility that reflect age, gender and ethnic-dependent variation: is revision of criteria for joint hypermobility syndrome and Ehlers-Danlos syndrome hypermobility type indicated?

Cited by 73 publications

References 6 publications

Need for international consensus on examining for joint laxity: Comment on the article by Clinch et al

Need for international consensus on examining for joint laxity: Comment on the article by Clinch et al

Muscular hypertonicity: a suspected contributor to rheumatological manifestations observed in ambulatory practice

Gynecologic and obstetric impact of the ehlers-danlos syndrome : clues from scrutinizing dermal ultrastructural alterations

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