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Epidemiology of General Joint Hypermobility and Basis for the Proposed Criteria for Benign Joint Hypermobility Syndrome: Review of the Literature
LARS REMVIG, DORTE V. JENSEN, and ROBERT C. WARD ABSTRACT. Objective. This literature review of generalized joint hypermobility (GJH) syndromes discusses information regarding sex-, age-, and race-related factors from publications that specifically document validated GJH criteria. Methods. We present an analysis of criterion-referenced connections that identify similarities among major and minor clinical criteria that identify both GJH and benign joint hypermobility syndrome (BJHS). In our search, we found considerable empirical evidence that supports an increased prevalence of hypermobility among children, women, and certain racial groups. Two commonly used clinical assessment tools, the Carter and Wilkinson criteria (≥ 3 positive tests out of 5) and the Beighton method (≥ 4 positive tests out of 9), are the sources of these data. BJHS is diagnosed through a set of major and minor criteria — a combination of symptoms and objective findings — that include arthralgia, back pain, spondylosis, spondylolysis/spondylolisthesis, joint dislocation/subluxation, soft tissue rheumatism, marfanoid habitus, abnormal skin, eye signs, varicose veins or hernia or uterine/rectal prolapse. Results. Clinically, there is some evidence that arthralgia, the proposed BJHS major criterion, is a major component of alleged hypermobility-related problems. In contrasting, there is no clear evidence that proposed BJHS minor diagnostic criteria are associated with hypermobility-related problems. An empirical correlation between hypermobility and osteoarthritis is possible, but so far unproven. There are no randomized controlled studies regarding effects of existing treatments. Conclusion. Generalized hypermobility is both sex- and age-related. Racial differences are also identifiable. The existence of BJHS can be accepted using present criteria. (First Release Jan 15 2007; J Rheumatol 2007;34:804–9) Key Indexing Terms:
JOINT LAXITY From the Clinic of Orthopaedic Medicine and Rehabilitation, Rigshospitalet, Copenhagen University, Copenhagen; Department of Rheumatology, Frederiksborg County Hospital, Hoersholm, Denmark; and College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA. L. Remvig, MD, DMSc, Chief Physician in Rheumatology, Clinic of Orthopaedic Medicine and Rehabilitation, Rigshospitalet, Copenhagen University; D.V. Jensen, MD, Staff Specialist, Department of Rheumatology, Frederiksborg County Hospital; R.C. Ward, DO, Professor Emeritus, College of Osteopathic Medicine, Michigan State University. Address reprint requests to Dr. L. Remvig, Clinic of Orthopaedic Medicine and Rehabilitation, Rigshospitalet, Department 4124, University Hospital of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark. E-mail: lars.remvig@rh.hosp.dk Accepted for publication November 28, 2006.
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