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Ewer ER, De Pauw R, Kazkazk H, Ninis N, Rowe P, Simmonds JV, De Wandele I. The Spider: a visual, multisystemic symptom impact questionnaire for people with hypermobility-related disorders-validation in adults. Clin Rheumatol 2024; 43:3005-3017. [PMID: 39085705 PMCID: PMC11330398 DOI: 10.1007/s10067-024-07071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are often accompanied by varied and complex multisystemic comorbid symptoms/conditions. The Spider questionnaire was developed to evaluate the presence and impact of eight common multisystemic comorbidities. Thirty-one questions across eight symptom domains assess neuromusculoskeletal, pain, fatigue, cardiac dysautonomia, urogenital, gastrointestinal, anxiety, and depression symptoms. This study aimed to evaluate the Spider's construct validity in adults. METHOD A cross-sectional observational study was conducted over four stages. Three international patient charities aided recruitment of participants through social media and website advertisements. Adults aged 18 to 65 years, with and without HSD/hEDS, were invited to participate. Validated, frequently used comparator questionnaires were used to establish convergent validity of Spider symptom domains. A control group was recruited for known-group validity analysis. Participants answered each Spider domain and the corresponding comparator questionnaire via surveys hosted by REDCap. Anonymous data were analysed using SPSS. Convergent validity was assessed through Spearman's correlational analysis and known-group validity through Mann-Whitney U analysis. RESULTS A total of 11,151 participants were recruited across the four stages. Statistically significant, moderate-to-strong correlations were found between all Spider domains and their comparators (p < 0.001, r = 0.63 to 0.80). Known-group validity analysis showed statistically significant differences (p < 0.001) between the hypermobile and control groups in all eight domains. CONCLUSIONS Convergent and known-group validity of the Spider was established with adults. These results suggest the Spider can measure the presence and impact of multisystemic comorbid symptoms/conditions in adults with HSD/hEDS, providing a tool which guides multidisciplinary management. Key Points • The Spider questionnaire is a novel tool assessing the presence and impact of the multisystemic comorbid symptoms/conditions associated with HSD/hEDS. • Convergent and known-group validity of the Spider questionnaire was established in adults aged 18 to 65. • This tool provides a quick and easy method to visualise the symptom profile of those with HSD/hEDS to guide symptom management.
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Affiliation(s)
- E R Ewer
- UCL Great Ormond Street Institute of Child Health, London, UK.
| | - R De Pauw
- Department of Epidemiology, Sciensano, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - H Kazkazk
- UCL Great Ormond Street Institute of Child Health, London, UK
- University College London Hospital NHS Trust, London, UK
| | - N Ninis
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - P Rowe
- Johns Hopkins University, Baltimore, USA
| | - J V Simmonds
- UCL Great Ormond Street Institute of Child Health, London, UK
- University College London Hospital NHS Trust, London, UK
- London Hypermobility Unit, Central Health Physiotherapy, London, UK
| | - I De Wandele
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
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Chuchin JD, Ornstein TJ. Fear avoidance, fear of falling, and pain disability in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Disabil Rehabil 2024; 46:4234-4245. [PMID: 37843031 DOI: 10.1080/09638288.2023.2268520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are understudied conditions characterized by hallmark hypermobility and chronic pain. Disease manifestations lead to significant disability. Understanding predictors of disability, over and above the univariate construct of pain severity, is necessary to tailor treatment. Thus, the current study examined the impact of the Fear-Avoidance Model [FAM] on disability in hEDS/HSD. Fear of falling was included as a novel fear-avoidance factor impacting disability. METHODS A total of 168 individuals with hEDS/HSD answered a cross-sectional online survey regarding FAM constructs, fear of falling, disability, and clinical-demographic factors. A hierarchical regression analysis was used to assess whether FAM constructs and fear of falling significantly predicted disability, over and above pain severity and age. RESULTS Pain catastrophizing, anxiety, and fear of falling contributed significant unique predictive relations, above age and average pain severity. Pain severity and fear of falling were the strongest unique predictors of disability. CONCLUSIONS This is the first study to assess the relations among FAM constructs, pain severity, and disability in hEDS/HSD, and introduces fear of falling as a novel fear-avoidance factor specific to this population. Future research should apply these findings towards individualized interventions to improve disability in hEDS/HSD.
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Affiliation(s)
- Jessica D Chuchin
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Tisha J Ornstein
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
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Ituen OA, Duysens J, Ferguson G, Smits-Engelsman B. The strength of balance: Strength and dynamic balance in children with and without hypermobility. PLoS One 2024; 19:e0302218. [PMID: 38923950 PMCID: PMC11206839 DOI: 10.1371/journal.pone.0302218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/30/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Generalized Joint hypermobility (GJH) is predominantly non-symptomatic. In fact, individuals with joint flexibility usually perform better than their non-hypermobile counterparts during physical activities. Notwithstanding, strength and balance are essential to maintain the control of the extra range of motion during activities and to prevent musculoskeletal complications. There are limited and conflicting pieces of evidence in literature regarding the association between strength and balance in children with GJH. OBJECTIVES The purpose of this study was to examine differences in functional strength, dynamic balance, proprioception, and isometric strength in children with and without joint hypermobility and determine the association between strength outcomes and dynamic balance. METHOD A cross-sectional study was conducted among children aged 6 to 11. Hypermobility was determined using the Beighton Score, with scores ≥6 representing hypermobility. Functional strength was assessed with the Functional Strength Measure (FSM), isometric strength was determined with a handheld dynamometer (HHD), the Y-Balance Test (YBT) was used to assess dynamic balance and the Wedges test to measure proprioception. RESULTS This study included 588 participants (age: 7.97 ± 1.3 years; height: 128±10.1 cm; mass: 27.18 ± 7.98 kg). 402 children were classified as having normal mobility and 186 as being hypermobile. Hypermobile children had better functional strength in the lower extremities than children with normal range mobility but lower reach distance in the YBT. No differences in proprioception, functional strength of the upper extremity or isometric strength in the hands were found. However, isometric lower extremity force was less in hypermobile children than children with normal range mobility. Irrespective of their joint mobility, a fair significant correlation existed between total Y-balance distance and FSM items r = 0.16-0.37, p = 0.01. Correlations between total Y-balance distance and isometric strength of knee and ankle muscles ranged between r = 0.26-0.42, p = 0.001. CONCLUSION Hypermobile joints seem to co-occur with lower extremity isometric strength, more functional strength in the lower extremities and less reaching distance in dynamic balance. The opposing direction of the results on functional and isometric strength tests highlights the importance of the type of outcome measures used to describe the association of strength and the range of motion.
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Affiliation(s)
- Oluwakemi A. Ituen
- University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
- Department of Health & Rehabilitation, University of Cape Town, Cape Town, South Africa
| | - Jacques Duysens
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group KU, Leuven, Belgium
| | - Gillian Ferguson
- University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
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Jeong HJ, Tarima S, Nguyen A, Qashqai A, Muriello M, Basel D, Slavens BA. Lower extremity inter-joint coupling angles and variability during gait in pediatric hypermobility spectrum disorder. J Biomech 2024; 170:112151. [PMID: 38851094 DOI: 10.1016/j.jbiomech.2024.112151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 06/10/2024]
Abstract
Complex musculoskeletal complications in children with hypermobility spectrum disorder (HSD) include pain, proprioception deficits, and joint instability, which may result in movement dysfunction during walking. However, no studies have explored the inter-joint coordination deficits in children with HSD. The purpose of this study was to determine the lower extremity inter-joint coupling angles, patterns, and variability during walking in children with HSD compared to children without HSD (non-HSD). Ankle, knee, and hip kinematics during the stance phase of walking in 18 children with HSD and 18 children without HSD were measured using three-dimensional motion analysis. Coupling angles, patterns, and variability of hip-knee, hip-ankle, and knee-ankle were quantified in the sagittal, frontal, and transverse planes using vector coding techniques. Statistical modeling of coupling angles on sine and cosine scales and bootstrapped standard errors were used to compare coupling angles between HSD and non-HSD groups. Permutational multivariate analysis of variance and statistical non-parametric mapping two-sample t-tests were used to compare the coupling patterns and variability between HSD and non-HSD groups, respectively. Our results indicated that coupling angles, patterns, and variability were not significantly different between the groups. These findings suggest that lower extremity inter-joint coordination and its variability during walking might not be a promising area for further research or intervention in children with HSD. Further research could use other biomechanical methods to investigate coordination deficits in pediatric patients with HSD, and how aging and disease progression are associated with coordination deficits in individuals with HSD.
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Affiliation(s)
- Hyo-Jung Jeong
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA; Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | - Sergey Tarima
- Institute for Health & Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anthony Nguyen
- Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Anahita Qashqai
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Michael Muriello
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Donald Basel
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brooke A Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Kelly M, Kagan RP, Yoo J. Increased Opioid Use in Patients With Ehlers-Danlos Syndrome Before and After Total Hip Arthroplasty. Arthroplast Today 2024; 27:101390. [PMID: 38690094 PMCID: PMC11058070 DOI: 10.1016/j.artd.2024.101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 05/02/2024] Open
Abstract
Background Ehlers-Danlos syndrome (EDS), a disorder affecting synthesis of collagen, typically presents with chronic pain, hypermobility, and early osteoarthritis. EDS patients undergoing total hip arthroplasty (THA) are at risk of dislocation and revision. Opioid use and impact on outcomes among this population remain unknown. Methods A retrospective review was performed with a large national database querying the International Classification of Disease, tenth revision procedure codes identifying 1,244,368 primary THAs from 2015-2020. Two hundred thirty-eight EDS patients underwent THA and were propensity matched with population control based on age, sex, and obesity when comparing opioid prescription. To compare dislocation and revision outcomes, EDS patients were stratified into those receiving opioid prescriptions and those not. Multivariate analysis evaluated the association. Results EDS patients were more likely prescribed opioids 90 days before (49.1% vs 34.7.0%, P < .0001) and after THA (59.7% vs 41.2%, P < .0001), with more preoperatively (1163.6 mme ±1562.8, P < .0001) and postoperatively (900.1 mme ±1235.9, P < .0001) than controls. In EDS patients prescribed opioids 90 days before THA, dislocation rate was 12.8% vs 7.1% not prescribed (odds ratio 2.08, 95% confidence interval 0.85-5.1). 14.8% of EDS patients who received opioids 90 days after THA dislocated vs 2.1% not prescribed (odds ratio 8.13, 95% confidence interval 1.87-35.7). Conclusions EDS patients are more likely prescribed opioids before and after THA. Opioid prescription was associated with risk of dislocation, though we caution interpretation of causation. However, this suggests that the risks of worse outcomes in EDS patients undergoing THA are multifactorial. We should look at strategies to reduce opioid use prior to THA.
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Affiliation(s)
- Mackenzie Kelly
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Ryland P. Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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Jeong HJ, Engel JM, Muriello M, Basel D, Slavens BA. The association of pain with gait spatiotemporal parameters in children with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder. Gait Posture 2024; 109:271-276. [PMID: 38368648 DOI: 10.1016/j.gaitpost.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/22/2023] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Children with hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (HSD/hEDS) have a high prevalence of chronic pain, which may influence gait dynamics. However, little is known about pain outcomes and their association with gait spatiotemporal parameters in children with HSD/hEDS. RESEARCH QUESTION Does pain correlate with gait spatiotemporal parameters in children with HSD/hEDS? METHODS Eighteen children with HSD/hEDS and eighteen typically developing (TD) children participated in the study. The current level of pain (0-10 on the numeric rating scale), modified Brief Pain Inventory, and Pain Catastrophizing Scale-Child version were implemented to assess pain in children with HSD/hEDS. All children completed a gait analysis at a self-selected speed. Mean and variability (measured using the coefficient of variation) of gait spatiotemporal parameters were analyzed. Gait parameters included stride length, stride time, gait speed, percent stance time, and step width. A Mann-Whitney U-test was used to compare the gait parameters between children with HSD/hEDS and TD children. Spearman correlations were used to examine the relationships between pain and gait spatiotemporal parameters in children with HSD/hEDS. RESULTS Children with HSD/hEDS had a longer percent stance time compared to TD children (p = 0.03). Lower pain interference in relationships with other people was significantly associated with faster gait speeds (ρ = -0.55, p = 0.03). Children with HSD/hEDS also had greater pain interference during mobility (ρ = 0.5, p = 0.05) and going to school (ρ = 0.65, p = 0.01), which were significantly correlated with greater stride length variability. Greater pain interference during enjoyment of life was significantly associated with greater percent stance time variability (ρ = 0.5, p = 0.05). Greater pain catastrophizing was correlated with decreased step width variability in children with HSD/hEDS (ρ = -0.49, p = 0.05). SIGNIFICANCE Pain interference and catastrophe were significantly associated with gait spatiotemporal variability. Our findings suggest that assessing pain-associated gait alterations may help understand the clinical features and gait kinematics of children with HSD/hEDS.
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Affiliation(s)
- Hyo-Jung Jeong
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA; Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | - Joyce M Engel
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Michael Muriello
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Donald Basel
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brooke A Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Department of Mechanical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Guedry SE, Langley BO, Schaefer K, Hanes DA. Integrative medicine for hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS): a feasibility study. Disabil Rehabil 2024:1-14. [PMID: 38353245 DOI: 10.1080/09638288.2024.2314713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS) are multisystem conditions marked by dysfunctional connective tissue. This feasibility study evaluated a 9-week integrative medicine program in this population. METHODS Using a single-arm study design, adults with HSD or EDS were given recommendations for an anti-inflammatory Mediterranean diet and self-management with additional behavioral and psychosocial support. Preliminary data on feasibility based on recruitment and retention, adherence to the diet, mobile app tracking, changes to perceived well-being via health outcomes, and satisfaction with care were obtained. RESULTS Thirteen participants were enrolled within a 4-month timeframe. Eight participants completed the study. Three participants met dietary tracking requirement in at least 4 of 8 intervention weeks and met the macronutrient requirements in at least half of the weeks tracked. No decreases in VAS pain scores after 5 and 9 weeks were noted; however, 62.5% (n = 5) of participants had decreased pain at 9 weeks, compared to baseline. There were significant improvements (p<.05) in six of twelve measurements of satisfaction with care at the end of the intervention. CONCLUSION This study provides a foundation for future research on patient experience and introduces a novel treatment paradigm focused on nutrition and self-management. Trial Registration: National Institutes of Health clinicaltrials.gov; identifier: NCT04734041. IMPLICATIONS FOR REHABILITATION Lifestyle and dietary interventions are relatively safe and well tolerated in the hypermobility spectrum disorder (HSD) and Ehlers-Danlos disorder (EDS) population.Participants in our 9-week integrative medicine program actively engaged in self-management of their condition and showed promising adherence to dietary and tracking requirements.Effective treatment of the intricacies and dynamics of these highly variable and clinically heterogeneous disorders may require a network of healthcare providers, integrative healthcare, as well as behavioral and psychosocial support.Dietary tracking through mobile apps might help promote self-efficacy and adherence to dietary changes.Symptom tracking might be an effective way for patients to track changes to their health and could provide valuable information for health professionals engaged in managing the disorders.
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Affiliation(s)
- Sara E Guedry
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Blake O Langley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- School of Nursing, University of WA, Seattle, WA, USA
| | - Kerry Schaefer
- Co-investigator, Healthy Living Community Clinic, Portland, OR, USA
| | - Douglas A Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
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Schubart JR, Mills SE, Francomano CA, Stuckey-Peyrot H. A qualitative study of pain and related symptoms experienced by people with Ehlers-Danlos syndromes. Front Med (Lausanne) 2024; 10:1291189. [PMID: 38235272 PMCID: PMC10792024 DOI: 10.3389/fmed.2023.1291189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/10/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Individuals with Ehlers-Danlos syndromes (EDS) often have complex and multi-faceted symptoms across the lifespan. Pain and the related symptoms of fatigue and sleep disorders are common. The objective of this qualitative study was to understand how participants manage their pain and related symptoms. Methods The design was a qualitative thematic content analysis. Twenty-eight interviews were conducted to collect data from individuals who were participants in a prior quantitative longitudinal study. A semi-structured interview guide was designed to focus on and understand the trajectory of pain, sleep, fatigue, and general function. The interview continued with questions about coping mechanisms and obstacles to maintaining a sense of well-being. Results Symptoms reported by participants were widespread and often interwoven. Pain was universal and often resulted in fatigue and disordered sleep which impacted physical function. Most participants reported that their symptoms worsened over time. Participants reported a wide range of effective interventions and most reported developing self-care strategies to adapt to their disabilities/limitations. Solutions included complementary interventions discovered when conventional medicine was unsuccessful. Very few relied on a "system" of health care and instead developed their own strategies to adapt to their disabilities/limitations. Discussion EDS symptoms are often debilitating, and their progression is unknown. For most participants, symptoms worsened over the time. Even though participants in our study, by experience, were self-reliant, the importance of knowledgeable medical providers to help guide self-care should be emphasized.
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Affiliation(s)
- Jane R. Schubart
- Department of Surgery, Penn State College of Medicine, Hershey, PA, United States
| | - Susan E. Mills
- Department of Surgery, Penn State College of Medicine, Hershey, PA, United States
| | - Clair A. Francomano
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
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Song JZ, Luong D, Feldman ECH, Tran S, Perrier L, Eubanks K, Bayley M, Kastner M, Slepian M, Munce SEP. Psychological interventions for individuals with Ehlers-Danlos syndrome and hypermobility spectrum disorder: a scoping review. Orphanet J Rare Dis 2023; 18:254. [PMID: 37653505 PMCID: PMC10472575 DOI: 10.1186/s13023-023-02799-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/05/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE To identify the nature and extent of the evidence on psychological interventions among individuals with Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD). MATERIALS AND METHODS Eligible studies reported on psychological interventions for individuals of all ages with EDS and/or HSD. All studies published in English were included, with no restrictions to publication year or status. MEDLINE, CINAHL, EMBASE, and PsycINFO were searched. Two reviewers independently screened studies and abstracted data. RESULTS This scoping review included 10 studies reporting on EDS, HSD, or both. Only cohort studies and case studies were identified. Four studies investigated Cognitive Behavioural Therapy (CBT), one investigated Dialectical Behavioural Therapy (DBT), two investigated psychoeducation, two investigated Intensive Interdisciplinary Pain Treatment (IIPT), and one investigated Acceptance Commitment Therapy (ACT). Interventions targeted pain management, self-destructive behaviours, and related psychological issues (e.g., depression/anxiety). Sample sizes were small (n < 50) for most studies and interventions were generally poorly described. CONCLUSIONS There is a critical need for high-quality research surrounding psychological interventions for individuals with EDS/HSD. Psychological interventions for these individuals are understudied and existing studies lack validity. Researchers should investigate psychological interventions for individuals with all types of EDS/HSD with high-quality studies to validate findings from the existing studies.
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Affiliation(s)
- Jessica Z Song
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
| | - Dorothy Luong
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Estée C H Feldman
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan Tran
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Laure Perrier
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Mark Bayley
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Monika Kastner
- North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maxwell Slepian
- GoodHope Ehlers-Danlos Syndrome Clinic, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E P Munce
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Ramírez-Paesano C, Rodiera Clarens C, Sharp Segovia A, Coila Bustinza A, Rodiera Olive J, Juanola Galceran A. Perioperative opioid-minimization approach as a useful protocol in the management of patients with Ehlers-Danlos syndrome-hypermobility type, craniocervical instability and severe chronic pain who are to undergo occipito-cervical fixation. Orphanet J Rare Dis 2023; 18:214. [PMID: 37491286 PMCID: PMC10369693 DOI: 10.1186/s13023-023-02829-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
Patients suffering from connective tissue disorders like Ehlers-Danlos syndrome hypermobility type/joint hypermobility syndrome (EDS-HT/JHS) may be affected by craniocervical instability (CCI). These patients experience myalgic encephalomyelitis, chronic fatigue, depression, extreme occipital-cervical pain, and severe widespread pain that is difficult to relieve with opioids. This complex and painful condition can be explained by the development of chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization. Given the challenges in treating such severe physical pain, we evaluated all the analgesic methods previously used in the perioperative setting, and updated information was presented. It covers important physiopathological aspects for the perioperative care of patients with EDS-HT/JHS and CCI undergoing occipital-cervical/thoracic fixation/fusion. Moreover, a change of paradigm from the current opioid-based management of anesthesia/analgesia in these patients to the perioperative opioid minimization strategies used by the authors was analyzed and proposed as follow-up considerations from our previous case series. These strategies are based on total-intravenous opioid-free anesthesia, multimodal analgesia, and a postoperative combination of anti-hyperalgesic coadjuvants (lidocaine, ketamine, and dexmedetomidine) with an opioid-sparing effect.
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Affiliation(s)
- Carlos Ramírez-Paesano
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain.
| | - Claudia Rodiera Clarens
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Allan Sharp Segovia
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Alan Coila Bustinza
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Josep Rodiera Olive
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Albert Juanola Galceran
- Servei Central d'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
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Whitmore M, Barker B, Chudej K, Goines C, Kester J, Campbell H, Jeffcoat A, Castleberry B, Lowder TW. A novel method of assessing balance and postural sway in patients with hypermobile Ehlers-Danlos syndrome. Front Med (Lausanne) 2023; 10:1135473. [PMID: 37396890 PMCID: PMC10312239 DOI: 10.3389/fmed.2023.1135473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/11/2023] [Indexed: 07/04/2023] Open
Abstract
Patients with hypermobile Ehlers-Danlos syndrome (hEDS) frequently suffer from poor balance and proprioception and are at an increased risk for falls. Here we present a means of assessing a variety of balance and postural conditions in a fast and non-invasive manner. The equipment required is commercially available and requires limited personnel. Patients can be repeatedly tested to determine balance and postural differences as a result of disease progression and aging, or a reversal following balance/exercise interventions.
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12
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Carroll MB. Hypermobility spectrum disorders: A review. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2023; 4:60-68. [PMID: 37637226 PMCID: PMC10457547 DOI: 10.2478/rir-2023-0010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/21/2023] [Indexed: 08/29/2023]
Abstract
It remains a clinical challenge identifying when joint hypermobility (JH) is responsible for pain. Previous nomenclature utilized terms such as (benign) joint hypermobility syndrome (JHS) but this was updated in 2017 as advances in genetics provide a basis for nearly all variants of Ehlers-Danlos syndrome (EDS) with the exception of hypermobile EDS (hEDS). New terminology describes hypermobility spectrum disorders (HSDs) as the updated term for JHS. Diagnosis of a subtype of HSDs should be considered in patients who have JH coupled with the presence of secondary musculo-skeletal manifestations (trauma, chronic pain, disturbed proprioception, and other manifestations) and at the exclusion of hEDS. Extra-articular manifestations are common. Treatment relies on management strategies for other chronic pain syndromes with a multidisciplinary approach likely optimal. Lifestyle modifications focus on weight loss and exercise. Physical therapy helps strengthen periarticular muscles, improving mobility. Pharmacologic therapies focus on judicious use of non-steroidal anti-inflammatory drugs and acetaminophen. Serotonin and norepinephrine reuptake inhibitor may help widespread pain. Avoidance of opioids remains prudent. The purpose of this review is to provide clinicians the rationale for the update in nomenclature, understand the musculoskeletal and extra-articular manifestations of the subtypes of HSDs, considerations when making the diagnosis, and treatment.
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Affiliation(s)
- Matthew B Carroll
- Rheumatology, Singing River Health System, 3603 Bienville Blvd, Ocean Springs, MS 39564, USA
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13
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de Koning LE, Warnink-Kavelaars J, van Rossum MA, Bosman D, Menke LA, Malfait F, de Boer R, Oosterlaan J, Engelbert RHH, Rombaut L. Somatic symptoms, pain, catastrophizing and the association with disability among children with heritable connective tissue disorders. Am J Med Genet A 2023. [PMID: 37186039 DOI: 10.1002/ajmg.a.63204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 05/17/2023]
Abstract
The aim of the present study was to investigate the nature and prevalence of nonspecific somatic symptoms, pain and catastrophizing in children with Heritable Connective Tissue Disorders (HCTD), and to determine their association with disability. This observational, multicenter study included 127 children, aged 4-18 years, with Marfan syndrome (MFS) (59%), Loeys-Dietz syndrome (LDS) (8%), Ehlers-Danlos syndromes (EDS) (12%) and hypermobile Ehlers-Danlos syndrome (hEDS) (23%). The assessments included the Children's Somatization Inventory or parent proxy (CSI, PCSI), pain visual-analogue scale (VAS), SUPERKIDZ body diagram, Pain Catastrophizing Scale Child or parent proxy (PCS-C, PCS-P) and Childhood Health Assessment Questionnaire (CHAQ-30). Data from children aged ≥8 years were compared to normative data. In children ≥ 8 years (n = 90), pain was present in 59%, with a median of 4 (IQR = 3-9) pain areas. Compared to normative data, the HCTD group reported significantly higher on the CSI (p ≤ 0.001, d = 0.85), VAS pain intensity (p ≤ 0.001, d = 1.22) and CHAQ-30 (p ≤ 0.001, d = 1.16) and lower on the PCS-C (p = 0.017, d = -0.82) and PCS-P (p ≤ 0.001, d = -0.49). The intensity of nonspecific somatic symptoms and pain explained 45% of the variance in disability (r2 = 0.45 F(2,48) = 19.70, p ≤ 0.001). In children ≤ 7 years (n = 37), pain was present in 35% with a median of 5(IQR = 1-13) pain areas. The mean(SD) VAS scores for pain intensity was 1.5(2.9). Functional disability was moderately correlated to the number of pain areas (r = 0.56, p ≤ 0.001), intensity of nonspecific somatic symptoms (r = 0.63, p ≤ 0.001) and pain (r = 0.83, p ≤ 0.001). In conclusion, this study supports the need for comprehensive assessment of nonspecific somatic symptoms, pain, and disability in children with HCTD to allow tailored treatment.
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Affiliation(s)
- Lisanne E de Koning
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Marion A van Rossum
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Diederik Bosman
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Leonie A Menke
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
| | - Rosa de Boer
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Lies Rombaut
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
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14
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Ituen OA, Anieto EM, Ferguson G, Duysens J, Smits-Engelsman B. Prevalence and Demographic Distribution of Hypermobility in a Random Group of School-Aged Children in Nigeria. Healthcare (Basel) 2023; 11:healthcare11081092. [PMID: 37107926 PMCID: PMC10137997 DOI: 10.3390/healthcare11081092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/08/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of hypermobility in randomly selected healthy children, without previous trauma or disease process affecting the joints and whether other demographic variables (age, sex, BMI) had an impact on Beighton scores and range of motion (RoM) in children between 6 and 10 years of age. RESULTS 286 children were included; 27.3% of them had a Beighton score ≥7/9 and 72% would be classified hypermobile if we had used a Beighton cut-off score ≥4/9. Prevalence declined with increasing age. Girls were more often hypermobile (34%) than boys (20%) and this was mainly caused by increased RoM in the knees. Positive scores of finger items of the Beighton were more common than on the other items, leading to a high prevalence of peripheral hypermobility. Localized hypermobility was only found in the fifth MCP joint. A total of 15% of the children with normal mobility reached 20 excess degrees RoM of the left and right fifth MCP. Pain was present in 12 of the 239 children but was not linked to the level of mobility. CONCLUSION Hypermobility is the rule in this pain-free population of children with GJH.
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Affiliation(s)
| | - Ebuka Miracle Anieto
- Department of Health & Rehabilitation, University of Cape Town, Cape Town 7701, South Africa
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Gillian Ferguson
- Department of Health & Rehabilitation, University of Cape Town, Cape Town 7701, South Africa
| | - Jacques Duysens
- Motor Control Laboratory, Movement Control and Neuroplasticity Research Group, KU Leuven, 3001 Leuven, Belgium
| | - Bouwien Smits-Engelsman
- Department of Health & Rehabilitation, University of Cape Town, Cape Town 7701, South Africa
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15
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Mayo Z, Keating C. Manual Therapy and Exercise for the Management of Chronic Neck Pain With Multiple Neurovascular Comorbidities: A Case Report. Cureus 2023; 15:e36961. [PMID: 37131562 PMCID: PMC10149087 DOI: 10.7759/cureus.36961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
This case describes the clinical decision-making behind the conservative clinical management of an individual presenting with chronic neck pain with myriad neuromuscular comorbidities. The focus of this case report is to support the safe utilization of manual therapy and describe the tolerable prescription of strength and endurance exercise in a patient with numerous complications to improve self-efficacy. A 22-year-old female college student presented with a chief complaint of chronic, non-specific neck pain with comorbid Chiari malformation, migraines, upper cervical spinal fusion, Ehlers-Danlos syndrome (EDS), and postural orthostatic tachycardia syndrome (POTS) to an outpatient physical therapy clinic for evaluation and treatment. Following four sessions of physical therapy treatment, no clinically significant improvement in the individual's symptoms and daily function was achieved. Despite the lack of measurable change, the patient reported the program's value on her ability to self-manage her complex condition. The patient responded well to manual therapy, specifically thrust manipulations. In addition, both endurance and strengthening exercises were well tolerated and provided a measure of self-management that may not have been achieved before physical therapy management. This case report highlights the need for exercise and pain-modulating interventions in highly complex individuals to reduce medical intervention by advancing the patient's self-efficacy. There is a need for further research about the utility of standardized outcome measures, joint manipulations, and the addition of cervico-ocular exercises for those who present with neck pain and pertinent neuromuscular comorbidities.
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Guerrieri V, Polizzi A, Caliogna L, Brancato AM, Bassotti A, Torriani C, Jannelli E, Mosconi M, Grassi FA, Pasta G. Pain in Ehlers-Danlos Syndrome: A Non-Diagnostic Disabling Symptom? Healthcare (Basel) 2023; 11:healthcare11070936. [PMID: 37046863 PMCID: PMC10094213 DOI: 10.3390/healthcare11070936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) is a phenotypically and genetically heterogeneous group of connective tissue disorders. Currently, diagnosis of EDS is based on a series of clinical and genetic tools. On the other hand, the hypermobile form has not yet been characterized from a genetic point of view: it is considered a part of a continuous spectrum of phenotypes, ranging from isolated non syndromic joint hypermobility, through to the recently defined hypermobility spectrum disorders (HSD). The aim of this study is to characterize the pain symptom that is not considered among the diagnostic criteria but is relevant to what concerns the quality of life of patients with EDS. (2) Methods: A review of the literature was performed on two medical electronic databases (PubMed and Embase) on 20 December 2022. Study selection and data extraction were achieved independently by two authors and the following inclusion criteria were determined a priori: published in the English language and published between 2000 and 2022. (3) Results: There were fifty eligible studies obtained at the end of the search and screen process. Pain is one of the most common symptoms found in Ehlers-Danlos (ED) patients. Different causes seem to be recognized in different phases of the syndrome. (4) Conclusions: Pain is a nonspecific symptom and cannot be considered among the diagnostic criteria, but it is a negative predictive factor in the quality of life of patients with EDS. Therefore, proper evaluation and treatment is mandatory.
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Affiliation(s)
- Viviana Guerrieri
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Alberto Polizzi
- Department of Othopaedics and Traumatology, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy
| | - Laura Caliogna
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Alice Maria Brancato
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Bassotti
- Regional Center of Ehlers-Danlos Syndrome, IRCCS Ca'Granda Foundation Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Camilla Torriani
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Eugenio Jannelli
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Mario Mosconi
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Federico Alberto Grassi
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Gianluigi Pasta
- Department of Othopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy
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17
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Jeong HJ, Engel JM, Wilwert O, Muriello M, Basel D, Slavens BA. Pain Characteristics and Symptom Management in Children with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder. Phys Occup Ther Pediatr 2023; 43:630-643. [PMID: 36647261 DOI: 10.1080/01942638.2022.2163601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/04/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
AIMS This study aims to investigate pediatric hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) pain features and management strategies. METHODS This is a mixed-methods, cross-sectional study design using patient-reported outcomes in 21 children diagnosed with hEDS/HSD. Children who reported bothersome pain were interviewed for pain features. The Child Activity Limitation Interview-21, the Brief Pain Inventory pain interference items, and the Functional Disability Inventory were used to investigate pain interference. To evaluate psychological symptoms regarding pain, the pediatric version of the Survey of Pain Attitude and the child version of the Pain Catastrophizing Scale were used. RESULTS Nineteen children had bothersome pain and of them, eight children reported constant pain. The most frequently reported regions of pain were at the ankle (mild pain) and the back (moderate-to-severe pain). Children reported mild-to-moderate pain interference and believed medications were beneficial for their pain management. Nineteen children sought treatment and of those 16 children used to exercise and acetaminophen and 13 visited physicians as a means of treatment. Parents were overall satisfied with their child's treatment (13 out of 19). CONCLUSIONS Sufficient awareness of pain-related symptoms and understanding of the treatment strategies in early childhood is needed to prevent deleterious consequences in adulthood.
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Affiliation(s)
- Hyo-Jung Jeong
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, Wisconsin, USA
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Joyce M Engel
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Olivia Wilwert
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Michael Muriello
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donald Basel
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brooke A Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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18
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Higo A, Pearce G, Palmer S, Grant L. The value of dynamic elastomeric fabric orthoses in the management of a complex hypermobile Ehlers-Danlos syndrome patient: A case report. Clin Case Rep 2023; 11:e6821. [PMID: 36694653 PMCID: PMC9842784 DOI: 10.1002/ccr3.6821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 01/18/2023] Open
Abstract
The use of dynamic elastomeric fabric orthoses is examined in a young woman with hypermobile Ehlers-Danlos syndrome (hEDS) referred for physiotherapy with hip dysplasia, prior to a right periacetabular osteotomy. Dynamic elastomeric fabric orthoses plus rigorous subjective examination, therapists' listening skills, and patient-centered goals were useful for this hEDS patient.
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Affiliation(s)
- Anna Higo
- Centre for Healthcare ResearchCoventry UniversityCoventryUK,Physiocure Physiotherapy ClinicLeedsUK
| | - Gemma Pearce
- Centre for Healthcare ResearchCoventry UniversityCoventryUK
| | - Shea Palmer
- Centre for Care ExcellenceCoventry University and University Hospitals Coventry & Warwickshire NHS TrustCoventryUK
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19
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An investigation of body awareness, fatigue, physical fitness, and musculoskeletal problems in young adults with hypermobility spectrum disorder. Musculoskelet Sci Pract 2022; 62:102642. [PMID: 35973358 DOI: 10.1016/j.msksp.2022.102642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Hypermobility Spectrum Disorder (HSD) is associated with excessive joint range of motion and the presence of musculoskeletal symptoms. The objective of this study was to examine body awareness, physical fitness parameters, fatigue levels, and musculoskeletal disorders in young adults with HSD and compare them with those without HSD. METHODS Young individuals in the age range of 18-24 years were included in the study. Joint hypermobility of individuals was determined by the Beighton Score. Evaluations were made using the Body Awareness Questionnaire, the Fatigue Severity Scale, the Eurofit Physical Fitness Test Battery, and the Cornell Musculoskeletal Discomfort Questionnaire. RESULTS A total of 94 healthy individuals (74 females, 20 males, mean age 21.44 years, SD ± 1.19 years), 47 with HSD and 47 without HSD, were included in the study. It was concluded that body awareness and fatigue levels were similar in two groups (p > 0.05). When physical fitness parameters were examined, there was a significant difference between the two groups in Sit and Reach test and the dominant side grip strength (p < 0.05). There was a significant difference between the two groups in the neck, back, dominant wrist, and total musculoskeletal problems (p < 0.05). CONCLUSION It was concluded that young individuals with HSD had more flexibility, lower grip strength, more pain especially in the neck and back region, and more musculoskeletal disorders in general. Joint hypermobility is a factor to be considered in evaluating functional performance in these individuals.
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20
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Buryk-Iggers S, Mittal N, Santa Mina D, Adams SC, Englesakis M, Rachinsky M, Lopez-Hernandez L, Hussey L, McGillis L, McLean L, Laflamme C, Rozenberg D, Clarke H. Exercise and Rehabilitation in People With Ehlers-Danlos Syndrome: A Systematic Review. Arch Rehabil Res Clin Transl 2022; 4:100189. [PMID: 35756986 PMCID: PMC9214343 DOI: 10.1016/j.arrct.2022.100189] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To conduct a systematic review examining the effect of exercise and rehabilitation in people with Ehlers-Danlos syndrome (EDS). Data Sources The following databases were systematically searched: MEDLINE, MEDLINE In-Process/ePubs, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health. The final time point captured by the search is November 27, 2020. Study Selection Eligible study designs included case-control, case-series, prospective cohort, retrospective cohort, and intervention studies of structured exercise or rehabilitation interventions. Eligible populations included adults (18 years or older) with EDS (all subtypes) and hypermobility spectrum disorders. The search was restricted to articles published in English. Data Extraction Data were extracted by 2 independent reviewers. Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials (RCTs) and Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS-I) for non-RCTs. Reporting quality of RCTs was assessed using the Consolidated Standards for Reporting of Trials statement with the harms extension. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data Synthesis The search yielded 10 eligible studies including 330 participants. The study designs included 5 RCTs, 1 cohort, 2 single-arm interventions, 1 retrospective, and 1 feasibility study. All studies showed some improvement in a physical and/or psychological outcome after the intervention period. One adverse event (nonserious) potentially related to the intervention was reported. Of the 5 RCTs, 2 were rated as high quality with low risk of bias using PEDro, and the majority of non-RCTs were rated as critical risk of bias by ROBINS-I. Conclusions The results suggest that exercise and rehabilitation may be beneficial for various physical and psychological outcomes. Adequately powered and rigorous RCTs of exercise and rehabilitation interventions for people with EDS are needed.
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Key Words
- 6MWT, 6-minute walk test
- AIMS-2, Arthritis Impact Measurement Scales-2
- CONSORT, Consolidated Standards for Reporting of Trials
- EDS, Ehlers-Danlos syndrome
- Ehlers-Danlos Syndrome
- Exercise
- HADS, Hospital and Anxiety Depression Scale
- HSD, hypermobility spectrum disorders
- Joint instability
- PEDro, Physiotherapy Evidence Database
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- QOL, quality of life
- RCT, randomized control trial
- ROBINS-I, Risk Of Bias In Nonrandomized Studies of Interventions
- Rehabilitation
- SF-36, Short Form-36
- VAS, visual analog scale
- hEDS, hypermobile EDS
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Affiliation(s)
- Stephanie Buryk-Iggers
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Nimish Mittal
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Scott C. Adams
- Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services Toronto General Hospital, Toronto, Ontario, Canada
| | - Maxim Rachinsky
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Laura Lopez-Hernandez
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Laura Hussey
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Laura McGillis
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lianne McLean
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Camille Laflamme
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Dmitry Rozenberg
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Respirology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Hance Clarke
- GoodHope Ehlers Danlos Syndrome Clinic, Toronto General Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
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21
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Rattray C. Idiopathic osteoporosis, Ehlers–Danlos syndrome, postural orthostatic tachycardia syndrome, and mast cell activation disorder in a 27‐year‐old male patient: A unique case presentation. Clin Case Rep 2022; 10:e05887. [PMID: 35600027 PMCID: PMC9122800 DOI: 10.1002/ccr3.5887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
A young male patient presents with widespread pain and varying chronic inflammatory symptoms for three years and idiopathic low bone density for more than ten years. Based on the patient’s clinical history, the patient has been diagnosed with an hypermobile Ehlers–Danlos syndrome, postural orthostatic tachycardia syndrome, and mast cell activation disorder trifecta with affiliated inflammation‐induced osteoporosis.
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Affiliation(s)
- Cameron Rattray
- St. George’s University School of Medicine St. George Grenada, West Indies
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22
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Schubart JR, Mills SE, Schaefer EW, Bascom R, Francomano CA. Longitudinal analysis of symptoms in the Ehlers-Danlos syndromes. Am J Med Genet A 2022; 188:1204-1213. [PMID: 34994522 PMCID: PMC10433231 DOI: 10.1002/ajmg.a.62640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/31/2021] [Accepted: 12/11/2021] [Indexed: 11/06/2022]
Abstract
Our study extends a cross-sectional dataset on the Ehlers-Danlos syndromes (EDS) assembled by the National Institute on Aging (NIA), under a protocol entitled Clinical and Molecular Manifestations of Heritable Disorders of Connective Tissue. We were successful in contacting 171 of the original 252 participants with EDS. Our study cohort included 91 participants who completed at least one of the following surveys: Brief Pain Inventory (BPI), Pittsburgh Sleep Quality Index (PSQI), Multidimensional Fatigue Inventory (MFI-20), and Short Form (SF-36) Health Survey, at both baseline and follow-up. Follow-up surveys occurred a median of 11.6 years after the baseline survey. We used mixed effects linear regression models to examine the change in scores for multiple indices reported by participants. There were small mean changes reflected in our estimates for the EDS population as a whole. There was wide heterogeneity between reported individual experiences, with some participants markedly improved and some dramatically worse. Men had a greater increase in mean pain severity over time than women. This is the first study to report a decade of longitudinal data in EDS.
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Affiliation(s)
- Jane R Schubart
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Susan E Mills
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric W Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Rebecca Bascom
- Department of Medicine, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Clair A Francomano
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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23
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Kalisch L, Boniwell I, Osin E, Baeza-Velasco C. Feeling Good Despite EDS: The Effects of a 5-Week Online Positive Psychology Programme for Ehlers-Danlos-Syndromes Patients. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021; 52:79-87. [PMID: 34667333 PMCID: PMC8517566 DOI: 10.1007/s10879-021-09521-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 01/07/2023]
Abstract
Ehlers–Danlos-Syndromes (EDS) is a group of hereditary, chronic and potentially disabling conditions. Few studies have tested the effects of psychological interventions to increase well-being in this population. We hypothesized that Positive Psychology Interventions (PPI), first applied to healthy and mentally ill subjects, can also be useful for people with somatic conditions and conducted a study to evaluate the efficacy of a 5-week online PPI designed to improve well-being in EDS patients. A sample of 132 EDS patients were allocated to three groups: assigned PPI, self-selected PPI, and waitlist control-group (WLC). Measures of positive and negative affect, pain disability, fatigue, and life satisfaction were administered before program start, 6 weeks later, and 1 month later. Satisfaction with the program was also evaluated. The results revealed that participants in the self-selected PPI-group, but not in the assigned PPI group, reported significantly lower levels of fatigue and higher levels of positive affect and life satisfaction compared to WLC after 6 weeks. There were no effects on negative affect and pain disability measures. Finally, 77% of the participants were satisfied or very satisfied with the program. These findings confirm and extend previous research by showing the efficacy of PPI for people with chronic illness under the condition that individuals can choose the program content. From a healthcare perspective, online PPIs could complement treatments aimed at symptom reduction and increase well-being in patients with EDS.
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Affiliation(s)
| | - Ilona Boniwell
- Positran, Epone, France
- Faculty of Science and Engineering Cambridge, Anglia Ruskin University (UK), Cambridge, UK
| | - Evgeny Osin
- International Laboratory of Positive Psychology of Personality and Motivation, National Research University Higher School of Economics, Moscow, Russia
- Laboratory LINP2, University of Paris Nanterre, Nanterre, France
| | - Carolina Baeza-Velasco
- LPPS, Université de Paris, 92100 Boulogne Billancourt, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
- IGT, University of Montpellier, CNRS, INSERM, Montpellier, France
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24
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Scicluna K, Formosa MM, Farrugia R, Borg I. Hypermobile Ehlers-Danlos syndrome: A review and a critical appraisal of published genetic research to date. Clin Genet 2021; 101:20-31. [PMID: 34219226 DOI: 10.1111/cge.14026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022]
Abstract
The Ehlers-Danlos syndromes (EDS) are a collection of rare hereditary connective tissue disorders with heterogeneous phenotypes, usually diagnosed following clinical examination and confirmatory genetic testing. Diagnosis of the commonest subtype, hypermobile Ehlers-Danlos Syndrome (hEDS), relies solely on a clinical diagnosis since its molecular aetiology remains unknown. We performed an up-to-date literature search and selected 11 out of 304 publications according to a set of established criteria. Studies reporting variants affecting collagen proteins were found to be hindered by cohort misclassification and subsequent lack of reproducibility of these genetic findings. The role of the described variants affecting Tenascin-X and LZTS1 is yet to be demonstrated in the majority of hEDS cases, while the functional implication of associated signaling pathways and genes requires further elucidation. The available literature on the genetics of hEDS is scant, dispersed and conflicting due to out-dated nosology terminology. Recent literature has suggested the role of several promising candidate mechanisms which may be linked to the underlying molecular aetiology. Knowledge of the molecular genetic basis of hEDS is expected to increase in the near future through the mainstream use of high-throughput sequencing combined with the updated classification of EDS, and the upcoming Hypermobile Ehlers-Danlos Genetic Evaluation (HEDGE) study.
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Affiliation(s)
- Kirsty Scicluna
- Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Melissa M Formosa
- Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Msida, Malta.,Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Rosienne Farrugia
- Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Msida, Malta.,Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Isabella Borg
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta.,Medical Genetics Unit, Department of Pathology, Mater Dei Hospital, Msida, Malta.,Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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25
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Eseonu KC, Payne K, Ward S, Fakouri B, Panchmatia JR. Chronic Low Back Pain Occurring in Association With Hypermobility Spectrum Disorder and Ehlers-Danlos Syndrome. Int J Spine Surg 2021; 15:449-457. [PMID: 33963027 DOI: 10.14444/8067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This review paper outlines recent advances in diagnostic criteria for hypermobility spectrum disorder (HSD) and its association with Ehlers-Danlos syndrome (EDS), as well as current literature on the association between joint hypermobility syndrome and lumbar back pain. We outline the optimal multidisciplinary management of lumbar back pain in the context of joint hypermobility syndrome, as well as the indications and possible side effects of surgical management of patients with these conditions.Several studies have suggested a link between chronic low back pain and hypermobility. HSD has been described as an excessive range of motion in a joint, when accounting for patient demographics. The nomenclature surrounding symptomatic joint hypermobility has varied historically, and various groups, including most notably the international EDS consortium, have introduced new classification schemes to acknowledge the systemic effects of joint hypermobility, which were previously poorly understood. METHODS Narrative literature review. RESULTS Not applicable. CONCLUSIONS Lower back pain experienced in patients on the HSD-EDS spectrum is multifactorial in origin and should not be considered solely in anatomical terms. Caution has been advised in the surgical management of patients on the HSD-hEDS spectrum, particularly where the subtype is unclear. The vascular type of EDS has a particular propensity for severe bleeding complications. Rates of perioperative complications after lumbar spinal surgery in the hypermobile EDS population have been reported to be up to 50%. When hypermobility and chronic lumbar back pain coexist, we advocate management in a multidisciplinary setting involving physiotherapists, pain physicians, surgeons, and psychologists.
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Affiliation(s)
| | - Kathy Payne
- Guy's and St Thomas' Hospitals, London, England
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26
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Ramírez-Paesano C, Juanola Galceran A, Rodiera Clarens C, Gilete García V, Oliver Abadal B, Vilchez Cobo V, Ros Nebot B, Julián González S, Cao López L, Santaliestra Fierro J, Rodiera Olivé J. Opioid-free anesthesia for patients with joint hypermobility syndrome undergoing craneo-cervical fixation: a case-series study focused on anti-hyperalgesic approach. Orphanet J Rare Dis 2021; 16:172. [PMID: 33849631 PMCID: PMC8045305 DOI: 10.1186/s13023-021-01795-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/30/2021] [Indexed: 12/31/2022] Open
Abstract
Background Patients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition. The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation (CCF). The secondary aim was to assess the needs of opioids at hospital-discharge, incidence of gastrointestinal complications and the requirement of anxiolytic. Methods A retrospective, consecutive case series study was designed. 42 patients with EDS-HT/JHS undergoing CCF were enrolled in two groups: an OFA-plus Group that received opioid-free anesthesia with propofol, lidocaine, ketamine and dexmedetomidine, and OP Group, opioid-based anesthesia-analgesia. The main variables: Preoperative Visual Analogue Score (VAS), postoperative VAS on the 1st, 2nd, 4th and 6th days, sufentanil or morphine requirements, need for methadone rescue, and VAS at hospital-discharge. Data was presented by mean ± SD, percentage, median or interquartile range. Chi-squared or Fisher’s test. 95% C.I and P values < 0.05. Results Nineteen patients in OFA-plus, and 23 patients in OP group. VAS was lower in OFA-plus on the postoperative days evaluated (p < 0.001).VAS at hospital-discharge was lower in OFA-plus: 4.96 (4.54–5.37) vs. OP 6.39 (6.07–6.71) (p < 0.001). Methadone requirement was lower in the OFA-plus (p < 0.001). 78% of patients in OFA-plus didn’t need methadone rescue. 95% in OP group needed methadone rescues at high doses(> 15 mg/day). No differences regarding equivalent doses of sufentanil or morphine consumption on the 2nd, 4th, and 6th postoperative days were found. OFA-plus decreased ileus, nausea and vomiting (p < 0.001). 60.9% in OFA-plus group decreased opioid requirements at hospital-discharge compared with preoperative values. A 77% reduction of anxiolytics requirements was shown. Conclusion OFA-plus management for patients undergoing CCF with EDS-HT/JHS shows significant reduction in postoperative pain and at hospital-discharge compared with opioid-based anesthesia. OFA-plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation. OFA-plus management is a feasible option to improve postoperative pain control, reducing the opioids’ use and their postoperative side-effects in patients undergoing CCF with EDS-HT/JHS.
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Affiliation(s)
- Carlos Ramírez-Paesano
- Servei Central D'Anestesiología (Anestalia), Centro Médico Teknon, Carrer Vilana 12, 08022, Barcelona, Spain.
| | - Albert Juanola Galceran
- Servei Central D'Anestesiología (Anestalia), Centro Médico Teknon, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Claudia Rodiera Clarens
- Hospital Universitari Dexeus, Grupo Quironsalud, Carrer Sabino Arana, 5, 19, 08028, Barcelona, Spain
| | - Vicenҫ Gilete García
- Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | | | - Verónica Vilchez Cobo
- Postoperative Pain Management Team of Servei Central D'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Bibiana Ros Nebot
- Postoperative Pain Management Team of Servei Central D'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Sara Julián González
- Servei Central D'Anestesiología (Anestalia), Centro Médico Teknon, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Lucía Cao López
- Postoperative Pain Management Team of Servei Central D'Anestesiología (Anestalia), Centro Médico Teknon, Grupo Quironsalud, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Jesús Santaliestra Fierro
- Servei Central D'Anestesiología (Anestalia), Centro Médico Teknon, Carrer Vilana 12, 08022, Barcelona, Spain
| | - Josep Rodiera Olivé
- Servei Central D'Anestesiología (Anestalia), Centro Médico Teknon, Carrer Vilana 12, 08022, Barcelona, Spain
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27
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Ishiguro H, Yagasaki H, Horiuchi Y. Ehlers-Danlos Syndrome in the Field of Psychiatry: A Review. Front Psychiatry 2021; 12:803898. [PMID: 35087434 PMCID: PMC8787077 DOI: 10.3389/fpsyt.2021.803898] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/16/2021] [Indexed: 12/27/2022] Open
Abstract
Ehlers-Danlos syndrome (EDS) comprises a series of rare hereditary connective tissue diseases characterized by joint hypermobility, joint dislocation, and hyperextensibility of the skin, as well as cardiovascular involvement. EDS is often associated with chronic widespread physical pain, which can lead to psychological pain. Poor awareness and limited diagnosis of EDS and related symptoms result in decreased self-esteem and confusion regarding physical sensation. Furthermore, EDS imposes substantial psychological burden on patients due to exercise restriction, scars, keloids, and subcutaneous fat accumulation on the extremities, which leads to parental overprotection and bullying experiences from other children at school age. Recent large-scale studies have suggested that patients with EDS have a higher risk of mood disorders than the general population. Other cohort studies indicated high prevalence of anorexia nervosa, addiction, obsessive compulsive disorder, and anxiety disorder were found in patients with EDS. Case reports instead indicated that some psychiatric disorders were secondary symptoms due to physical problems from EDS. Therefore, psychiatrists must be more knowledgeable and proactive about EDS in their practice. We review the previous case reports and literature for patients with EDS, along with our own case of complicated psychiatric problems, which are strongly related to early stressful situations through childhood and adolescence. This is to aid general psychiatrists in the discussion of appropriate medical management in such infrequent, yet challenging conditions.
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Affiliation(s)
- Hiroki Ishiguro
- Center of Genetic Medicine, Hospital, University of Yamanashi, Kofu, Japan.,Cancer Counseling and Support Center, Hospital, University of Yamanashi, Kofu, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, University of Yamanashi, Kofu, Japan
| | - Hideaki Yagasaki
- Center of Genetic Medicine, Hospital, University of Yamanashi, Kofu, Japan
| | - Yasue Horiuchi
- Center of Genetic Medicine, Hospital, University of Yamanashi, Kofu, Japan.,Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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28
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Spanhove V, Calders P, Berckmans K, Palmans T, Malfait F, Cools A, De Wandele I. Electromyographic muscle activity and three-dimensional scapular kinematics in patients with multidirectional shoulder instability. Arthritis Care Res (Hoboken) 2020; 74:833-840. [PMID: 33253470 DOI: 10.1002/acr.24525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate differences in EMG muscle activity and scapular kinematics during elevation in the scapular plane between healthy controls, participants with multidirectional shoulder laxity (MDL), and patients with multidirectional shoulder instability (MDI) who are diagnosed with hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD). METHODS Twenty-seven women with hEDS/HSD and MDI, 27 female healthy control subjects, and 28 female subjects with MDL participated in this study. Scapular 3D kinematic data were obtained using 8 Oqus Qualisys cameras. Simultaneously, surface electromyography (EMG) was used to measure muscle activity of the upper, middle, and lower trapezius, infraspinatus, latissimus dorsi, serratus anterior, posterior deltoid, and pectoralis major during arm elevation in the scapular plane. Group differences were assessed using statistical parametric mapping. RESULTS Regarding scapular kinematics, significantly less upward rotation was observed in hEDS/HSD patients with MDI compared to both healthy controls and MDL subjects. Significantly less posterior tilt was seen in hEDS/HSD patients compared to MDL subjects. Furthermore, significantly higher EMG activity of the infraspinatus, middle trapezius, and posterior deltoid was found in hEDS/HSD patients with MDI. CONCLUSION hEDS/HSD patients with MDI demonstrate altered scapular kinematics and increased EMG muscle activity compared to subjects without MDI. These findings could serve as stepping stone for future research regarding treatment strategies in patients belonging to the hypermobility spectrum.
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Affiliation(s)
- Valentien Spanhove
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Kelly Berckmans
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Tanneke Palmans
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Fransiska Malfait
- Center for Medical Genetics, Department for Biomolecular Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Ann Cools
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Inge De Wandele
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Center for Medical Genetics, Department for Biomolecular Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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29
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Nikolenko VN, Oganesyan MV, Vovkogon AD, Cao Y, Churganova AA, Zolotareva MA, Achkasov EE, Sankova MV, Rizaeva NA, Sinelnikov MY. Morphological signs of connective tissue dysplasia as predictors of frequent post-exercise musculoskeletal disorders. BMC Musculoskelet Disord 2020; 21:660. [PMID: 33032568 PMCID: PMC7545870 DOI: 10.1186/s12891-020-03698-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/01/2020] [Indexed: 12/01/2022] Open
Abstract
Background Connective tissue dysplasia (CTD) is a risk factor for musculoskeletal disorders. Changes caused by disorganization of collagen and elastin fibers lead to the inability of withstanding heavy mechanical stress. In clinical practice, diagnosis of these disorders depends on physical and anthropomorphic evaluation. Methods Forty-eight patients with frequent post-exercise musculoskeletal disorders were evaluated for CTD. The control group included 36 healthy participants. Both groups were evaluated via therapeutic examination with assessment of anthropometric indicators and physical-physiological evaluation, surveying and gathering of anamnesis. Based on testing results, study participants were evaluated on CTD presence and risk factors. Results All experimental group patients had connective tissue dysplasia of moderate and severe degree, with a total score of 49.44 ± 13.1. Certain morphological characteristics showed prevalence, allowing to determine pathognomonic predictors of high predisposition to frequent post-exercise musculoskeletal disorders. Back pain (100%), asthenic syndrome and kyphotic spinal deformation (75%), high gothic palate, hypermobility of joints and the auricles, excessive elasticity (63%), varicose veins of the lower extremities (56%) and hemorrhoids (56%), changes in the shape of the legs and temporomandibular joint (50%) showed to be significant clinical factors indicating possible connective tissue dysplasia. Conclusions The presence of these diagnostically significant morphological signs of CTD in humans is a pathognomonic predictor of a high predisposition to frequent injuries. Their early detection helps promote proper appointment of adequate physical activity regimen and develop treatment for the underlying cause.
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Affiliation(s)
- V N Nikolenko
- First Moscow State Medical University named after I.M.Sechenov (Sechenov University), st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia.,Lomonosov Moscow State University, Leninskie Gory, 1, 119991, Moscow, Russia
| | - M V Oganesyan
- First Moscow State Medical University named after I.M.Sechenov (Sechenov University), st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia
| | - A D Vovkogon
- First Moscow State Medical University named after I.M.Sechenov (Sechenov University), st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia.,European Osteopathic Clinical Center of the Moscow branch of the "Medical Academy of Osteopathic Education", Gavanskaya St., 4, block 2, 199106, St. Petersburg, Russia
| | - Yu Cao
- First Moscow State Medical University named after I.M.Sechenov (Sechenov University), st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia
| | - A A Churganova
- First Moscow State Medical University named after I.M.Sechenov (Sechenov University), st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia
| | - M A Zolotareva
- First Moscow State Medical University named after I.M.Sechenov (Sechenov University), st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia
| | - E E Achkasov
- First Moscow State Medical University named after I.M.Sechenov (Sechenov University), st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia
| | - M V Sankova
- First Moscow State Medical University named after I.M.Sechenov (Sechenov University), st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia
| | - N A Rizaeva
- First Moscow State Medical University named after I.M.Sechenov (Sechenov University), st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia
| | - M Y Sinelnikov
- Institute for Regenerative Medicine, Sechenov University, st. Trubetskaya, 8, bld. 2, 119991, Moscow, Russia.
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30
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Feldman ECH, Hivick DP, Slepian PM, Tran ST, Chopra P, Greenley RN. Pain Symptomatology and Management in Pediatric Ehlers-Danlos Syndrome: A Review. CHILDREN-BASEL 2020; 7:children7090146. [PMID: 32967103 PMCID: PMC7552757 DOI: 10.3390/children7090146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
Ehlers-Danlos syndromes (EDS) are a group of connective tissue disorders that manifest with hyperextensibility of joints and skin, and general tissue fragility. While not a major criterion for clinical diagnosis, pain is a frequently endorsed symptom across subtypes of EDS. As such, the present review aims to summarize research to date on pain characteristics and management, and the relationship between such pain symptomatology and quality of life in pediatric EDS. Characteristics of pain, including theorized etiology, relative intensity and extent of pain are described, as well as descriptions of frequently endorsed pain sites (musculoskeletal, and non-musculoskeletal). Interventions related to the management of musculoskeletal (e.g., pharmaceutical intervention, physical therapy) and non-musculoskeletal pain (e.g., pharmaceutical and psychological interventions) are discussed, highlighting the need for additional research related to pediatric pain management in the context of hypermobility syndromes. In addition, the relationship between pain in pediatric EDS and quality of life is described. Finally, limitations of literature to date are described and recommendations for future lines of research are outlined.
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Affiliation(s)
- Estée C. H. Feldman
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
- Correspondence:
| | - Daniel P. Hivick
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| | - P. Maxwell Slepian
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Susan T. Tran
- Department of Psychology, DePaul University, Chicago, IL 60614, USA;
| | - Pradeep Chopra
- Alpert Medical School, Brown University, Providence, RI 02903, USA;
| | - Rachel Neff Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
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31
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van Meulenbroek T, Huijnen IPJ, Simons LE, Conijn AEA, Engelbert RHH, Verbunt JA. Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain. Scand J Pain 2020; 21:22-31. [PMID: 32862151 DOI: 10.1515/sjpain-2020-0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/12/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES A significant proportion of adolescents with chronic musculoskeletal pain (CMP) experience difficulties in physical functioning, mood and social functioning, contributing to diminished quality of life. Generalized joint hypermobility (GJH) is a risk factor for developing CMP with a striking 35-48% of patients with CMP reporting GJH. In case GJH occurs with one or more musculoskeletal manifestations such as chronic pain, trauma, disturbed proprioception and joint instability, it is referred to as generalized hypermobility spectrum disorder (G-HSD). Similar characteristics have been reported in children and adolescents with the hypermobile Ehlers-Danlos Syndrome (hEDS). In the management of CMP, a biopsychosocial approach is recommended as several studies have confirmed the impact of psychosocial factors in the development and maintenance of CMP. The fear-avoidance model (FAM) is a cognitive-behavioural framework that describes the role of pain-related fear as a determinant of CMP-related disability. CONTENT Pubmed was used to identify existing relevant literature focussing on chronic musculoskeletal pain, generalized joint hypermobility, pain-related fear and disability. Relevant articles were cross-referenced to identify articles possibly missed during the primary screening. In this paper the current state of scientific evidence is presented for each individual component of the FAM in hypermobile adolescents with and without CMP. Based on this overview, the FAM is proposed explaining a possible underlying mechanism in the relations between GJH, pain-related fear and disability. SUMMARY AND OUTLOOK It is assumed that GJH seems to make you more vulnerable for injury and experiencing more frequent musculoskeletal pain. But in addition, a vulnerability for heightened pain-related fear is proposed as an underlying mechanism explaining the relationship between GJH and disability. Further scientific confirmation of this applied FAM is warranted to further unravel the underlying mechanism.In explaining disability in individuals with G-HSD/hEDS, it is important to focus on both the physical components related to joint hypermobility, in tandem with the psychological components such as pain-related fear, catastrophizing thoughts and generalized anxiety.
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Affiliation(s)
- Thijs van Meulenbroek
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
| | - Ivan P J Huijnen
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
| | - Laura E Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Arnoud E A Conijn
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Pediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; and ACHIEVE, Centre for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam,The Netherlands
| | - Jeanine A Verbunt
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
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32
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Abstract
Ehlers-Danlos syndrome (EDS) is a multifaceted debilitating disease. Affected patients are at risk for complications such as joint hypermobility and cardiac disease, but the prevalence, course, and management of these conditions are not well understood. The objective of this retrospective cohort study was to investigate the demographic characteristics and systemic manifestations in EDS. We performed a retrospective analysis of 98 EDS patients seen in a physical medicine and rehabilitation clinic between January 2015 and April 2019. Charts were reviewed for demographic information, subtype of EDS, characteristics of musculoskeletal pain, and presence of certain systemic comorbid diagnoses: autonomic dysfunction, headaches/migraines, gastrointestinal conditions, cardiovascular anomalies, mast cell activation syndrome, and temporomandibular joint dysfunction. Of 98 patients, 75 were diagnosed with EDS-hypermobile type (EDS-HT); 94 patients were women, and the mean age was 36.7 years. On average, each patient reported involvement of 5.4 joints, with the shoulder, knee, and lumbar spine as the most common. The average number of comorbid systemic conditions was 2.8, of which autonomic dysfunction was the most common. This study aims to provide a better understanding of this disease to promote earlier and more accurate diagnoses to guide treatment and prevent complications.
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Affiliation(s)
- Bo Song
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Peter Yeh
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - John Harrell
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
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Javadi Parvaneh V, Modaress S, Zahed G, Rahmani K, Shiari R. Prevalence of generalized joint hypermobility in children with anxiety disorders. BMC Musculoskelet Disord 2020; 21:337. [PMID: 32487116 PMCID: PMC7265217 DOI: 10.1186/s12891-020-03377-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background Concerning the high prevalence of anxiety disorders and joint hypermobility in children and the lack of related studies in this age group, we aimed to assess the association of hypermobility with anxiety disorders in children. Methods In this case-control study, 93 children ages 8–15 years with anxiety disorders referring to the Child and Adolescent Psychiatry Clinic of Mofid Children’s Hospital, Tehran, Iran, during 2018, were enrolled. The control group consisted of 100 age and sex-matched children without anxiety disorders. Anxiety was evaluated using the Spence Children Anxiety Scale (SCAS). The diagnosis of generalized joint hypermobility was done based on Beighton and Shiari-Javadi criteria. Results Based on Beighton’s diagnostic criteria 52.7% of the children in the case group and 16% of the children in the control group had generalized joint hypermobility. Moreover, based on Shiari-Javadi criteria, 49.5 and 13% of the children in the case and control groups had generalized joint hypermobility, respectively. Moreover, the internal correlation between the two criteria was 0.91 showing almost complete compatibility between the two (P < 0.001). Age was a risk factor that could predict hypermobility in these children. Other variables such as sex, severity, and type of anxiety disorders, and ADHD, were not predictors of hypermobility syndrome. Conclusion The prevalence of hypermobility was three times higher in children with anxiety disorders and only age was a predictor for the possibility to suffer from generalized joint hypermobility in these children.
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Affiliation(s)
- Vadood Javadi Parvaneh
- Department of pediatric rheumatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadialsadat Modaress
- Department of pediatric rheumatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Zahed
- Child and Adolescent Psychiatry department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Shariati Ave, Hosseinieh Ershad, Tehran, Iran.
| | - Khosro Rahmani
- Department of pediatric rheumatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shiari
- Department of pediatric rheumatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Schubart JR, Schaefer E, Hakim AJ, Francomano CA, Bascom R. Use of Cluster Analysis to Delineate Symptom Profiles in an Ehlers-Danlos Syndrome Patient Population. J Pain Symptom Manage 2019; 58:427-436. [PMID: 31153935 PMCID: PMC6708773 DOI: 10.1016/j.jpainsymman.2019.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 02/04/2023]
Abstract
CONTEXT The Ehlers-Danlos Syndromes (EDSs) are a set of rare heritable disorders of connective tissue, characterized by defects in the structure and synthesis of extracellular matrix elements that lead to a myriad of problems including joint hypermobility and skin abnormalities. Because EDS affects multiple organ systems, defining clear boundaries and recognizing overlapping clinical features shared by disease phenotypes is challenging. OBJECTIVES The objective of this study was to seek evidence of phenotypic subgroups of patients with distinctive symptom profiles and describe these resulting subgroups. METHODS Data were extracted from a repository assembled 2001-2013 by the National Institute on Aging Intramural Research Program. Agglomerative hierarchical clustering was used to form distinct subgroups of patients with respect to the domains of pain, physical and mental fatigue, daytime sleepiness, and nighttime sleep. Domains were selected based on literature review, clinician expertise, and guidance from patient advisors. RESULTS One hundred seventy-five patients met all inclusion criteria. Three subgroups were identified. The Pain Dominant subgroup (39 patients) had the highest mean pain values, but lowest mean values of other symptoms. The High Symptom Burden subgroup (71 patients) had high mean values in all domains. The Mental Fatigue subgroup (65 patients) had a high mean value for mental fatigue and daytime sleepiness, but a lower mean value for pain. CONCLUSION The subgroups aligned with clinical observation of the heterogeneous nature of EDS, with overlapping symptoms between subtypes and a wide divergence in degree of symptoms within subtypes. This exploratory study helps characterize the various phenotypes and comorbidities of patients with EDS.
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Affiliation(s)
- Jane R Schubart
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Alan J Hakim
- The Wellington Hospital, Platinum Medical Centre, London, UK
| | - Clair A Francomano
- Ehlers-Danlos Society Center for Clinical Care and Research, Greater Baltimore Medical Center, Baltimore, Maryland, USA
| | - Rebecca Bascom
- Department of Medicine, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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To M, Strutton PH, Alexander CM. Central fatigue is greater than peripheral fatigue in people with joint hypermobility syndrome. J Electromyogr Kinesiol 2019; 48:197-204. [PMID: 31442925 DOI: 10.1016/j.jelekin.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 07/08/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE People with Joint Hypermobility Syndrome (JHS) suffer with fatigue. The purpose of this project was to investigate the contribution of central and peripheral fatigue. METHODS Electrical stimulation of the musculocutaneous nerve to biceps brachii, and transcranial magnetic stimulation over the motor cortex supplying biceps brachii were used. Peripheral and central fatigue were assessed during a control, fatiguing and recovery phase protocol. RESULTS JHS participants perceived greater fatigue during the protocol compared to a control group and did not recover. Central and peripheral fatigue did not occur in the control group. However, the JHS group showed central fatigue. MEP amplitude increased in the JHS group during the fatiguing protocol (p < 0.01) before recovering. Superimposed twitch amplitude increased in the JHS group during the fatiguing protocol and stayed elevated during the recovery phase (p < 0.04). Time to peak (TTP) amplitude of the torque generated by the TMS was longer in the JHS group (p < 0.05). RMS during MVCs decreased during the fatiguing protocol reaching significance during the recovery phase (p < 0.01). CONCLUSION JHS participants suffered central but not peripheral fatigue. A modified strength programme to target this is discussed.
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Affiliation(s)
- May To
- Physiotherapy Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Paul H Strutton
- Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK
| | - Caroline M Alexander
- Physiotherapy Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK; Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK.
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36
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Martin A. An acquired or heritable connective tissue disorder? A review of hypermobile Ehlers Danlos Syndrome. Eur J Med Genet 2019; 62:103672. [PMID: 31102747 DOI: 10.1016/j.ejmg.2019.103672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/27/2019] [Accepted: 05/12/2019] [Indexed: 12/13/2022]
Abstract
Hypermobile Ehlers Danlos Syndrome (hEDS) is a multifaceted disorder that is difficult to diagnose and manage primarily due to the unknown causes. Research on hEDS continues to evolve but tangible progress will be realized when the growing body of evidence compliments clinical practice. This critical review of the literature aims to stimulate lateral thinking about the pathogenesis, diagnosis and management of hEDS. The current international classification of Ehlers Danlos Syndrome introduced stricter diagnostic criteria for hEDS, which bore a blanket category (hypermobility spectrum disorders) for conditions presenting with symptomatic joint hypermobility, but do not match the hEDS diagnostic criteria. One would argue hEDS is another all-encompassing classification for heritable connective tissue disorders and or acquired musculoskeletal conditions without a definitive molecular basis. As scientific research progresses to accommodate validated and or annulled hypotheses, the plethora of unknowns in hEDS continue to challenge healthcare outcomes and care experiences.
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Affiliation(s)
- Anne Martin
- England Centre for Practice Development, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, North Holmes Road, CT1 1QU, UK.
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Kalisch L, Hamonet C, Bourdon C, Montalescot L, de Cazotte C, Baeza-Velasco C. Predictors of pain and mobility disability in the hypermobile Ehlers-Danlos syndrome. Disabil Rehabil 2019; 42:3679-3686. [PMID: 31060411 DOI: 10.1080/09638288.2019.1608595] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: Among the Ehlers-Danlos syndromes, the hypermobile subtype (hEDS) is the most common. The variety, accumulation and duration of the painful symptoms make hEDS a chronic and highly disabling condition. Identifying drivers of pain and mobility disability in hEDS is necessary to provide adapted prevention and intervention programs.Methods: A cross-sectional sample of 75 adults with hEDS according to Villefranche criteria (67 women; 36 years, SD = 11.2) responded to self-assessment questionnaires regarding psychological (negative thoughts and emotions), health (pain, fatigue, diagnostic delay, body mass index, and mobility disability) and socio-demographic variables.Results: Forty-three percent of the participants suffer from severe pain, and two thirds suffer from a high level of mobility disability. Multivariate analyses show that delay of diagnosis, being professionally active and thoughts of helplessness are variables that increase the likelihood of severe pain, whereas age, fatigue, and body mass index predict mobility disability.Conclusion: These results confirm previous research concerning the high disease burden observed in hEDS patients, and highlight the importance of multidisciplinary management that includes nutritional and psychological advice to address this pathology. Increasing awareness of the clinical aspects of hEDS among physicians is necessary to reduce diagnostic delay and minimize negatives outcomes.Implications for RehabilitationA high proportion of patients with hypermobile Ehlers-Danlos syndrome suffer from severe pain (>42%) and a high level of mobility disability (>65%).Different psychosocial and health variables predict pain and mobility disability in patients with hypermobile Ehlers-Danlos syndrome.Awareness concerning the clinical picture of hypermobile Ehlers-Danlos syndrome among health care professionals is necessary to reduce diagnosis delay and the burden of the disease.
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Affiliation(s)
- Larissa Kalisch
- Department of Psychology, Anglia Ruskin University, Cambridge, UK
| | - Claude Hamonet
- Faculty of Medecine, University Paris-Est Créteil, Créteil, France
| | | | - Lucile Montalescot
- Laboratory of Psychopathology and Health Processes (EA 4057), University Paris Descartes-Sorbonne Paris Cité, Boulogne-Billancourt, France
| | - Cécile de Cazotte
- Laboratory of Psychopathology and Health Processes (EA 4057), University Paris Descartes-Sorbonne Paris Cité, Boulogne-Billancourt, France
| | - Carolina Baeza-Velasco
- Laboratory of Psychopathology and Health Processes (EA 4057), University Paris Descartes-Sorbonne Paris Cité, Boulogne-Billancourt, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
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38
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Zhang W, Windsor K, Jones R, Taunton DO. Hypermobile type Ehlers-Danlos syndrome associated with hypogammaglobulinemia and fibromyalgia: A case-based review on new classification, diagnosis, and multidisciplinary management. Clin Case Rep 2019; 7:680-685. [PMID: 30997063 PMCID: PMC6452458 DOI: 10.1002/ccr3.2070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 11/23/2018] [Accepted: 02/03/2019] [Indexed: 12/21/2022] Open
Abstract
Hypermobile type Ehlers-Danlos syndrome (hEDS) is an underdiagnosed connective tissue disorder characterized by generalized joint hypermobility, chronic fatigue, widespread joints pain, and impaired quality of life. Here, we reported the first hEDS complicated by hypogammaglobulinemia. New insights into classification, diagnosis, and proper management of hEDS are also reviewed.
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Affiliation(s)
- Wei Zhang
- Internal Medicine Residency ProgramBrookwood Baptist HealthBirminghamAlabama
| | - Kevin Windsor
- Alabama Oncology at Grandview Medical CenterBirminghamAlabama
| | - Richard Jones
- Internal Medicine Residency ProgramBrookwood Baptist HealthBirminghamAlabama
- Clinic for Rheumatic DiseasesTuscaloosaAlabama
| | - David Oscar Taunton
- Internal Medicine Residency ProgramBrookwood Baptist HealthBirminghamAlabama
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Leoni C, Triumbari EKA, Vollono C, Onesimo R, Podagrosi M, Giorgio V, Kuczynska E, Veltri S, Tartaglia M, Zampino G. Pain in individuals with RASopathies: Prevalence and clinical characterization in a sample of 80 affected patients. Am J Med Genet A 2019; 179:940-947. [DOI: 10.1002/ajmg.a.61111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 01/08/2019] [Accepted: 02/19/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Chiara Leoni
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Elizabeth Katherine Anna Triumbari
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Catello Vollono
- Department of Geriatrics, Unit of Neurophysiopathology and Sleep Medicine, Neurosciences and OrthopedicsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Roberta Onesimo
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Maria Podagrosi
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Valentina Giorgio
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Eliza Kuczynska
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Stefania Veltri
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
- Department of Neuroscience, Unit of NeuropsychiatryOspedale Pediatrico Bambino Gesù Rome Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research DivisionOspedale Pediatrico Bambino Gesù Rome Italy
| | - Giuseppe Zampino
- Department of Woman and Child Health, Center for Rare Diseases and Birth Defects, Institute of PediatricsFondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
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Fragkos KC, Keetarut K, Cox A, Eady J, Emmanuel AV, Zarate-Lopez N. Joint Hypermobility Syndrome Affects Response to a Low Fermentable Oligosaccharide, Disaccharide, Monosaccharide and Polyol Diet in Irritable Bowel Syndrome Patients: A Retrospective Study. Gastroenterology Res 2019; 12:27-36. [PMID: 30834032 PMCID: PMC6396789 DOI: 10.14740/gr1133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet causes significant clinical improvement in patients with irritable bowel syndrome (IBS). Joint hypermobility syndrome (JHS), defined as musculoskeletal symptoms in a hypermobile individual in the absence of systemic rheumatological disease, may be associated with functional gastrointestinal symptoms, including IBS. The aim of this study is to examine whether JHS can affect the response to the low FODMAP diet in patients with IBS. METHODS In this retrospective study, we included patients with IBS according to Rome III criteria who had followed a low FODMAP diet. Symptoms scores were measured before and after the low FODMAP diet. RESULTS A total of 165 patients (130 females, age 44 ± 14 years) were included. Diarrhea predominant IBS (IBS-D) was present in 40.6% of our patients while JHS was present in 21.2%. The score for abdominal pain was higher for JHS compared to non-JHS prior to intervention (P = 0.011). Symptoms improved in both groups of patients after a low FODMAP diet (P < 0.0001). The largest effects were shown with significant decreases of the average score and bloating. When broken down by JHS and IBS type, a low FODMAP diet significantly improved pain, bloating, diarrhea, constipation, and the average score with the largest effect in JHS/constipation predominant IBS (IBS-C), JHS/mixed IBS and unclassified IBS (IBS-M), JHS/IBS-D, non-JHS/IBS-C and JHS/IBS-M, respectively. CONCLUSIONS Our study suggests that a low FODMAP diet has a greater effect on IBS symptoms in JHS than non-JHS patients.
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Affiliation(s)
- Konstantinos C. Fragkos
- GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Katie Keetarut
- Dietetics Department, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Anna Cox
- GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Johanna Eady
- Dietetics Department, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Anton V. Emmanuel
- GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Natalia Zarate-Lopez
- GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
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Schubart JR, Schilling A, Schaefer E, Bascom R, Francomano C. Use of prescription opioid and other drugs among a cohort of persons with Ehlers-Danlos syndrome: A retrospective study. Am J Med Genet A 2019; 179:397-403. [PMID: 30624009 DOI: 10.1002/ajmg.a.61031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/18/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023]
Abstract
Against the backdrop of increased opioid prescribing in the United States and the associated high rate of side effects, dependence, and addiction, our study examined how opioids and other medications are being used among persons with Ehlers-Danlos syndrome (EDS). EDS is a set of heritable connective tissue disorders with high symptom burden, including chronic pain. Prescription medication use among persons with EDS was compared to a cohort of matched controls using 10 years of administrative claims data from a large database of privately insured patients (2005-2014). Our dataset included 4,294 persons with EDS, ages 5-62 years old. In both adults and children, we found that the percentage of persons with a prescription drug claim was higher in the EDS cohort for all prescription drug classes examined. Among children, opioid use was double in the EDS cohort compared to the control group (27.5% vs. 13.5%); in adults, it was nearly double in EDS patients (62% vs. 34.1%). Among persons who were prescribed opioids, those with EDS had higher cumulative dosages over a 2-year time period versus controls. Our study aids in understanding opioid and prescription drug use patterns in a vulnerable population with high symptom burden and chronic pain that is often severe.
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Affiliation(s)
- Jane R Schubart
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.,Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Amber Schilling
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Eric Schaefer
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Rebecca Bascom
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.,Department of Medicine, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Clair Francomano
- Ehlers-Danlos Society Center for Clinical Care and Research, Greater Baltimore Medical Center, Baltimore, Maryland
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42
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Zhou Z, Rewari A, Shanthanna H. Management of chronic pain in Ehlers-Danlos syndrome: Two case reports and a review of literature. Medicine (Baltimore) 2018; 97:e13115. [PMID: 30407326 PMCID: PMC6250522 DOI: 10.1097/md.0000000000013115] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Ehlers-Danlos syndromes (EDSs) are a heterogeneous group of heritable connective tissue disorders involving defective collagen synthesis. Patients with EDS are prone for chronic myofascial pain, apart from other comorbidities. Although the initial pathology is commonly nociceptive, progression of EDS leads to neuropathies and central sensitization of pain signals. Overall, approximately 90% or more EDS patients suffer from chronic pain. There are no existing guidelines to manage chronic pain in EDS patients. In this article, we illustrate 2 case reports of EDS patients with chronic pain and review the relevant literature regarding the pathological considerations and management of chronic pain in EDS. PATIENT CONCERNS Our first patient had worsening multiple joint pains despite treatment with medications and a recent diagnosis of EDS-type 3. The second patient had a complicated history including longstanding EDS and multiple previous surgeries. She was referred due to concern about complex regional pain syndrome (CRPS) in her upper extremity. DIAGNOSES For the first patient, apart from chronic pain due to her EDS, her history also revealed that she suffered from kinesiophobia. For the second patient, a detailed clinical assessment revealed no signs of CRPS but instead a generalized worsening of EDS symptoms. INTERVENTIONS Both patients were evaluated by the multidisciplinary team consisting of a pain physician, nurse, pain psychologist, and a kinesiologist. Their treatment involved optimization of daily medications, participation in pain self-management sessions that included cognitive behavioral therapy, graded exercises, coping, and relaxation strategies. OUTCOMES Both patients demonstrated significantly better pain control and achieved overall improvement in daily living. LESSONS EDS is a complex illness with a multitude of symptoms. As in our patients, EDS patients also suffer from panic and anxiety disorders that increase the burden of pain. Apart from optimization of medications, EDS patients are best managed by a multidisciplinary approach that includes pain education and life style changes. The caution that they are resistant to local anesthetics is unwarranted. Appropriate pain interventions in selected patients may have a role to decrease pain intensity.
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Affiliation(s)
| | | | - Harsha Shanthanna
- Department of Anesthesia, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada
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43
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Wardeh A, Jackson T, Nelson B, Ernst C, Théroux J, Al‐Hertani W, Sobering AK, Maj MC. Identification of a de novo case of COL5A1-related Ehlers-Danlos syndrome in an infant in the West Indies leading to improved targeted clinical care. Clin Case Rep 2018; 6:2256-2261. [PMID: 30455932 PMCID: PMC6230631 DOI: 10.1002/ccr3.1873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 01/08/2023] Open
Abstract
A 1-year-old girl from an underserved community presented with irritability, pain, and delayed motor skills. Our genetics outreach program facilitated the diagnosis of Ehlers-Danlos syndrome masquerading as developmental delay after noting hyperextensible skin. Diagnosis for this family allows for state-of-the-art cardiac monitoring and appropriate symptomatic treatment for this rare disease.
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Affiliation(s)
- Amr Wardeh
- Department of BiochemistrySt. George’s UniversitySt. George’sGrenada
| | - Tyson Jackson
- Department of BiochemistrySt. George’s UniversitySt. George’sGrenada
| | - Beverly Nelson
- Pediatrics WardGrenada General HospitalSt. George'sGrenada
| | - Carl Ernst
- Department of PsychiatryMcGill UniversityMontrealQuébecCanada
| | | | - Walla Al‐Hertani
- Department of Medical Genetics, Cummings School of MedicineUniversity of Calgary, Alberta Children's HospitalCalgaryAlbertaCanada
| | | | - Mary C. Maj
- Department of BiochemistrySt. George’s UniversitySt. George’sGrenada
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Fitzcharles MA, Perrot S, Häuser W. Comorbid fibromyalgia: A qualitative review of prevalence and importance. Eur J Pain 2018; 22:1565-1576. [PMID: 29802812 DOI: 10.1002/ejp.1252] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2018] [Indexed: 12/11/2022]
Abstract
Fibromyalgia (FM) may be an unrecognized cause of suffering for persons with an array of medical conditions. This is especially true for illness that is characterized by pain of any nature. Once believed to be a unique diagnosis, FM is recently reported to occur concomitantly with various rheumatic diseases, and importantly adversely impacts global health status. However, there is increasing report of FM associated with other diseases that are not defined by chronic pain. This qualitative review examines the evidence for comorbid FM in illness, and where available the effect of FM on the primary disease. Other than for musculoskeletal disorders, the published literature reporting an association of FM with illness is limited with scanty reports for some neurological, gastrointestinal, mental health and other overlapping pain conditions. Comorbid FM adversely affects both health status and outcome for rheumatic diseases, but with limited study in other diseases. When unrecognized, comorbid FM may be mistaken as poor control of the primary disease, leading to incorrect treatment decisions. FM may be a neglected condition that pervades many conditions and may contribute to the burden of illness. Physicians should be alert to the possibility of comorbid FM, and symptoms of FM should be specifically addressed. SIGNIFICANCE Comorbid fibromyalgia (FM) in other medical conditions is largely unrecognized. When reported as accompanying rheumatic diseases, FM adversely affects global health status. With limited reports of comorbid FM with other conditions, neglect to diagnose comorbid FM may misdirect treatments.
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Affiliation(s)
- M-A Fitzcharles
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - S Perrot
- Pain Center, Cochin Hospital, Paris Descartes University, France
| | - W Häuser
- Department Internal Medicine I, Klinikum Saarbrücken, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Germany
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Baeza-Velasco C, Bulbena A, Polanco-Carrasco R, Jaussaud R. Cognitive, emotional, and behavioral considerations for chronic pain management in the Ehlers–Danlos syndrome hypermobility-type: a narrative review. Disabil Rehabil 2018; 41:1110-1118. [DOI: 10.1080/09638288.2017.1419294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Carolina Baeza-Velasco
- Laboratory of Psychopathology and Health Processes, University Paris Descartes - Sorbonne Paris Cité, Boulogne Billancourt, France
- Inserm U1061, La Colombière Hospital, Montpellier, France
| | - Antonio Bulbena
- Department of Psychiatry, Autonoma University of Barcelona, Barcelona, Spain
| | | | - Roland Jaussaud
- Department of Internal Medicine and Clinical Immunology, Medicine School, University of Lorraine, CHRU Nancy, Nancy, France
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Pennetti A. A multimodal physical therapy approach utilizing the Maitland concept in the management of a patient with cervical and lumbar radiculitis and Ehlers-Danlos syndrome-hypermobility type: A case report. Physiother Theory Pract 2018; 34:559-568. [PMID: 29308941 DOI: 10.1080/09593985.2017.1422207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The purpose of this case report is to present a multimodal approach for patient management using the Maitland concept framework for cervical and lumbar radiculitis with an underlying diagnosis of Ehlers-Danlos Syndrome-Hypermobility Type (EDS-HT). This case presents care guided by evidence, patient values, and rationale for the selected course of physical therapy treatment provided by therapist experience. A 35-year-old female with a 2-year history of worsening lumbar and cervical pain was referred to physical therapy to address these musculoskeletal issues concurrent with diagnostic testing for EDS. A multimodal approach including manual therapy, therapeutic exercise, postural and body mechanics education, and a home exercise program was used. The patient specific functional scale (PSFS) was used to gauge patient's perceived improvements which were demonstrated by increased scores at reevaluation and at discharge. Following the Maitland concept framework, the physical therapist was able to make sound clinical decisions by tracking the logical flow of constant patient assessment. A 10-month course of treatment designed to maximize recovery of function was successful with a chronic history of pain and the EDS-HT diagnosis. The role of education and empowering the patient is shown to be of utmost importance. Optimizing therapeutic outcomes long-term for this patient population requires maintaining a home exercise program, adaptation and modifications of work and lifestyle activities.
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Engelbert RHH, Juul-Kristensen B, Pacey V, de Wandele I, Smeenk S, Woinarosky N, Sabo S, Scheper MC, Russek L, Simmonds JV. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:158-167. [PMID: 28306230 DOI: 10.1002/ajmg.c.31545] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children, adolescents, and adults with JHS/hEDS. Due to the complexity of the symptoms in the profile of JHS/hEDS, the International Classification of Functioning, Disability and Health (ICF) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions, activities and participation, as well as environmental and personal factors. The current evidence-based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions. Multicenter randomized controlled trials are warranted to assess the clinical and cost-effectiveness of interventions for children and adults. Until further multicenter trials are conducted, clinical decision-making should be based on theoretical and the current limited research evidence. For all individuals diagnosed with JHS/hEDS, international consensus and combined efforts to identify risk profiles would create a better understanding of the pathological mechanisms and the potential for optimizing health care for affected individuals. © 2017 Wiley Periodicals, Inc.
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[Ehlers-Danlos syndromes]. Ann Dermatol Venereol 2017; 144:744-758. [PMID: 29032848 DOI: 10.1016/j.annder.2017.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/27/2017] [Accepted: 06/12/2017] [Indexed: 11/22/2022]
Abstract
Ehlers-Danlos syndromes (EDS) are a heterogeneous group of inheritable connective tissue disorders characterized by skin hyperextensibility, joint hypermobility and cutaneous fragility with delayed wound healing. Over and above these common features, they differ in the presence or absence of various organ and tissue abnormalities, and differences in genetic causal mechanisms and degree of severity. They are complex and multisystem diseases, with the majority being highly disabling because of major joint problems and neurosensory deficiencies, and in some cases, they may be life-threatening due to associated complications, especially vascular disorders. In 1997, the Villefranche classification defined 6 subtypes of EDS. However, many other new variants have been described over the last years. The "historical" EDS were characterized by abnormalities in fibrillar collagen protein synthesis. More recently, disorders of synthesis and organization of the extracellular matrix have been shown to be responsible for other types of EDS. Thus, many EDS are in fact metabolic diseases related to enzymatic defects. While there is no curative treatment for any type of EDS, early diagnosis is of utmost importance in order to optimize the symptomatic management of patients and to prevent avoidable complications. Patients must be treated and monitored by multidisciplinary teams in highly specialized reference centers. In this article, we present the current state of knowledge on these diseases that continue to be elucidated thanks to new molecular genetic techniques.
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Rabin J, Brown M, Alexander S. Update in the Treatment of Chronic Pain within Pediatric Patients. Curr Probl Pediatr Adolesc Health Care 2017; 47:167-172. [PMID: 28716513 DOI: 10.1016/j.cppeds.2017.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pediatric chronic pain is a challenging entity to evaluate and treat as it encompasses a wide variety of presentations often with overlapping psychosocial implications. Chronic pain may have significant effects upon a child's involvement in academic, athletic, and social participation. If unrecognized, it may have deleterious effects upon family interactions and stability. The treatment of pediatric chronic pain is focused on not only providing analgesia, but also on assisting the child and family with reintegrating into a more functional lifestyle. Given the complex multifactorial causes of pain, a comprehensive multidisciplinary treatment plan is often the most effective way to achieve remission. This paper will discuss two examples of pediatric pain that have shown the good response to treatment with a multidisciplinary team approach: complex regional pain syndrome (CRPS) and amplified pain due to Ehlers-Danlos syndrome-hypermobility type (EDS-HT). Treatment of these patients often encompasses a multimodal approach that incorporates physical therapy (PT), occupational therapy (OT), medication(s), pain psychology, procedure(s), sleep hygiene, education, and encouragement of overall physiologic wellness. Management principles are to reduce pain and help prevent future occurrences.
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Diagnostic confounders of chronic widespread pain: not always fibromyalgia. Pain Rep 2017; 2:e598. [PMID: 29392213 PMCID: PMC5741304 DOI: 10.1097/pr9.0000000000000598] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 12/11/2022] Open
Abstract
Although chronic widespread pain is the defining feature of fibromyalgia, a myriad of other conditions may present with similar pain complaint leading to misdiagnosis. Conditions that may mimic fibromyalgia may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. In this review, we examine these various conditions that should be considered in a differential diagnosis and provide direction that will help the clinician differentiate these conditions from fibromyalgia. Introduction: Chronic widespread pain (CWP) is the defining feature of fibromyalgia (FM), a worldwide prevalent condition. Chronic widespread pain is, however, not pathognomonic of FM, and other conditions may present similarly with CWP, requiring consideration of a differential diagnosis. Objectives: To conduct a literature search to identify medical conditions that may mimic FM and have highlighted features that may differentiate these various conditions from FM. Methods: A comprehensive literature search from 1990 through September 2016 was conducted to identify conditions characterized by CWP. Results: Conditions that may mimic FM may be categorized as musculoskeletal, neurological, endocrine/metabolic, psychiatric/psychological, and medication related. Characteristics pertaining to the most commonly identified confounding diagnoses within each category are discussed; clues to enable clinical differentiation from FM are presented; and steps towards a diagnostic algorithm for mimicking conditions are presented. Conclusion: Although the most likely reason for a complaint of CWP is FM, this pain complaint can be a harbinger of illness other than FM, prompting consideration of a differential diagnosis. This review should sensitize physicians to a broad spectrum of conditions that can mimic FM.
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