Skin compliance: Measuring skin consistency in the spinal region of healthy children and adults

Searching for subtle features of laxity of connective tissue in patients with ruptured intracranial aneurysms: a pilot study

BACKGROUND

A disruption of the extracellular matrix (ECM) of the intracranial arterial wall is a likely contributing factor in the pathogenesis of intracranial aneurysms. If this is a generalized process, patients with subarachnoid haemorrhage (SAH) may have subtle signs of a general laxity of the connective tissue. We performed a pilot study to assess general laxity in SAH patients and to examine which tests for joint mobility can be best used in these patients.

METHODS

In 59 SAH patients and sex- and age-matched controls we compared: (1) joint mobility (scores of Beighton and Bulbena and the total range of joint motion); (2) skin extensibility, and (3) bone quantity and stiffness. For the analyses we used the independent-samples T test and linear regression with adjustment for possible confounders.

RESULTS

The patients had a higher degree of joint mobility according to the Beighton criteria (total score of 4 in patients vs. 2 in controls, p = 0.001) and the summation of Z scores of active range of motion measurements (0.1 in patients vs. -0.1 in controls, p = 0.0036), and a tendency towards a higher degree of joint mobility according to the Bulbena criteria (total score of 3 in patients vs. 2 in controls, p = 0.097) and the summation of active range of joint motion measurements (1,292 in patients vs. 1,275 in controls, p = 0.13). No differences were found for the other investigated characteristics.

CONCLUSIONS

Our preliminary results suggest that SAH patients have a higher degree of joint mobility than controls. The Beighton score can be best used in our patient population.

Stiffness of the arterial wall, joints and skin in women with a history of pre-eclampsia

OBJECTIVE

The epidemiology of pre-eclampsia suggests a constitutional component for the disorder. We have recently shown an association for blood pressure (BP) with stiffness of joints and skin in adolescents, suggesting that constitutionally determined stiffness of body tissues is associated with blood pressure. Therefore, we compared stiffness of the arterial wall, joints and skin between women with a history of pre-eclampsia and women with an uncomplicated pregnancy.

DESIGN

Cases were 44 women with a history of early onset pre-eclampsia and controls were 46 women with a history of uncomplicated pregnancy. Arterial stiffness was determined non-invasively with pulse wave velocity measurement. As a measure of capsule and ligament stiffness, the active range of motion of various joints was measured. Skin stiffness was measured using a tissue compliance meter. Analysis of variance (ANOVA) multiple comparison tests were used for comparison of the study groups. Linear regression models were used to determine the associations between stiffness parameters and possible confounders.

RESULTS

For the cases, body mass index (BMI) was significantly higher and age and parity were significantly lower. BP was significantly higher for the cases. Stiffness of the arterial wall, joints and skin were significantly higher. After adjustment for mean arterial pressure, stiffness of the joints and skin were significantly higher, but no difference remained for arterial stiffness.

CONCLUSIONS

Women with a history of pre-eclampsia had a significantly higher stiffness of the arterial wall, joints and skin compared with controls. This suggests a constitutionally determined stiffness of connective tissues in former pre-eclamptic cases.

Is chronic fatigue syndrome a connective tissue disorder? A cross-sectional study in adolescents

OBJECTIVES

To investigate whether constitutional laxity of the connective tissues is more frequently present in adolescents with chronic fatigue syndrome (CFS) than in healthy controls. Increased joint hypermobility in patients with CFS has been previously described, as has lower blood pressure in fatigued individuals, which raises the question of whether constitutional laxity is a possible biological predisposing factor for CFS.

DESIGN

Cross-sectional study.

PARTICIPANTS

Thirty-two adolescents with CFS (according to the criteria of the Centers for Disease Control and Prevention) referred to a tertiary hospital and 167 healthy controls.

METHODS

The 32 adolescents with CFS were examined extensively regarding collagen-related parameters: joint mobility, blood pressure, arterial stiffness and arterial wall thickness, skin extensibility, and degradation products of collagen metabolism. Possible confounding factors (age, gender, height, weight, physical activity, muscle strength, diet, alcohol consumption, and cigarette smoking) were also measured. The results were compared with findings in 167 healthy adolescents who underwent the same examinations.

RESULTS

Joint mobility, Beighton score, and collagen biochemistry, all indicators of connective tissue abnormality, were equal for both groups. Systolic blood pressure, however, was remarkably lower in patients with CFS (117.3 vs. 129.7 mm Hg; adjusted difference: -13.5 mm Hg; 95% confidence interval [CI]: -19.1, -7.0). Skin extensibility was higher in adolescents with CFS (mean z score: 0.5 vs. 0.1 SD; adjusted difference: 0.3 SD; 95% CI: 0.1, 0.5). Arterial stiffness, expressed as common carotid distension, was lower in adolescents with CFS, indicating stiffer arteries (670 vs 820 mum; adjusted difference: -110 mum; 95% CI: -220, -10). All analyses were adjusted for age, gender, body mass index, and physical activity. Additionally, arterial stiffness was adjusted for lumen diameter and pulse pressure.

CONCLUSIONS

These findings do not consistently point in the same direction of an abnormality in connective tissue. Patients with CFS did have lower blood pressure and more extensible skin but lacked the most important parameter indicating constitutional laxity, ie, joint hypermobility. Moreover, the collagen metabolism measured by crosslinks and hydroxyproline in urine, mainly reflecting bone resorption, was not different. The unexpected finding of stiffer arteries in patients with CFS warrants additional investigation.

A relation between blood pressure and stiffness of joints and skin

BACKGROUND

Blood pressure, particularly pulse pressure, is associated with arterial wall stiffness, but little is known about its relation to stiffness of other parts of the body. We examined the extent to which blood pressure levels in young healthy children are related to stiffness of various tissues.

METHODS

In November 2000, we studied 95 healthy prepubertal children (41 boys and 54 girls, within age range 8-10 years) from two primary schools in the city of Zeist, The Netherlands. Systolic and diastolic blood pressure and pulse pressure were analyzed in relation to various tissue indicators of stiffness, including active joint mobility and skin extensibility. All results were adjusted for age, sex, body height, body weight and muscle strength as possible confounders.

RESULTS

Diastolic blood pressure was lower with increased active joint mobility (multivariate generalized linear regression coefficient = -4.5 mmHg per standard deviation [SD] joint mobility; 95% confidence interval [CI] = -7.8 to -1.2). Pulse pressure was lower with increased skin extensibility (-3.2 mmHg per SD skin extensibility; CI = -5.2 to -1.1), through a higher diastolic blood pressure (2.0 mmHg per SD skin extensibility; CI = 0.2-3.9) and possibly lower systolic blood pressure (-0.8 mmHg per SD skin extensibility; CI = -3.5 to 1.9). These associations were mutually independent. Additional adjustment for reported musculoskeletal problems or physical activity levels did not materially change the findings.

CONCLUSIONS

Our findings support the hypothesis that constitutional stiffness of body tissues may be associated with blood pressure levels and eventually cardiovascular risk.