Joint Hypermobility and Fibromyalgia

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Joint hypermobility is defined as “abnormally increased mobility of small and large joints beyond the limits of their physiological movement.” Joint hypermobility is common among in young females and is seen in about 5% of the healthy adult population.

When musculoskeletal symptoms occur in hypermobile people in the absence of any other systemic rheumatological disorder, it is called “hypermobility syndrome.” Joint hypermobility is also a feature of a medical condition called Ehlers-Danlos syndrome (EDS) that is characterized by weakness of the connective tissues of the body.

Similarity of symptoms

Could there be a possible link between joint hypermobility and fibromyalgia? Or do these two syndromes simply overlap and mimic each other? They certainly share the same symptoms of wide spread musculoskeletal pain and stiffness, but does the liaison end there or do they share a similar underlying disease process?

The jury is still out within the medical community, but research teams across the world are in the process of finding out. Joint hypermobility is most common in young women and its prevalence can vary between populations. For example, it is believed to affect about 5 % of the Caucasian population compared to a frequency 38 % of Middle Eastern women.

How to confirm the diagnosis

If you have fibromyalgia, I’d like you to think back to your childhood.   Were your joints extremely flexible or were you double jointed?   When you straightened your fingers, did they curve backward?   Could you bend your thumb to touch your forearm?   When you fully extended your legs or arms, did they look like they were bending slightly backward?  

If you can answer “yes” to one or more of these questions, you may have (or have had) joint hypermobility syndrome. Joint hypermobility can be diagnosed by asking an individual to perform a series of hyperextensive movements.

For example, placing their palms on the floor by leaning forward without bending their knees or placing the palm of their hand on the table and extending their fifth finger backwards by 90 degrees, If a person can perform a certain number of these abnormal ranges of movement then they are diagnosed as having hypermobile joints.

Proprioceptive impairment

Another symptom is known as ‘proprioceptive impairment’, where patients don’t ‘know’ where they are physically in space, which can make them less stable and prone to falls, and awkward or clumsy. Some people with joint hypermobility syndrome (possibly up to half) are more sensitive to pain than the rest of the population, and have pain at a number of sites across their bodies. Other symptoms can include low blood pressure when standing up, light-headedness and fainting, tachycardia (fast heart rate), anxiety, panic attacks, tiredness and heat intolerance.

As well as having hypermobile joints, people with joint hypermobility syndrome may also have skin that is thinner and more fragile than other people’s skin, and they may bruise more easily. Young people with joint hypermobility syndrome may develop stretch marks on their skin during periods of fast growth.

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Association between fibromyalgia and joint hypermobility

The association between fibromyalgia and joint hypermobility is not totally understood. Joint hypermobility may cause widespread arthralgia in patients due to misuse or overuse of hypermobile joints. Data from this particular study indicated:

  • >That typical complaints of fibromyalgia were primarily observed in the patients that did meet the ACR criteria.
  • >Some patients who exhibit fibromyalgia symptoms clinically but do not meet the ACR criteria could actually have joint hypermobility misdiagnosed as fibromyalgia.

Joint hypermobility was first featured in rheumatology literature in 1967. Today, joint hypermobility is better understood and more widely recognized. However, further investigation and research is still needed to learn even more about the interaction between joint hypermobility and fibromyalgia.

One of the theories behind fibromyalgia syndrome is that chronic pain causes hypersensitisation to pain, and this leads to fibromyalgia syndrome. People with joint hypermobility syndrome can be vulnerable to frequent strains and dislocations because their joints overextend more easily – this could be the trigger for chronic pain and therefore fibromyalgia syndrome.

Similarities between these two syndromes

How do these two syndromes compare in the field of research? Current research studies have come up with conflicting results. Researchers Acasuso-Diaz and Collantes-Estevez from Cordoba in Spain believe the two disorders are associated and that mobile joints may play an important role in the underlying cause of fibromyalgia.

Their study in 1998 compared 66 women with fibromyalgia to 70 women diagnosed with other rheumatic diseases. Statistical analysis revealed a significant difference between these two groups, with 27 % of the women with fibromyalgia having hypermobile joints compared to only 11.4% of the women with other rheumatic disorders.

Ehlers-Danlos Syndrome

Once in a while, hypermobility may be a symptom of a rarer and more serious disorder called Ehlers-Danlos syndrome.   Ehlers-Danlos syndrome (EDS) is a group of inherited disorders that weaken connective tissues.   There are six different types of EDS and the seriousness can range from mild to life-threatening.

Treatment of hypermobile joints

There is no treatment for joint hypermobility syndrome, but exercise can strengthen the muscles around the joints and the joints themselves, making them more stable. It’s also important to look after any injuries properly, to prevent the development of chronic pain.

Conclusion

It seems evident from all the studies donethat joint hypermobility is linked to widespread musculoskeletal pain in some individuals. However, the research studies conflict as to whether there is a direct link to fibromyalgia. It is feasible that joint hypermobility could mimic and be misdiagnosed as fibromyalgia, underlining the importance of the ARC criteria.

Nevertheless, rheumatologists tend to differ in opinion as to whether strict adherence to ARC criteria is beneficial, but in the light of the evident overlap in symptoms some criteria need to be in place to prevent misdiagnosis.

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References:

  • Joint Hypermobility and Primary Fibromyalgia: A Clinical Enigma, Journal of Rheumatology, July 2000 (27:1774-6)
  • Joint Hypermobility and Fibromyalgia By Carol Eustice via Verywell Health

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