• Musculo-Skeletal
• Rheumatology
• Pain
• Orthopaedics
• General Paediatrics

Research into childhood joint hypermobility is singularly lacking, yet the problem seems to be increasing and poses difficulties for specialists and generalists alike. Hypermobility or ligamentous laxity is thought to be an aetiological factor in several symptom complexes. These include idiopathic nocturnal leg pain, ‘growing pains’, recurrent lower limb arthralgia, anterior knee pain, lower back pain and by definition, the benign joint hypermobility syndrome (BJHS).

Pacey et al's1 timely paper observes clinical heterogeneity in children and young people (CYP) with joint hypermobility syndrome and attempts to subtype the condition on clinical symptoms and signs. They used the Brighton criteria (detailed) to diagnose and recruit 89 CYP, 20% of whom were ‘family or friends’, not seeking professional help, and 8% did not report musculoskeletal pain. Only 66% could be categorised into one of five subtypes. Twenty per cent were classified as ‘joint affected’ with a higher number of painful joints, recurrent joint instability (≥3 subluxations or dislocations) and ‘orthostatic hypotension symptoms’ (dizziness on standing). This group were the most symptomatic with more pain, fatigue and lower health related quality of life (HRQOL). The second largest group (14%) was designated the ‘athletic subtype’ and obtained higher scores for motor proficiency, exercise capacity and physical activity participation, with better HRQOL, less pain and fatigue.

Whether CYP remain in one subtype, and whether these subtypes confer any aetiological, clinical, prognostic or management value remains to be seen. As a practising paediatric rheumatologist, I am sceptical. The reader needs some background to inform his or her own opinion.

Recent years have seen an explosion in the diagnosis of BJHS or ‘Ehlers Danlos syndrome-hypermobility type’ (widely recognised as being clinically and genetically indistinguishable) first described in the literature …