There are surprisingly few studies of joint hypermobility (sometimes also called hyperlaxity or, erroneously, "double-jointedness"), even though it is a very common – though often undiagnosed – condition which affects 10–30% of the population. It is an often unrecognized cause of chronic pain.
A more serious form of hypermobility called Ehlers–Danlos syndrome can cause symptoms very similar to chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and fibromyalgia. It is also one of the strongest known risk factors for developing CFS/ME and even so-called benign hypermobility can increase the risk.
Benign Joint Hypermobility Syndrome
Also known as BJHS, HMS or JHS, "benign" means this form of hypermobility is not as serious as diseases like Ehlers–Danlos syndrome. It can be diagnosed with the so-called Beighton criteria.
Joint hypermobility has been associated with joint and muscle pain and fatigue. Increased prevalence of sleep disturbances, rashes, depression and gastrointestinal and cardiac symptoms has also been reported.
Ehlers–Danlos Syndrome
Ehlers–Danlos syndrome or EDS is a group of rare, heritable connective tissue disorders. It is divided into six different types, most of them characterized by joint hypermobility; fragile, soft and hyperextensible skin; delayed wound healing and easy bruising. There are also numerous other symptoms and signs.
People with EDS often have neuromuscular symptoms, such as muscle weakness, myalgia (muscle aches) and atrophy (muscle wasting). They also frequently suffer from fatigue. In one study three-quarters of EDS patients had severe fatigue.
Joint Hypermobility Risks and Disease Associations
Hypermobility, especially EDS (both classical and hypermobility types), has been associated with an increased risk of CFS/ME. In two different studies about 60% of people with CFS/ME were found to suffer from hypermobility. Similar prevalence has been found in fibromyalgia. People with JHS and especially EDS appear to have more severe forms of CFS/ME and fibromyalgia than those without hyperlaxity.
Dysautonomia (problems with autonomic function) is common with hypermobility and includes symptoms like fatigue, low blood pressure, exercise intolerance, heat intolerance, palpitations, syncope (fainting) and presyncope. Particularly common is a condition called POTS (postural orthostatic tachycardia syndrome). Up to 70% of people with JHS have dysautonomia.
The strongest illness association with hypermobility is perhaps surprisingly with anxiety (agoraphobia and panic disorder). Most people with hypermobility suffer from anxiety – and curiously, most people with anxiety are hypermobile, in one study as many as two-thirds. The severity of hypermobility appears to correlate with severity of anxiety.
The reason for the anxiety link is not fully understood. Hypermobility is also associated with mitral valve prolapse (a usually benign heart condition also common in CFS/ME and fibromyalgia) and MVP is also associated with anxiety, so some researchers believe this is the missing link.
People with hypermobile joints are more likely to get sports injuries, carpal tunnel syndrome and conditions like whiplash. Joint hypermobility has also been associated with an increased risk of temporomandibular joint disorder (TMJ/TMD), varicose veins, migraines, myopia (nearsightnedness) and recurrent urinary tract infections.
There is also a possibly increased risk of asthma, allergies and osteoarthritis. Joint hypermobility appears to increase the risk of Crohn's disease, but not the similar ulcerative colitis.
Importance of Diagnosis
Hypermobility is very frequently undiagnosed, even Ehlers–Danlos syndrome which causes a variety of often severe symptoms. Undiagnosed EDS can lead to severe complications. With JHS the risks are less serious, but it is still important to get diagnosed, as things like special insoles can reduce symptoms.
Diagnosing CFS/ME in a person with EDS is often difficult and some doctors do not want to make the diagnosis at all, as they believe the symptoms are just manifestations of EDS. However, CFS/ME can cause many symptoms not a part of EDS, such as certain neurological symptoms, fever and other immunological symptoms and unusually severe post-exertional malaise.
Physiotherapy and low-impact exercise like tai chi are recommended reduce injuries and other complications of hypermobility. However, many doctors do not understand that those with CFS/ME cannot exercise.
There are numerous medications that can treat CFS/ME and fibromyalgia, while there are no such treatments for EDS and JHS except for painkillers.
References
Hakim AJ, Grahame R. "Non-musculoskeletal symptoms in joint hypermobility syndrome. Indirect evidence for autonomic dysfunction?" Rheumatology (Oxford). 2004 Sep;43(9):1194-5.
Barron DF, Cohen BA, Geraghty MT, et al. "Joint hypermobility is more common in children with chronic fatigue syndrome than in healthy controls." J Pediatr. 2002 Sep;141(3):421-5.
Ofluoglu D, Gunduz OH, Kul-Panza E, et al. "Hypermobility in women with fibromyalgia syndrome."Clin Rheumatol. 2006 May;25(3):291-3.
Martín-Santos R, Bulbena A, Porta M, et al. "Association between joint hypermobility syndrome and panic disorder." Am J Psychiatry. 1998 Nov;155(11):1578-83.
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