Benign joint hypermobility syndrome: a hospital-based study from northern India

ObjectivesTo study the frequency, demography, clinical features and response to treatment of benign joint hypermobility syndrome (BJHS) in a rheumatology clinic at a tertiary referral centre in India and to ascertain the association of hypermobility with musculoskeletal symptoms.MethodsConsecutive adult patients with Beighton score of 5 or more and conforming to Brighton criteria were recruited from the rheumatology clinic over 18 months. Detailed clinical and laboratory work-up was carried out including ophthalmologic and echocardiographic evaluation. Treatment comprised reassurance, physiotherapy and nonsteroidal anti-inflammatory drugs/analgesics. Pain score and patient global assessment were measured at 0, 2 and 12 weeks. The association of hypermobility with musculoskeletal symptoms was ascertained in a case-control study performed separately.ResultsHypermobility (Beighton score ≥ 5) was observed in about 20% (405/2050) of rheumatology referrals. However, only about half of them (204/2050) met the Brighton criteria for BJHS. One hundred BJHS patients (mean age 30 ± 9.4 years, female : male = 2.2 : 1) were recruited for detailed study. All had gross hypermobility and knee was the commonest joint involved. Rheumatoid distribution of painful joints often raised suspicion of rheumatoid arthritis (RA) but objective clinical and laboratory findings of RA were lacking. Sixty-one had received a wrong diagnosis before referral (RA, ankylosing spondylitis, rheumatic fever) and 22 had been taking long-term penicillin prophylaxis for suspected rheumatic fever. About 40% had negligible symptoms after 12 weeks while others continued to suffer from mild to moderate symptoms with no synovitis or joint damage. Case-control study showed greater likelihood of presence of hypermobility amongst the patients referred to the rheumatology clinic with odds ratio = 3.23 (CI = 1.86–5.63, P= 0.000).Conclusions BJHS is common in Indians and is often mistaken for other rheumatic disorders. There is 3.2 times more likelihood of finding joint hypermobility amongst patients referred to a rheumatology clinic, thereby confirming its association with musculoskeletal complaints.