Adolescents with hypermobility in their joints – or "double jointedness" – are almost twice as likely as their normal-jointed counterparts are to develop musculoskeletal pain in their shoulders, knees, ankles, and feet as they enter adulthood, according to a case-control study.
Dr. Jonathan Tobias
The risk of later knee pain was even greater for obese, double-jointed teens, with 10 times greater odds than for normal-weight adolescents without joint hypermobility.
The 4-year prospective study found that 44.8% of teens (with or without joint hypermobility) in the study reported joint pain within the past month that lasted at least a day. A higher proportion of girls (47.5%) than boys (41.3%, P = .001) reported joint pain, which included the spine, shoulder, knee and ankle/foot, reported Dr. Jonathan H. Tobias of the University of Bristol and his associates (Arthritis Rheum. 2013 Feb. 28 [doi:10.1002/art.37836]).
The researchers assessed hypermobility with the Beighton score in 2,901 teens enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) when the participants were a mean 13.8 years old. The 4.6% of teenagers classified as hypermobile included 7% of the 1,634 girls and 1.3% of the 1,267 boys (P less than .001).
The Beighton score runs from 0 to 9, based on the number of hypermobile joints in an evaluation of both thumbs, both little fingers, both elbows, both knees, and the trunk. In this study, joint hypermobility is classified as having a score of 6 or greater, which is higher than the score of 4 or more that has been frequently used in other studies.
The researchers gave participants a pain questionnaire 4 years after enrollment to determine which teens had experienced "at least moderately troublesome pain lasting 1 day or longer within the last month, at specific musculoskeletal sites." Participants rated the severity of their pain and the degree to which it interfered with daily activities on scales from 1 to 10.
The 44.8% of participants who reported pain most often cited lower back pain (16.1%), followed by upper back pain (8.9%), neck pain (8.6%), shoulder pain (9.5%), knee pain (8.8%), and ankle/foot pain (6.8%). A total of 4.8% of the participants reported knee, hip, shoulder, or lower back chronic pain for at least 3 months. Another 4.4% reported having chronic widespread pain for at least 3 months.
The researchers used a Chi-squared test and then logistic regression analysis to determine odds ratios after adjusting for sex, maternal education, and body-mass index. The adolescents with joint hypermobility had greater odds for shoulder pain (odds ratio, 1.68; 95% confidence interval, 1.04-2.72), knee pain (OR, 1.83; 95% CI, 1.10-3.02), and ankle/foot pain (OR, 1.82; 95% CI, 1.05-3.16). No association was found between joint hypermobility and musculoskeletal pain at the spine, elbows, hands, or hips.
Another analysis that accounted for risks associated with obesity found that obese adolescents with joint hypermobility were particularly at high risk for knee pain, with an odds ratio of 1.6 for nonobese hypermobile teens and an OR of 11.0 for obese hypermobile teens (P = .04).
When the researchers analyzed the data using a more common cut-off Beighton score of at least 4, only shoulder pain was significantly associated with hypermobility (OR, 1.42; P = .02) while knee pain (OR, 1.17) and ankle/foot pain (OR, 0.92) were nonsignificant after adjustment.
While this study’s findings are consistent with another study involving a cohort of 228 younger children aged 10 years and 12 years, these findings are inconsistent with a recent systematic review of 15 papers that found an association between joint hypermobility and musculoskeletal pain in Afro Asian region residents but not in Europeans. The authors of the current study note that its differences include its larger sample size, prospective design, and its definition of joint hypermobility as a Beighton score of 6 or greater, thereby including only children in the top 5%-10% for joint hypermobility.
The pain research in the study was funded by a grant from Arthritis Research UK. The ALSPAC is funded by the UK Medical Research Council, the Wellcome Trust, and the University of Bristol, England. The authors had no disclosures.