ASSOCIATION BETWEEN HYPERMOBILITY AND CHRONIC MUSCULOSKELETAL PAIN IN ADULTS (HAMS STUDY) NCT01032863

Background: Studies in children failed to find a significant association between Benign Joint Hypermobility Syndrome (BJHS) and chronic musculoskeletal (MSK) pain. However, children with symptomatic hypermobility represent a different phenotype compared to asymptomatic hypermobility. We hypothesized that the decrease in prevalance of hypermobility with age probably occurs due to reduction of the asymptomatic phenotype. If so, then the symptomatic hypermobility phenotype which would persist into adulthood would be associated with musculoskeletal pain. Objectives: Primary: To determine whether chronic MSK pain is associated with Hypermobility among adults. Secondary: Determine the association between Fibromyalgia and BJHS. Methods: Randomly selected healthy adults aged 25 to 40 years (relatives of admitted patients or blood donors) were prospectively evaluated. Subjects filled a self administered questionnaire which included, among other things, a pain mannequin, the symptom intensity scale (SIS), and some features of Birghton criteria. One of the investigators (SK) blinded to the responses in the questionnaire examined for features of BJHS as well a tender point score. Results: Among the 112 adults (53men and 59women) studied 75 reported having experienced chronic MSK pain of whom 23 fulfilled the Brighton criteria and 30 had a Beighton score≥4. This was significantly different to those not having had chronic MSK pain (table 1). Correlation (Phi coefficient) between Brighton criteria and Chronic MSK pain was 0.357 (p<0.001) and between Beighton score ≥4 and chronic MSK pain was 0.211 (p=0.026). BJHS was also significantly associated with low back pain (LBP) as well (table) (Phi=0.378, p<0.001). Eight subjects reported chronic widespread pain (CWP) but none of them fulfilled the criteria for fibromyalgia (neither ACR,nor survey criteria,nor SIS criteria). Hence, correlation between BJHS and fibromyalgia could not be determined. The association between BJHS and either the presence of CWP or tender points ≥11 was insignificant (table). The correlation (Pearson's r) between Beighton score and the tender point score was 0.102 (p=0.286) and that between Beighton score and the SIS score was -0.052 (p=0.587). Variable (n)Brighton criteria presentp valueBeighton score ≥4p value Chronic MSK pain absent (37)0 (0%)<0.0017 (18.9%)0.033 Chronic MSK pain present (75)23 (30.7%)30 (40%) LBP absent (61)4 (6.6%)<0.00115 (24.6%)0.045 LBP present (51)19 (37.3%)22 (43.1%) CWP absent (104)20 (19.2%)0.35836 (34.6%)0.267 CWP present (8)3 (37.5%)1 (12.5%) Tender point score <11 (87)18 (20.7%)1.028 (32.2%)0.81 Tender point score ≥11 (25)5 (20%)9 (36%) Conclusions: In this prospectively tested cohort, BJHS was significantly associated with the presence of chronic MSK pain (as well as chronic LBP) in adults. The lack of subjects with fibromyalgia precluded the study of it's association with BJHS in this study. The negative association between BJHS and CWP as well lack of correlation between Beighton score and tender point score tends to suggest that there is probably no such association. However this needs to be tested in an adequately powered study with sufficient numbers of fibromyalgia patients. References: 1. Leone V et al. Arch.Dis.Child 2009;94:627-632. 2. Engelbert RH et al. Pediatrics 2003;111:e248-e254. 3. WolfeF et al. J Rheumatol 2006; 33:2291–2299. Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 70, supplement 3, year 2011, page 349Session: Back pain, mechanical musculoskeletal problems, local soft tissue disorders (Poster Presentations )