Phenotypic manifestations of connective tissue dysplasia in individuals with joint hypermobility
https://doi.org/10.21518/2079-701X-2022-16-21-156-161
Abstract
Introduction. Joint hypermobility is a common polyetiological condition that can be accompanied by pain in the joints and lead to the early onset of osteoarthritis. The study of the comorbidity of JH and somatic pathology, in connective tissue dysplasia, is fragmentary and relevant for optimizing the classification and criteria for early diagnosis of this condition.
Aim. Analysis of the frequency of phenotypic signs of uCTD in individuals with JH.
Materials and methods. A cross-sectional study of 35 men (21.77 ± 0.60 years) and 226 women (21.42 ± 0.18 years) was carried out. 2 groups were formed – with the presence of HMS (n = 156) and the control group (n = 105). JH was determined according to the Beighton scale, phenotypic signs of uCTD – according to the modified table by T. Kadurina.
Results. Statistically significant differences were found in the frequency of occurrence of phenotypic signs of CTD in individuals with hypermobility – a decrease in BMI < 18 kg/m2 (p = 0.0001), skin hyperelasticity (p = 0.0001), ptosis of internal organs (p = 0.038), dolichostenomyelia (p = 0.010), hyperkyphosis/hyperlordosis (p = 0.003), joint crunch (p = 0.009), GERD (p = 0.021) and arterial hypotension (p = 0.0001). Mild myopia was more common in the control group (p = 0.020), and severe myopia was more common in the JH group (p = 0.003). Keloid scars were more common in the group with severe JH (p = 0.021).
Conclusions. In patients with joint hypermobility, phenotypic manifestations of connective tissue dysplasia were revealed, most often involving the musculoskeletal system (dolichostenomelia, crunching in the joints, curvature of the spine) and skin (hyperelasticity, keloid scars).
Keywords
About the Authors
K. E. AkhiiarovaRussian Federation
Karina E. Akhiiarova, Postgraduate Student, Department of Internal Medicine
3, Lenin St., Ufa, 450008
Kh. Kh. Gantseva
Russian Federation
Khalida Kh. Gantseva, Dr. Sci. (Med.), Professor of the Department of Internal Medicine
3, Lenin St., Ufa, 450008
R. I. Khusainova
Russian Federation
Rita I. Khusainova, Dr. Sci. (Biol.), Professor of the Department of Medical Genetics; Leading Researcher of the Institute of Biochemistry and Genetics
3, Lenin St., Ufa, 450008
71, October Ave., Ufa, 450054
A. V. Tyurin
Russian Federation
Anton V. Tyurin, Cand. Sci. (Med.), Associate Professor, Head of the Department of Internal Medicine
3, Lenin St., Ufa, 450008
References
1. Sundemo D., Hamrin Senorski E., Karlsson L., Horvath A., Juul-Kristensen B., Karlsson J. et al. Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review. BMJ Open Sport Exerc Med. 2019;5(1):e000620. http://doi.org/10.1136/bmjsem-2019-000620.
2. Беленький А.Г. Фенотипические признаки при гипермобильности суставов у взрослых лиц. Научно-практическая ревматология. 2002;(4):18–29. Режим доступа: https://med-click.ru/uploads/files/docs/fenotipicheskiepriznaki-pri-gipermobilnosti-sustavov-u-vzroslyh-lits.pdf. Belenky A.G. Phenotypic signs of joint hypermobility in adults. Rheumatology Science and Practice. 2002;(4):18–29. (In Russ.) Available at: https://medclick.ru/uploads/files/docs/fenotipicheskie-priznaki-pri-gipermobilnostisustavov-u-vzroslyh-lits.pdf.
3. Folci M., Capsoni F. Arthralgias, fatigue, paresthesias and visceral pain: can joint hypermobility solve the puzzle? A case report. BMC Musculoskelet Disord. 2016;17:58. http://doi.org/10.1186/s12891-016-0905-2.
4. Simmonds J. Masterclass: Hypermobility and hypermobility related disorders. Musculoskelet Sci Pract. 2022;57. http://doi.org/10.1016/j.msksp.2021.102465.
5. Сатыбалдыев А.М. Синдром гипермобильности суставов в ревматологии. Современная ревматология.2017;11(2):68–74. https://doi.org/10.14412/1996-7012-2017-2-68-74. Satybaldyev A.M. Joint hypermobility syndrome in rheumatology. Modern Rheumatology Journal. 2017;11(2):68–74. (In Russ.) https://doi.org/10.14412/1996-7012-2017-2-68-74.
6. Steinberg N., Tenenbaum S., Zeev A., Pantanowitz M., Waddington G., Dar G., Siev-Ner I. Generalized joint hypermobility, scoliosis, patellofemoral pain, and physical abilities in young dancers. BMC Musculoskelet Disord. 2021;22(1):161. http://doi.org/10.1186/s12891-021-04023-z.
7. Кадурина Т.И., Гнусаев С.Ф. Наследственные и многофакторные нарушения соединительной ткани у детей алгоритмы диагностики. Тактика ведения. Проект российских рекомендаций. Медицинский вестник Северного Кавказа. 2015;10(1):1–35. http://doi.org/10.14300/mnnc.2015.10001. Kadurinа Т., Gnusaev С. Hereditary and multivariate connective tissue disorders in children Algorithm of diagnosis. Management tactics. Medical News of North Caucasus. 2015;10(1):1–35. (In Russ.) http://doi.org/10.14300/mnnc.2015.10001.
8. Meyer K., Chan C., Hopper L., Nicholson L. Identifying lower limb specific and generalised joint hypermobility in adults: validation of the Lower Limb Assessment Score. BMC Musculoskelet Disord. 2017;18(1):514. http://doi.org/10.1186/s12891-017-1875-8.
9. Remvig L., Jensen D.V., Robert C. Ward Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol. 2007;34(4):804–809. Available at: https://pubmed.ncbi.nlm.nih.gov/17407233.
10. Antonio D.H, Magalhaes C.S. Survey on joint hypermobility in university students aged 18–25 years old. Adv Rheumatol. 2018;58(1):1–7. http://doi.org/10.1186/s42358-018-0008-x.
11. Викторова И.А., Иванова Д.С., Коншу Н.В. Синдром гипермобильности суставов: дифференциальная диагностика с ревматологическими заболеваниями. Медицинский вестник Северного Кавказа. 2016;2(2). http://doi.org/10.14300/mnnc.2016.11064. Viktorova I.A., Ivanova D.S., Konshu N.V. Joint hypermobility syndrome: differential diagnosis with rheumatological diseases. Medical News of the North Caucasus. 2016;2(2). (In Russ.) http://doi.org/10.14300/mnnc.2016.11064.
12. Sohrbeck-Nøhr O., Kristensen J., Boyle E., Remvig L., Juul-Kristensen B. Generalized joint hypermobility in child hood is a possible risk for the development of joint pain in adolescence: a cohort study. BMC Pediatrics. 2014;14(1):1–9. http://doi.org/10.1186/s12887-014-0302-7.
13. Ахиярова К.Э., Садретдинова Л.Д., Ахметова А.М., Ганцева Х.Х., Тюрин А.В. Исследование качественного и количественного состава тела у лиц молодого возраста с гипермобильностью суставов. Медицинский вестник Башкортостана. 2020;15(3):91–93. Режим доступа: https://medvestb.elpub.ru/jour/article/view/546/546. Akhiyarova K.E., Sadretdinova L.D., Akhmetova A.M., Gantseva Kh.Kh., Tyurin A.V. The study of the qualitative and quantitative composition of the body in young people with joint hypermobility. Bashkortostan Medical Journal. 2020;15(3):91–93. (In Russ.) Available at: https://medvestb.elpub.ru/jour/article/view/546/546.
14. Malfait F., Francomano C., Byers P., Belmont J., Berglund B., Black J. et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8–26 http://doi.org/10.1002/ajmg.c.31552.
15. Islam M., Chang C., Gershwin M. Ehlers-Danlos Syndrome: Immunologic contrasts and connective tissue comparisons. J Transl Autoimmun. 2021;4:100077. http://doi.org/10.1016/j.jtauto.2020.100077.
16. Калаева Г.Ю., Хохлова О.И., Деев И.А., Самойлова Ю.Г. Распространенность и клиническая характеристика дисплазии соединительной ткани у подростков. Педиатрическая фармакология. 2017;14(5):373–379. https://doi.org/10.15690/pf.v14i5.1785. Kalaeva G., Khokhlova О., Deev I., Samoilova J. The Incidence and Clinical Characteristics of the Connective Tissue Dysplasia in Adolescents. Pediatric Pharmacology. 2017;14(5):373–379. (In Russ.) http://doi.org/10.15690/pf.v14i5.1785.
17. Tsybulskaya T.E., Zavgorodnyaya N.G., Pashkova E.E. Evaluation of phenotypic markers of the syndrome of undifferentiated connective tissue dysplasia in children with acquired myopia. Journal of Ophthalmology (Ukraine). 2017;(2):12–17. http://doi.org/10.31288/oftalmolzh201721217.
18. Castori M., Colombi M. Generalized joint hypermobility, joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet C Semin Med Genet. 2015;169C(1):1–5. http://doi.org/10.1002/ajmg.c.31432.
19. Ratani R.S., Yang D.C., Kalani J., Winer-Muram H.T., Okadigwe C., Siddalingappa M., Steiner R.M. An intrathoracic wandering spleen in a patient with Ehlers – Danlos syndrome and diaphragmatic hernia. Clin Nucl Med. 2000;2(9):738–739. http://doi.org/10.1097/00003072-200009000-00025.
20. Dordoni C., Ritelli M., Venturini M., Chiarelli N., Pezzani L., Vascellaro A. et al. Recurring and Generalized Visceroptosis in Ehlers-Danlos Syndrome Hypermobility Type. Am J Med Genet A. 2013;161A(5):1143–1147. http://doi.org/10.1002/ajmg.a.35825.
21. Санеева Г.А., Воротников А.А. Боль в спине: роль соединительнотканных нарушений, ассоциированных с гипермобильным синдромом. Современные проблемы науки и образования. 2016;(2). Режим доступа: https://science-education.ru/ru/article/view?id=24153. Saneeva G.A., Vorotnikov A.A. Back pain: the role of connective tissue disorders associated with hypermobility syndrome. Modern Problems of Science and Education. 2016;(2). (In Russ.) Available at: https://scienceeducation.ru/ru/article/view?id=24153.
22. Van Meulenbroek T., Huijnen I.P., Engelbert R.H., Verbunt J.A. Are chronic musculoskeletal pain and generalized joint hypermobility disabling contributors to physical functioning? Eur J Phys Rehabil Med. 2021;57(5):747–757. http://doi.org/10.23736/S1973-9087.21.06455-8.
23. Smith T., Jerman E., Easton V., Bacon H., Armon K., Poland F., Macgregor A. Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis. Rheumatol Int. 2013;33(11):2709–2716. http://doi.org/10.1007/s00296-013-2790-4.
24. Le Berre M., Guyot M., Agnani O., Bourdeauducq I., Versyp M.C., Donze C. et al. Clinical balance tests, proprioceptive system and adolescent idiopathic scoliosis. Eur Spine J. 2016;26(6):1638–1644. http://doi.org/10.1007/s00586-016-4802-z.
25. Zhou L., Xiao X., Li S., Jia X., Wang P., Sun W. et al. Phenotypic characterization of patients with early-onset high myopia due to mutations in COL2A1 or COL11A1: Why not Stickler syndrome? Mol Vis. 2018;24:560–573. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089037.
26. Gharbiya M., Moramarco A., Castori M., Parisi F., Celletti C., Marenco M. et al. Ocular Features in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type: A Clinical and In Vivo Confocal Microscopy Study. Am J Ophthalmol. 2012;154(3):593–600. http://doi.org/10.1016/j.ajo.2012.03.023.
27. Лычкова А. Э. Нервная регуляция моторной активности пищевода. Экспериментальная и клиническая гастроэнтерология. 2013;(6):52–59. Режим доступа: https://www.elibrary.ru/item.asp?id=21440269. Lychkova A.E. Nervous regulation of motor activity of the esophagus. Experimental and Clinical Gastroenterology. 2013;(6):52–59. (In Russ.) Available at: https://www.elibrary.ru/item.asp?id=21440269.
28. Carbone F., Fikree A., Aziz Q., Tack J. Joint Hypermobility Syndrome in Patients With Functional Dyspepsia. Clin Transl Gastroenterol. 2020;11(11):p.e00220. http://doi.org/10.14309/ctg.0000000000000220.
29. Aktar R., Peiris M., Fikree A., Cibert-Goton V., Walmsley M., Tough I.R. et al. The extracellular matrix glycoprotein tenascin-X regulates peripheral sensory and motor neurones. J Physiol. 2018;596(17):4237–4251 http://doi.org/10.1113/JP276300.
30. Nikolenko V.N., Oganesyan M.V., Vovkogon A.D., Cao Y., Churganova A.A., Zolotareva M.A. et al. Morphological signs of connective tissue dysplasia as predictors of frequent post-exercise musculoskeletal disorders. BMC Musculoskelet Disord. 2020;21(1):660. http://doi.org/10.1186/s12891-020-03698-0.
Review
For citations:
Akhiiarova KE, Gantseva KK, Khusainova RI, Tyurin AV. Phenotypic manifestations of connective tissue dysplasia in individuals with joint hypermobility. Meditsinskiy sovet = Medical Council. 2022;(21):156-161. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-21-156-161