title: Fatigue is associated with muscle weakness in Ehlers-Danlos syndrome: an explorative study.
abstract: OBJECTIVE
  Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterised by joint hypermobility, skin hyperextensibility and tissue fragility. It has recently been shown that muscle weakness occurs frequently in EDS, and that fatigue is a common and clinically important symptom. The aim of this study was to investigate the relationship between fatigue severity and subjective and objective measures of muscle weakness. Furthermore, the predictive value of muscle weakness for fatigue severity was determined, together with that of pain and physical activity.
  
  
  METHODS
  An explorative, cross-sectional, observational study.
  
  
  METHODS
  Thirty EDS patients, recruited from the Dutch patient association, were investigated at the neuromuscular outpatient department of a tertiary referral centre in The Netherlands.
  
  
  METHODS
  Muscle strength measured with manual muscle strength testing and hand-held dynamometry. Self-reported muscle weakness, pain, physical activity levels and fatigue were assessed with standardised questionnaires.
  
  
  RESULTS
  Fatigue severity in EDS was significantly correlated with measured and self-reported muscle weakness (r=-0.408 for manual muscle strength, r=0.461 for hand-held dynamometry and r=0.603 for self-reported muscle weakness). Both muscle weakness and pain severity were significant predictors of fatigue severity in a multiple regression analysis.
  
  
  CONCLUSIONS
  The results suggest a positive and direct relationship between fatigue severity and muscle weakness in EDS. Future research should focus on the relationship between fatigue, muscle weakness and objectively measured physical activity, preferably in a larger cohort of EDS patients.
authors.affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. n.voermans@neuro.umcn.nl
authors.forename: N C
authors.initials: NC
authors.lastname: Voermans
authors.forename: H
authors.initials: H
authors.lastname: Knoop
authors.forename: G
authors.initials: G
authors.lastname: Bleijenberg
authors.forename: B G
authors.initials: BG
authors.lastname: van Engelen
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004535:Ehlers-Danlos Syndrome / Q000150:complications* / Q000534:rehabilitation; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology* / Q000534:rehabilitation; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation; D012044:Regression Analysis; D012720:Severity of Illness Index; D055815:Young Adult