title: Clinical profile of benign joint hypermobility syndrome from a tertiary care military hospital in India.
abstract: OBJECTIVE
  Joint hypermobility when associated with symptoms in the absence of systemic rheumatologic disease is termed as benign joint hypermobility syndrome (BJHS). BJHS is often an under-recognised and a poorly managed entity. Indian studies on BJHS are very few and none have been carried out in any of the service rheumatology centres. Hence this retrospective study was carried out at a tertiary medical institute of the Indian Army to assess the varied clinical profile of BJHS.
  
  
  METHODS
  All patients consecutively diagnosed as BJHS at the rheumatology clinic of the Army Hospital (Research and Referral) Delhi from May 2010 to May 2011 were included in the study. Their age, sex, presenting features, clinical profile, laboratory and radiological parameters were studied.
  
  
  RESULTS
  The mean age of these patients was 30 ± 5.71 years with a median duration of symptoms of 42 (06-120) months. There were 45 males and 39 females (male : female = 1.15 : 1.00). The median Beighton's score in these patients was 6/9 (range 4-9). Most of our patients were military personnel (43/84), and all had knee joint pain with evidence of degenerative changes in 19 and synovitis in two patients. Eleven patients including nine military personnel had evidence of soft tissue rheumatism with associated fibromyalgia in four and anxiety disorder in one. Out of 18 patients with a Beighton's score of ≥ 7, nine had incidental findings of lateral head tilt on frontal observation. There was evidence of carpal tunnel syndrome in a patient with wrist synovitis and one patient had associated skin laxity without features of Ehlers-Danlos syndrome.
  
  
  CONCLUSIONS
  BJHS is often under-recognized in clinical practice and is usually missed because of a lack of awareness. A high index of clinical suspicion to diagnose this entity is essential due to its associated morbidities, especially among those exposed to strenuous physical activities.
authors.affiliation: Department of Rheumatology, Army Hospital Research and Referral, New Delhi, India.
authors.forename: Gautam
authors.initials: G
authors.lastname: Mullick
authors.forename: Darshan S
authors.initials: DS
authors.lastname: Bhakuni
authors.forename: Krishnan
authors.initials: K
authors.lastname: Shanmuganandan
authors.forename: Mahendra K
authors.initials: MK
authors.lastname: Garg
authors.forename: Vivek
authors.initials: V
authors.lastname: Vasdev
authors.forename: Sivasami
authors.initials: S
authors.lastname: Kartik
authors.forename: Rahul
authors.initials: R
authors.lastname: Jain
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D018771:Arthralgia / Q000175:diagnosis / Q000503:physiopathology; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000503:physiopathology; D006772:Hospitals, Military; D006801:Humans; D007194:India; D007593:Joint Instability / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D007596:Joints / Q000503:physiopathology*; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008889:Military Personnel; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000503:physiopathology; D013577:Syndrome; D013585:Synovitis / Q000175:diagnosis / Q000503:physiopathology; D062606:Tertiary Care Centers
keywords: Brighton criteria; joint hypermobility; military personnel; physical activity