title: Generalized joint hypermobility in childhood is a possible risk for the development of joint pain in adolescence: a cohort study.
abstract: BACKGROUND
  There is some evidence that indicates generalized joint hypermobility (GJH) is a risk factor for pain persistence and recurrence in adolescence. However, how early pain develops and whether GJH without pain in childhood is a risk factor for pain development in adolescence is undetermined. The aims for this study were to investigate the association between GJH and development of joint pain and to investigate the current GJH status and physical function in Danish adolescents.
  
  
  METHODS
  This was a longitudinal cohort study nested within the Copenhagen Hypermobility Cohort. All children (n = 301) were examined for the exposure, GJH, using the Beighton test at baseline at either 8 or 10 years of age and then re-examined when they reached 14 years of age. The children were categorized into two groups based on their number of positive Beighton tests using different cut points (i.e. GJH4 defined as either < 4 or ≥ 4, GJH5 and GJH6 were similarly defined). The outcome of joint pain was defined as arthralgia as measured by the Brighton criteria from the clinical examination. Other outcome measures of self-reported physical function and objective physical function were also collected.
  
  
  RESULTS
  Children with GJH had three times higher risk of developing joint pain in adolescence, although this association did not reach statistical significance (GJH5: 3.00, 95% [0.94-9.60]). At age 14, the adolescents with GJH had significantly lower self-reported physical function (for ADL: GJH4 p = 0.002, GJH5 p = 0.012; for pain during sitting: GJH4 p = 0.002, GJH5 p = 0.018) and had significantly higher body mass index (BMI: GJH5 p = 0.004, GJH6 p = 0.006) than adolescents without GJH. There was no difference in measured physical function.
  
  
  CONCLUSIONS
  This study has suggested a possible link between GJH and joint pain in the adolescent population. GJH was both a predictive and a contributing factor for future pain. Additional studies with larger sample sizes are needed to confirm our findings.
authors.affiliation: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark. olinedagmar@gmail.com.
authors.forename: Oline
authors.initials: O
authors.lastname: Sohrbeck-Nøhr
authors.affiliation: Department of Infectious Medicine and Rheumatology, University Hospital of Copenhagen, COHYPCO, 2100, Copenhagen Ø, Denmark. jens.halkjaer.kristensen@regionh.dk.
authors.forename: Jens Halkjær
authors.initials: JH
authors.lastname: Kristensen
authors.affiliation: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark. eboyle@heatlh.sdu.dk.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. eboyle@heatlh.sdu.dk.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Boyle
authors.affiliation: Department of Infectious Medicine and Rheumatology, University Hospital of Copenhagen, COHYPCO, 2100, Copenhagen Ø, Denmark. l.remvig@dadlnet.dk.
authors.forename: Lars
authors.initials: L
authors.lastname: Remvig
authors.affiliation: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark. bjuul-kristensen@health.sdu.dk.|Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, Bergen University College, Bergen, Norway. bjuul-kristensen@health.sdu.dk.
authors.forename: Birgit
authors.initials: B
authors.lastname: Juul-Kristensen
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000209:etiology*; D002648:Child; D003430:Cross-Sectional Studies; D006801:Humans; D007593:Joint Instability / Q000150:complications* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D016059:Range of Motion, Articular; D012008:Recurrence; D012307:Risk Factors