title: Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type): it is a challenge.
abstract: Generalized joint hypermobility (GJH) is highly prevalent among patients diagnosed with chronic pain. When GJH is accompanied by pain in ≥4 joints over a period ≥3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS) may be diagnosed. In addition, GJH is also a clinical sign that is frequently present in hereditary diseases of the connective tissue, such as the Marfan syndrome, osteogenesis imperfecta, and the Ehlers-Danlos syndrome. However, within the Ehlers-Danlos spectrum, a similar subcategory of patients having similar clinical features as HMS but lacking a specific genetic profile was identified: Ehlers-Danlos syndrome hypermobility type (EDS-HT). Researchers and clinicians have struggled for decades with the highly diverse clinical presentation within the HMS and EDS-HT phenotypes (Challenge 1) and the lack of understanding of the pathological mechanisms that underlie the development of pain and its persistence (Challenge 2). In addition, within the HMS/EDS-HT phenotype, there is a high prevalence of psychosocial factors, which again presents a difficult issue that needs to be addressed (Challenge 3). Despite recent scientific advances, many obstacles for clinical care and research still remain. To gain further insight into the phenotype of HMS/EDS-HT and its mechanisms, clearer descriptions of these populations should be made available. Future research and clinical care should revise and create consensus on the diagnostic criteria for HMS/EDS-HT (Solution 1), account for clinical heterogeneity by the classification of subtypes within the HMS/EDS-HT spectrum (Solution 2), and create a clinical core set (Solution 3).
authors: School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands ; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Mark C
authors: MC
authors: Scheper
authors: School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands ; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands ; Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors: Janneke E
authors: JE
authors: de Vries
authors: Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands ; Adelante, Center of expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands.
authors: Jeanine
authors: J
authors: Verbunt
authors: School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands ; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Raoul Hh
authors: RH
authors: Engelbert
keywords: Ehlers-Danlos hypermobility type; chronic musculoskeletal pain; generalized joint hypermobility; hypermobility syndrome