title: Arthralgias, fatigue, paresthesias and visceral pain: can joint hypermobility solve the puzzle? A case report.
abstract: BACKGROUND
  Joint hypermobility syndrome describes a disorder in which musculoskeletal pain occurs in a generalized joint hypermobility substrate. The clinical picture comprises variable manifestations which involve mainly but not exclusively the musculoskeletal system, and evolve over the person's lifetime.
  
  
  METHODS
  Describing the case of a 20-year-old female with generalized arthro-myalgias, persistent fatigue and troublesome visceral pain, we illustrate how a frequently ignored clinical sign such as joint hypermobility can be the keystone to clarify different simultaneous symptoms. All of the patient's physical complaints had been investigated separately during her previous medical examinations, and several tests repeatedly gave negative results. The patient received different diagnoses that describe only part of her problems, such as irritable bowel syndrome for visceral pain, fibromyalgia for arthralgias or depression for fatigue. These approaches gave rise to pharmacological or physical treatments which did not improve her quality of life in any way and in some instances worsened the situation. Pronounced joint hypermobility which led the patient to flex her joints excessively, causing subluxations in several districts, was the only sign overlooked.
  
  
  CONCLUSIONS
  Exploring the patient's articular features in her clinical context led us to diagnose joint hypermobility syndrome, a complex and often ignored condition. The case highlights the utility of a multidisciplinary approach and coordinated interventions to define and manage this clinical entity.
authors: Allergy, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy. marco.folci@unimi.it.|University of Milan, Milan, Italy. marco.folci@unimi.it.
authors: Marco
authors: M
authors: Folci
authors: Allergy, Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy. franco.capsoni@unimi.it.|University of Milan, Milan, Italy. franco.capsoni@unimi.it.
authors: Franco
authors: F
authors: Capsoni
mesh_terms: D018771:Arthralgia / Q000150:complications / Q000175:diagnosis*; D005221:Fatigue / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000151:congenital* / Q000175:diagnosis; D010292:Paresthesia / Q000150:complications / Q000175:diagnosis*; D059265:Visceral Pain / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult