Epidemiology of Generalized Joint Laxity (Hypermobility) in Fourteen-Year-Old Children From the UK: A Population-Based Evaluation

Objective Although diagnostic criteria for generalized ligamentous laxity (hypermobility) in children are widely used, their validity may be limited, due to the lack of robust descriptive epidemiologic data on this condition. The present study was undertaken to describe the point prevalence and pattern of hypermobility in 14-year-old children from a population-based cohort. Methods We performed a cross-sectional analysis using the Avon Longitudinal Study of Parents and Children, a large population-based birth cohort. Hypermobility among children in the cohort (mean age 13.8 years) was measured using the Beighton scoring system. Objective measures of physical activity were ascertained by accelerometry. Data on other variables, including puberty and socioeconomic status, were collected. Simple prevalence rates were calculated. Chi-square tests and logistic regression analyses were used to assess associations of specific variables with hypermobility. Results Among the 6,022 children evaluated, the prevalence of hypermobility (defined as a Beighton score of ≥4 [i.e., ≥4 joints affected]) in girls and boys age 13.8 years was 27.5% and 10.6%, respectively. Forty-five percent of girls and 29% of boys had hypermobile fingers. There was a suggestion of a positive association between hypermobility in girls and variables including physical activity, body mass index, and maternal education. No associations were seen in boys. Conclusion We have shown that the prevalence of hypermobility in UK children is high, possibly suggesting that the Beighton score cutoff of ≥4 is too low or that this scoring is not appropriate for use in subjects whose musculoskeletal system is still developing. These results provide a platform to evaluate the relationships between the Beighton criteria and key clinical features (including pain), thereby testing the clinical validity of this scoring system in the pediatric population.

[1]  P. Helders,et al.  Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder? , 2003, Pediatrics.

[2]  Y. Shih,et al.  Physiological anterior laxity in healthy young females: the effect of knee hyperextension and dominance , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[3]  P. Kannus,et al.  Age, overweight, sex, and knee instability: their relationship to the post-traumatic osteoarthrosis of the knee joint. , 1988, Injury.

[4]  R. Grahame.  Joint hypermobility and the performing musician. , 1993, The New England journal of medicine.

[5]  J. Cheng,et al.  Joint Laxity in Children , 1991, Journal of pediatric orthopedics.

[6]  N. Petty,et al.  Contribution of lumbar spine and hip movement during the palms to floor test in individuals with diagnosed hypermobility syndrome , 2008, Physiotherapy theory and practice.

[7]  S. Blair,et al.  Calibration of an accelerometer during free-living activities in children. , 2007, International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity.

[8]  S. Shenoi,et al.  Joint hypermobility in Indian children. , 2008, Clinical and experimental rheumatology.

[9]  M. Moustaki,et al.  Benign hypermobility syndrome in Greek schoolchildren , 2000, European Journal of Pediatrics.

[10]  J. Tobias,et al.  Social Position Affects Bone Mass in Childhood Through Opposing Actions on Height and Weight , 2005, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[11]  A. El-Garf,et al.  Hypermobility among Egyptian children: prevalence and features. , 1998, The Journal of rheumatology.

[12]  Jennifer J Verhoeven,et al.  Joint hypermobility in African non-pregnant nulliparous women. , 1999, European journal of obstetrics, gynecology, and reproductive biology.

[13]  T. Hewett,et al.  The effects of gender and pubertal status on generalized joint laxity in young athletes. , 2008, Journal of science and medicine in sport.

[14]  H. Bird.  Joint hypermobility in children. , 2005, Rheumatology.

[15]  D. A. Grebenev.  [Hypermobility of the joints]. , 1989, Terapevticheskii arkhiv.

[16]  H. Bird,et al.  The quantification of joint laxity in dancers and gymnasts. , 1999, Journal of sports sciences.

[17]  M. Pembrey,et al.  ALSPAC--the Avon Longitudinal Study of Parents and Children. I. Study methodology. , 2001, Paediatric and perinatal epidemiology.

[18]  C. Naspitz,et al.  Articular hypermobility in school children in Sao Paulo, Brazil. , 1993, The Journal of rheumatology.

[19]  P. Renström,et al.  General joint laxity in 1845 Swedish school children of different ages: age‐ and gender‐specific distributions , 2004, Acta paediatrica.

[20]  C CARTER,et al.  PERSISTENT JOINT LAXITY AND CONGENITAL DISLOCATION OF THE HIP. , 1964, The Journal of bone and joint surgery. British volume.

[21]  V. Leone,et al.  Joint hypermobility and its relationship to musculoskeletal pain in schoolchildren: a cross-sectional study , 2009, Archives of Disease in Childhood.

[22]  P. Beighton,et al.  Articular mobility in an African population. , 1973, Annals of the rheumatic diseases.

[23]  K. Janaki,et al.  Joint hypermobility in south Indian children. , 1996, Indian pediatrics.

[24]  P. Renström,et al.  Evaluation of general joint laxity, shoulder laxity and mobility in competitive swimmers during growth and in normal controls , 2005, Scandinavian Journal of Medicine & Science in Sports.

[25]  L. Remvig,et al.  Prevalence of general hypermobility in 12–13-year-old school children and impact of an intervention against injury and pain incidence , 2007 .

[26]  T. Arasıl,et al.  The prevalence of joint hypermobility among high school students , 2005, Rheumatology International.

[27]  Way of life as a determinant of physical fitness , 2004, European Journal of Applied Physiology and Occupational Physiology.

[28]  R. Gajdosik,et al.  Influence of hamstring length on the standing position and flexion range of motion of the pelvic angle, lumbar angle, and thoracic angle. , 1994, The Journal of orthopaedic and sports physical therapy.

[29]  P. Dongen,et al.  Hypermobility in two Dutch school populations. , 1997, European journal of obstetrics, gynecology, and reproductive biology.

[30]  R. Grahame,et al.  Injury and joint hypermobility syndrome in ballet dancers--a 5-year follow-up. , 2009, Rheumatology.

[31]  H. Jonsson,et al.  Articular hypermobility in Icelandic 12-year-olds. , 1999, Rheumatology.

[32]  J. Cordeiro,et al.  Analysis of joint mobility patterns among preschool children. , 2005, Sao Paulo medical journal = Revista paulista de medicina.

[33]  E. Giannini,et al.  Hypermobility of the joints in juvenile episodic arthritis/arthralgia. , 1985, The Journal of pediatrics.