Deciphering Hypermobility Spectrum Disorder vs EDS

Understanding Hypermobility

Hypermobility refers to the condition in which joints have more flexibility and range of motion than normal. This increased joint mobility can put individuals at risk of injuries due to the excessive stretching and movement of their joints. Two related conditions associated with hypermobility are Hypermobility Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (EDS).

Definition and Symptoms

Hypermobility Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (EDS) are conditions characterized by excessive joint flexibility. According to the American Academy of Family Physicians, individuals with these conditions may experience various symptoms, including:

• Abdominal cramping
• Bloating
• Loose stools
• Constipation
• Anxiety
• Chronic pain
• Dizziness
• Easy bruising
• Fatigue
• Joint problems (such as arthritis and dislocation)
• Skin healing problems

It's important to note that the symptoms can vary in severity and may not be present in all individuals with HSD or Hypermobile EDS. Proper diagnosis and management are essential for addressing the specific symptoms and improving the quality of life for those affected.

Types of Hypermobility Disorders

Hypermobile EDS and HSD are the most common symptomatic joint hypermobility conditions seen in clinical practice. The 2017 International Classification of the Ehlers-Danlos syndromes introduced the term Hypermobile EDS and Hypermobility Spectrum Disorders. The diagnostic criteria for these conditions were updated in 2017.

Hypermobility Spectrum Disorder (HSD) is used to describe patients who do not meet the diagnostic criteria for Hypermobile EDS but still experience symptoms related to joint hypermobility. This diagnosis helps address the needs of individuals who may not have all the features required for a diagnosis of Hypermobile EDS but still require appropriate management and care.

Hypermobile Ehlers-Danlos Syndrome (EDS) is characterized by joint hypermobility, skin findings, and joint pains or recurrent dislocations. It is inherited in an autosomal dominant pattern, but there is no known genetic mutation specifically associated with its diagnosis. In addition to joint-related symptoms, individuals with Hypermobile EDS may also experience various extra-articular symptoms, including anxiety disorders, chronic pain, fatigue, orthostatic intolerance, functional gastrointestinal disorders, and pelvic and bladder dysfunction.

The exact prevalence of Hypermobile EDS and HSD is unknown. However, studies suggest that their combined prevalence is lower than the prevalence of all EDS and joint hypermobility syndrome codes combined, which range from 0.13% to 0.19%. Further research and studies are needed to better understand the prevalence and impact of these conditions on affected individuals.

Understanding the definition, symptoms, and types of hypermobility disorders is crucial for accurate diagnosis and appropriate management strategies. By recognizing the specific characteristics of HSD and Hypermobile EDS, healthcare professionals can provide tailored care and support to individuals with these conditions.

Diagnosis and Testing

Diagnosing hypermobility spectrum disorder and Ehlers-Danlos syndrome (EDS) involves a combination of physical examination and additional testing. These steps are crucial in determining the specific condition present and guiding appropriate management strategies.

Physical Examination

A thorough physical examination is vital in diagnosing hypermobility spectrum disorders and EDS. During the examination, healthcare professionals assess joint flexibility, skin elasticity, and the presence of other physical characteristics associated with these conditions. They may also evaluate the eyes, heart, and other potentially affected areas.

For hypermobility spectrum disorders, the focus is on assessing joint hypermobility and related symptoms. The Beighton score, a standardized assessment, is often used to measure joint flexibility. Other physical characteristics, such as skin hyperextensibility and easy bruising, may also be examined.

In the case of EDS, clinical examination plays a crucial role. Different types of EDS present with distinct clinical features. The examination aims to identify specific signs associated with each type. Family history is also considered, as some forms of EDS have a genetic component.

Blood Tests and Additional Testing

Blood tests and additional testing may be necessary to confirm a diagnosis and provide further insights into hypermobility spectrum disorders and EDS.

In hypermobility spectrum disorders, blood tests may be conducted to rule out other conditions and assess potential underlying causes of symptoms. In more severe cases, additional testing, such as imaging studies or cardiac evaluations, may be required to evaluate the impact on the eyes, blood vessels, or heart.

For EDS, the diagnostic process varies depending on the type. While genetic testing is available for some types, it is important to note that there is currently no genetic testing available for the most common form, hypermobile EDS [3]. Instead, clinical examination and family history are integral in diagnosing classical EDS (cEDS). Molecular testing may also be necessary to establish a definitive diagnosis for cEDS. Biomarkers associated with the clinical features, such as complement proteins and aquaporin 9, may aid in confirming the diagnosis and assessing disease severity.

In both hypermobility spectrum disorders and EDS, blood tests can provide valuable information. For example, elevated serum prolactin levels have been associated with chronic pain conditions and may serve as a useful diagnostic biomarker for individuals with EDS who frequently experience pain [4].

The combination of physical examination and appropriate testing allows healthcare professionals to make an accurate diagnosis and develop an effective management plan for individuals with hypermobility spectrum disorders and EDS.

Management Strategies

When it comes to managing hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (EDS), there are various strategies that individuals can implement to improve their quality of life and minimize symptoms. These strategies typically involve lifestyle adjustments, along with the use of medications and therapies tailored to each person's specific needs.

Lifestyle Adjustments

Lifestyle adjustments play a crucial role in managing hypermobility disorders. These adjustments focus on maintaining overall health, preventing joint injuries, and controlling symptoms. Here are some lifestyle recommendations:

• Staying Active: Engaging in gentle exercises like walking, swimming, or biking can help improve muscle strength and joint stability. It is important to consult with a healthcare professional or physical therapist to determine the most suitable exercises for individual needs.
• Maintaining Good Posture: Practicing proper posture can help reduce strain on joints and alleviate discomfort. Implementing ergonomic adjustments in workspaces and using supportive seating can also contribute to better posture.
• Getting Adequate Sleep: Prioritizing quality sleep is essential for overall health. Creating a comfortable sleep environment and establishing a consistent sleep routine can promote better rest and aid in symptom management.
• Eating a Healthy Diet: Consuming a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall well-being. It is important to consult with a healthcare professional or registered dietitian for personalized dietary recommendations.
• Avoiding Harmful Substances: Limiting alcohol consumption and avoiding smoking or drug use is advised to minimize symptoms and promote general health.

Medications and Therapies

Medications and therapies can be valuable tools in managing hypermobility disorders. While there is no cure for HSD or EDS, these treatment approaches aim to alleviate symptoms and improve daily functioning. Here are some commonly used strategies:

• Medications: Over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help manage pain and inflammation associated with hypermobility disorders. It is crucial to follow healthcare professionals' guidance and consult with them before starting any new medications.
• Relaxation Techniques: Incorporating relaxation techniques into daily routines, such as deep breathing exercises, meditation, or mindfulness practices, can help reduce pain and manage stress levels.
• Cognitive Behavior Therapy (CBT): CBT is a therapeutic approach that can assist individuals in developing coping strategies and managing the psychological impact of living with a hypermobility disorder. It may help address feelings of being a burden to others and improve mental well-being.
• Physical Therapy: Working with a physical therapist who specializes in hypermobility disorders can be beneficial. They can provide personalized exercise programs, educate individuals about joint protection techniques, and help improve overall strength and flexibility.
• Massage Therapy: Massage therapy may help alleviate muscle tension and provide relief from pain associated with hypermobility disorders. It is important to find a qualified massage therapist who understands the specific needs and limitations of individuals with hypermobility.

It is crucial for individuals with hypermobility disorders to work closely with healthcare professionals to develop a comprehensive management plan that addresses their unique needs. By implementing lifestyle adjustments and incorporating appropriate medications and therapies, individuals can better manage their symptoms and enhance their overall well-being.

Hypermobile EDS Overview

Hypermobile Ehlers-Danlos syndrome (EDS) is a specific subtype of EDS that is characterized by joint hypermobility and connective tissue abnormalities. Understanding the clinical features and genetic basis of hypermobile EDS is essential for accurate diagnosis and management.

Clinical Features

Hypermobile EDS often presents with a range of clinical features that distinguish it from other hypermobility spectrum disorders. Individuals with hypermobile EDS may exhibit the following characteristics:

• Joint hypermobility: Excessive flexibility and range of motion in joints, which can lead to joint instability, dislocations, and chronic joint pain.
• Soft and stretchy skin: Skin that is velvety, smooth, and may be more prone to bruising and scarring.
• Chronic pain: Individuals with hypermobile EDS may experience chronic pain, which can affect multiple areas of the body, including joints, muscles, and ligaments.
• Fatigue: Persistent fatigue and low energy levels, which can significantly impact daily activities and quality of life.
• Gastrointestinal issues: Some individuals with hypermobile EDS may experience gastrointestinal symptoms such as constipation, diarrhea, or gastroesophageal reflux disease (GERD).
• Autonomic dysfunction: Dysregulation of the autonomic nervous system, leading to symptoms such as orthostatic intolerance, dizziness, and fainting.

It's important to note that the severity and combination of symptoms can vary among individuals with hypermobile EDS. Some individuals may have milder symptoms, while others may experience more severe complications affecting the eyes, blood vessels, or heart.

Diagnosis and Genetic Basis

The diagnosis of hypermobile EDS involves a comprehensive evaluation, including a physical examination and assessment of medical history. There is currently no definitive genetic test available for hypermobile EDS. However, genetic testing may be performed to rule out other types of EDS or genetic connective tissue disorders.

While the genetic basis of hypermobile EDS is still unknown, studies have identified potential biomarkers that may aid in the diagnosis. Transcriptome analysis of fibroblasts from individuals with hypermobile EDS has shown increased expression of aquaporin 9 (AQP9) and down-regulation of IL6, which may serve as potential biomarkers for diagnosing hypermobile EDS.

It's important to differentiate hypermobile EDS from other hypermobility spectrum disorders, as hypermobile EDS is typically more severe and associated with more serious complications. Genetic testing is not routinely necessary for the diagnosis of hypermobile EDS, but it may be considered in certain cases to confirm the diagnosis or rule out other genetic conditions.

By understanding the clinical features and genetic basis of hypermobile EDS, healthcare professionals can make an accurate diagnosis and develop appropriate management strategies for individuals with this condition. A multidisciplinary approach, involving various healthcare specialists, may be necessary to address the diverse range of symptoms and provide comprehensive care.

Treatment Approaches

When it comes to managing hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (EDS), the primary goal is to address symptoms, prevent joint injury, and provide patients with a comprehensive understanding of their condition. Treatment approaches for these conditions involve a combination of strategies, including symptom management and the involvement of a multidisciplinary care team.

Symptom Management

Symptom management plays a crucial role in the treatment of hypermobility spectrum disorders. The focus is on alleviating pain, reducing joint instability, and improving overall quality of life. Some common strategies for symptom management include:

• Physical and Occupational Therapy: Physical and occupational therapy can help strengthen muscles, improve joint stability, and enhance mobility. Therapists may also provide guidance on proper body mechanics and recommend assistive devices or braces to support joints.
• Medications: Pain relief can be achieved using over-the-counter medications such as acetaminophen and anti-inflammatory drugs. These medications help to alleviate pain and reduce inflammation. However, it's important to consult with a healthcare provider before starting any medication regimen.
• Heat and Cold Therapy: Applying heat or cold packs to affected areas can help alleviate pain and reduce inflammation. Heat therapy promotes muscle relaxation, while cold therapy can help numb pain and reduce swelling.
• Orthostatic Intolerance Management: Orthostatic intolerance, a common symptom in HSD and EDS, can be managed by increasing fluid intake, increasing salt intake, and using compression stockings. These strategies help improve blood flow and minimize symptoms like dizziness and lightheadedness.

Multidisciplinary Care Team

The management of hypermobility spectrum disorders and hypermobile EDS often requires a multidisciplinary care approach. A diverse team of healthcare professionals collaborates to address various aspects of the condition and provide comprehensive care. The multidisciplinary care team may include:

• Physicians: Physicians specializing in rheumatology, genetics, or other relevant fields play a crucial role in diagnosing and managing hypermobility spectrum disorders and EDS. They provide medical expertise and oversee the overall treatment plan.
• Physical and Occupational Therapists: These professionals assist with improving joint stability, enhancing muscle strength, and promoting functional independence. They work closely with patients to develop personalized exercise programs and provide guidance on joint protection techniques.
• Psychologists: Mental health support is essential for individuals with hypermobility spectrum disorders and EDS. Psychologists can help patients cope with chronic pain, address feelings of being a burden, and develop strategies to manage stress and improve overall well-being.
• Nutritionists and Lifestyle Coaches: Nutritionists provide guidance on maintaining a balanced diet and optimizing nutrition to support overall health. Lifestyle coaches can assist individuals in developing strategies for self-management and making lifestyle adjustments to improve quality of life.
• Community and Online Support: Connecting with others who have similar conditions can be highly beneficial. Community and online support groups provide a platform for individuals to share experiences, seek advice, and find a sense of belonging.

The involvement of a multidisciplinary care team ensures that patients with hypermobility spectrum disorders and hypermobile EDS receive holistic care that addresses the complex nature of these conditions. By combining various treatment approaches and expertise from different disciplines, individuals can effectively manage symptoms and achieve a better quality of life.

Prevalence and Prognosis

Understanding the prevalence and long-term outlook of hypermobility spectrum disorder (HSD) and Ehlers-Danlos syndrome (EDS) is important in recognizing the impact of these conditions on individuals. While the exact prevalence of these disorders is not known, estimates provide insight into their occurrence within the population.

Population Estimates

The prevalence of hypermobile EDS and hypermobility spectrum disorders varies based on different studies and diagnostic criteria. Studies utilizing diagnostic codes for EDS and joint hypermobility syndrome, a prior term for hypermobile EDS, have provided valuable estimates.

Based on these studies in national or patient registries from Sweden and Wales, United Kingdom, the combined prevalence of hypermobile EDS and hypermobility spectrum disorders is expected to be lower than the prevalence of all EDS and joint hypermobility syndrome codes combined. The estimated prevalence from these studies ranges from 0.13% to 0.19%.

Another estimate comes from a population survey in the United Kingdom, which found that 3.4% of adults endorsed hypermobility and chronic widespread pain using validated instruments. While not specific to hypermobile EDS and hypermobility spectrum disorders, this survey provides additional insight into the prevalence of hypermobility in the general population [1].

For Ehlers-Danlos syndrome, the prevalence varies depending on the specific type. The hypermobile type is estimated to affect approximately 1 in 5,000 to 20,000 people, while the classical type occurs in approximately 1 in 20,000 to 40,000 people. Other forms of Ehlers-Danlos syndrome are rare, often with only a few cases or affected families described in the medical literature.

Long-Term Outlook

The long-term outlook for individuals with hypermobility spectrum disorder and Ehlers-Danlos syndrome can vary depending on several factors, including the specific type and severity of the condition. While these conditions are generally chronic and lifelong, management strategies can help individuals lead fulfilling lives.

With proper diagnosis, awareness, and proactive management, individuals with hypermobility spectrum disorder and Ehlers-Danlos syndrome can minimize the impact of symptoms and improve their quality of life. Multidisciplinary care teams, including healthcare professionals from various specialties, play a crucial role in developing personalized treatment plans and providing ongoing support.

Regular monitoring, symptom management, and lifestyle adjustments can contribute to better outcomes for individuals with these conditions. It's important for individuals with hypermobility spectrum disorder and Ehlers-Danlos syndrome to work closely with their healthcare providers to address their specific needs and optimize their long-term prognosis.

Understanding the prevalence and long-term outlook of hypermobility spectrum disorder and Ehlers-Danlos syndrome can help individuals, healthcare professionals, and society as a whole to better comprehend and address the challenges faced by those affected by these conditions.

References

• ‍https://www.aafp.org/pubs/afp/issues/2021/0415/p481.html
• ‍https://www.aafp.org/pubs/afp/issues/2021/0415/p481-s1.html
• ‍https://www.mayoclinic.org/diseases-conditions/ehlers-danlos-syndrome/diagnosis-treatment/drc-20362149
• ‍https://pubmed.ncbi.nlm.nih.gov/34618061/
• ‍https://medlineplus.gov/genetics/condition/ehlers-danlos-syndrome/