Generalized joint hypermobility in childhood is a possible risk for the development of joint pain in adolescence: a cohort study.

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. CONCLUSION: 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.

Gait pattern in 9-11-year-old children with generalized joint hypermobility compared with controls; a cross-sectional study.

BACKGROUND: To study differences in gait patterns in 10-year-old children with Generalized Joint Hypermobility (GJH) and with no GJH (NGJH). METHODS: A total of 37 children participated (19 GJH, 18 NGJH, mean age 10.2 (SD 0.5) years). Inclusion criteria for GJH were a Beighton score of ≥5, with at least one hypermobile knee joint; for NGJH a Beighton score of ≤4, and no hypermobile knees and for both groups no knee pain during the previous week. All children were recorded by five video cameras, while they walked across three force platforms. Net joint moments were calculated in 3D by inverse dynamics and peak values provided input to statistical analyses. RESULTS: In the frontal plane, children with GJH had a significantly lower peak knee abductor moment and peak hip abductor moment. In the sagittal plane, the peak knee flexor moment and the peak hip extensor moment were significantly lower in the GJH group although the absolute difference was small. CONCLUSIONS: The walking pattern was the same for children with GJH and for healthy children, as there were no differences in kinematics, but it was, however, performed with different kinetics. Children with GJH walked with lower ankle, knee and hip joint moments compared to children with NGJH. However, the clinical importance of these differences during normal gait is unknown. To obtain this knowledge, children with GJH must be followed longitudinally. TRIAL REGISTRATION: The study was approved by the Committee on Biomedical Research Ethics for Copenhagen and Frederiksberg, Denmark (jnr. KF01-2006-178).

Knee function in 10-year-old children and adults with Generalised Joint Hypermobility.

PURPOSE: Knee function is reduced in patients with Benign Joint Hypermobility Syndrome. The aim was to study knee function in children and adults with Generalised Joint Hypermobility (GJH) and Non-GJH (NGJH)). MATERIALS AND METHODS: In a matched comparative study, 39 children and 36 adults (mean age children 10.2 years; adults 40.3 years) were included, comprising 19 children and 18 adults with GJH (Beighton ≥ 5/9; Beighton ≥ 4/9), minimum one hypermobile knee, no knee pain (children), and 20 children and 18 adults with NGJH (Beighton <5; Beighton <4). Totally, 85% of the adults were parents to these children. Knee function was determined by self-reported physical fitness (100mm VAS), Knee injury and Osteoarthritis Outcome Score (KOOS) (only adults), measured maximum isokinetic knee strength (60°/s) and peak vertical jump displacement (PVJD), with calculated knee strength balance, Hamstring/Quadriceps (H/Q) ratio and peak rate of force development (PRFD). RESULTS: Adults with GJH had lower knee function (KOOS: pain, p=0.001; symptoms, p=0.001; Activities of Daily Living, p=0.001; Sport/Recreation, p=0.003; knee-related quality of life, p<0.001), and H/Q ratio (0.46 vs. 0.54, p=0.046) than adults with NGJH, regardless of age and knee pain. Both GJH groups had normal physical fitness, isokinetic knee strength, and (only children) H/Q ratio. CONCLUSIONS: Children at 10 years with GJH have normal, but adults with GJH have impaired knee function. To track the risk of developing impaired knee function, children with GJH must be followed longitudinally. Meanwhile, attention to knee function may be given to children with GJH who have parents presenting GJH.

Motor competence and physical activity in 8-year-old school children with generalized joint hypermobility.

OBJECTIVE: Because the criteria used for diagnosing between generalized joint hypermobility (GJH) and musculoskeletal complaints, as well as relations between GJH and an insufficient motor development and/or a reduced physical activity level differ, the prevalence of GJH varies considerably. The aim of this study was to survey the prevalence of GJH defined by a Beighton score at >or=4, >or=5, or >or=6 positive tests of 9 and benign joint hypermobility syndrome (BJHS) in Danish primary school children at 8 years of age. A second aim was to compare children with and without GJH and BJHS regarding motor competence, self-reported physical activity, and incidence of musculoskeletal pain and injuries. METHODS: A cross-sectional study of 524 children in the second grade from 10 public schools was performed. A positive response rate was obtained for 416 (79.4%) children, and 411 (78.4%) children were clinically examined and tested for motor competence, whereas questionnaire response to items comprising musculoskeletal pain and injuries, in addition to daily level and duration of physical activity, corresponded to 377 (71.9%) children. RESULTS: In total, 29% of the children had GJH4, 19% had GJH5, 10% had GJH6, and 9% had BJHS, with no gender difference. There was no difference in daily level and duration of physical activity and in frequency of musculoskeletal pain and injuries between those with and without GJH. Children with >or=GJH5 as well as with >or=GJH6 performed better in the motor competence tests. CONCLUSION: Motor competence and physical activity are not reduced in primary school children at 8 years of age with GJH or BJHS. It is recommended that a potential negative influence on the musculoskeletal system over time, as a result of GJH, be investigated by longitudinal studies.

[Fatigue in hematological patients treated with allogeneic stem cell transplantation]. / Traethed hos haematologiske patienter behandlet med allogen stamcelletransplantation.

INTRODUCTION: Fatigue and poor physical function are well-known symptoms in cancer patients. Allogeneic stem cell transplantation is an established treatment for certain cancer diagnoses, especially leukaemia. The aim of this study was to investigate physical function and fatigue in relation to allogeneic stem cell transplantation. MATERIALS AND METHODS: 21 patients awaiting allogeneic stem cell transplantation were included in a descriptive follow-up design. Fatigue and physical function was assessed by a standardized test programme consisting of a stair test, a test of maximum oxygen uptake and questionnaires on physical activity and fatigue prior to transplantation as well as 3 and 6 months after transplantation. RESULTS: 10 men and 11 women were included. The mean age was 39 years (19-60). Prior to transplantation patients had a low maximum oxygen uptake and reported more fatigue than the Danish general population. Physical fatigue rather than mental fatigue was pronounced both before and after transplantation. No significant changes in the parameters were found from before transplant to 6 months after transplant. CONCLUSION: The results indicate that prior to transplantation patients have poor physical function and increased physical fatigue. The symptoms seem to persist 6 months after transplantation. This could indicate a need for an extensive rehabilitation programme following transplantation.

Myosin heavy-chain isoform distribution, fibre-type composition and fibre size in skeletal muscle of patients on haemodialysis.

OBJECTIVE: Chronic uraemia is associated with abnormalities in skeletal muscles, which can affect their working capacity. It is also well known that the fibre-type composition of skeletal muscles influences endurance, muscle strength and power. In this study we therefore determined the size and distribution of muscle fibres and the myosin heavy-chain (MHC) isoform composition in patients on haemodialysis (HD) in order to establish any differences with values for untrained control subjects. MATERIAL AND METHODS: Muscle biopsies were obtained from the vastus lateralis muscle of 14 non-diabetic patients on HD. The size and distribution of muscle fibres were evaluated using adenosine triphosphate synthase (ATPase) histochemistry, whilst MHC isoform composition was determined in muscle homogenates using sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Values were compared to those for a group of age-, gender- and BMI-matched untrained control subjects. The aerobic work capacity of the patients was also determined. RESULTS: The MHC composition for I, IIA and IIX isoforms was found to be 35.3% +/- 18.2%, 35.9% +/- 7.1% and 28.9% +/- 15.6%, respectively, findings supported by the ATPase histochemically determined fibre-type composition of the vastus lateralis muscle. The mean fibre area of type 1 and 2 fibres was 3283 +/- 873 and 3594 +/- 1483 MICROm2, respectively. The MHC composition and the size of the type 1 fibres of the patients on HD were significantly different from those of the control subjects. CONCLUSIONS: The data demonstrate relatively fewer type 1 and consequently more type 2x fibres, with a corresponding change in MHC isoforms (MHC I and MHC IIX) in the skeletal muscle of patients on HD. Several patients on HD were found to have <15% type 1 (or relative percentage of MHC I) fibres. Such a low percentage of type 1 fibres is very rarely observed in normal untrained subjects. Chronic uraemia more severely affects the composition than the size of fibres.

Five months of physical exercise in hemodialysis patients: effects on aerobic capacity, physical function and self-rated health.

BACKGROUND: The number of chronic renal failure patients treated by hemodialysis (HD) is continuously increasing. Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases. The aim of this study was to determine the effects of 5 months physical exercise of HD patients' physical capacity, self-rated health and risk factors for cardiovascular disease. METHODS: 33 HD patients were included in the study. INCLUSION CRITERIA: HD for more than 3 months, age >18 years. EXCLUSION CRITERIA: Diabetes mellitus, symptomatic cardiovascular disease, musculoskeletal limitations, severe peripheral polyneuropathy, inability to speak Danish or English, dementia or other mental disorders. The patients were randomly assigned to an exercise group (EG, n = 22) or a control group (CG, n = 11). Prior to randomization, baseline testing was performed. The effects were measured by aerobic capacity, '2-min stair climbing', 'squat test', self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. RESULTS: 20 patients completed the intervention. Attendance was 74% of all sessions. There were no dropouts caused by complications related to the intervention. The EG had a significant increase in aerobic capacity, 'squat test' and Physical Function and Physical Component Scale (SF36). No significant changes were observed in any of the parameters in the CG. CONCLUSION: Physical exercise twice a week for 5 months increases physical function and aerobic capacity in HD patients. An exercise program with only two exercise sessions per week seems easy to implement in clinical practice with high attendance among participants. Further investigation is needed to determine the effects on blood pressure and lipids. There were no medical complications related to the exercise program.