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Benign Joint Hypermobility Minimally Impacts Autonomic Abnormalities in Pediatric Subjects with Chronic Functional
Gisela Chelimsky1, Katja Kovacic1, Pippa Simpson2
1Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI.
Insights
Children with benign joint hypermobility syndrome (BJH) and chronic pain do not show more autonomic dysfunction compared to those without BJH. This suggests BJH is not the primary cause of these associated autonomic and comorbid disorders.
Area of Science:
- Pediatric Medicine
- Autonomic Nervous System Research
- Rheumatology
Background:
- Benign joint hypermobility (BJH) syndrome is a condition characterized by joint laxity.
- Chronic functional pain disorders are common in children and can be associated with various comorbidities.
- Autonomic dysfunction, affecting involuntary bodily functions, is increasingly recognized in pediatric chronic pain populations.
Purpose of the Study:
- To investigate whether children diagnosed with benign joint hypermobility (BJH) syndrome and chronic functional pain disorders exhibit greater autonomic dysfunction compared to peers without BJH.
- To explore potential differences in autonomic testing results and comorbid conditions between these two groups.
Main Methods:
- A retrospective chart review was conducted on pediatric patients within a specialized neurogastroenterology and autonomic clinic.
- Patients were categorized based on Beighton scores and Brighton criteria for BJH (≥6 or ≤2).
- Autonomic testing was performed, evaluating for conditions like postural tachycardia syndrome, syncope, orthostatic intolerance, and sudomotor function.
Main Results:
- No significant differences were found in diagnoses of postural tachycardia syndrome, syncope, orthostatic intolerance, or orthostatic hypotension between groups.
- Baseline and peak heart rates during head-up tilt, as well as sudomotor index, did not differ between children with and without BJH.
- Commonly reported symptoms such as migraine, chronic nausea, fatigue, and functional abdominal pain were similarly prevalent in both groups.
Conclusions:
- Children with chronic functional pain disorders and BJH do not demonstrate increased autonomic dysfunction on testing compared to those without BJH.
- The findings suggest that BJH itself may not be the primary driver of autonomic dysfunction or associated comorbid conditions in this pediatric cohort.
- Further research may be needed to elucidate the complex interplay between hypermobility, chronic pain, and autonomic regulation in children.
Objective:
To determine if children with benign joint hypermobility (BJH) syndrome and chronic functional pain disorders have more autonomic dysfunction.
Study Design:
Retrospective chart review study of pediatric patients seen in the pediatric neurogastroenterology and autonomic clinic who underwent autonomic testing and had either a Beighton score of ≥6 and met Brighton criteria for BJH (with BJH) or a score of ≤2 (no BJH).
Results:
Twenty-one female subjects (10 without BJH) met inclusion criteria; 64% of BJH had diagnosis confirmed by genetics consultation. We evaluated for postural tachycardia syndrome, syncope, orthostatic intolerance, and orthostatic hypotension. None of these diagnoses, as well as baseline heart rate, peak heart rate in first 10 minutes of head up tilt (P = .35 and P = .61, respectively), and sudomotor index (suggestive of autonomic neuropathy) (P = .58), showed differences between the groups. Age of onset of symptoms was also similar (P = .61) (BJH vs without BJH: median [range]:15.6 years [12.9-17.5] vs 15.4 years [11.1-18.2]). There was no difference between groups in complaints of migraine, chronic nausea, chronic fatigue, lightheadedness, dizziness, fainting >3 times/lifetime, delayed onset of sleep, irritable bowel syndrome, dyspepsia, abdominal migraine, functional abdominal pain, constipation, or fibromyalgia.
Conclusions:
Children with chronic functional pain disorders and BJH have autonomic testing findings and comorbid features compared with a similar cohort of subjects without BJH, suggesting that BJH is not the driver of the autonomic and comorbid disorders.
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