Hypermobility: An Indian Perspective


In response to the article, "Joint hypermobility syndrome", by J. Ross and R. Grahame ( BMJ 2011;342:c7167 , doi: http://dx.doi.org/10.1136/bmj.c7167 ) Dr. Arvind Chopra, Centre for Rheumatic Diseases, Pune, India, writes:

Undoubtedly hypermobility (HM) and hypermobility syndrome (HMS) is missed in clinical practice and many a patient made to suffer from needless investigations and therapy. Still worse, the patient may be wrongly diagnosed as having rheumatoid arthritis and treated with long term steroids and disease modifying and immunosuppressive agents.... a clinician ought to look out for HM in all cases with musculoskeletal and joint pains. Irrespective of any other rheumatic disorder that may coexist, it is very comforting for the patient to learn that the problem is largely a benign disorder called HMS and that drugs have a very little role if any.

I wish more clinicians would know this, and not just some scattered rheumatologists across India.

I just hope people would stop using the word "benign". I know that the morbidity in JHS is less than autoimmune inflammatory diseases of the joints, but it is sufficient and correct to say that JHS or HMS is not autoimmune and there is no place for steroids. Please do not tell me that the destruction of my life, health and career have been any less because my condition does not require steroids. 

I also agree that once correctly diagnosed, in an Indian setting, it would be reasonable to refer the patient with JHS back to an orthopedician and a physiotherapist and free up resources (the rheumatologist) for patients with serious autoimmune disorders of joints.

But where are the orthopedician and the physiotherapist who have heard of JHS and who know the correct management regime?






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