Indian Articles: Joint hypermobility in Indian children

"Joint hypermobility in Indian children." 

R. P. Hasija, R. P. Khubchandani, and S. Shenoi.
Clinical & Experimental Rheumatology 26.1 (2008): 146.

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Key Takeaway:
The most important finding of this article is the correlation between nutritional status and the incidence of hypermobility in children.

This is an article published in the journal Clinical and Experimental Rheumatology in 2008. The study used the currently accepted Beighton scoring system for assessing hypermobility of joints in 829 children in the age range 3-19 years from an urban low socio-economic strata in Mumbai. 734 children of these had moderate to severe malnutrition. 

It is one of the first two Indian studies that have assessed the prevalence of generalized joint hypermobility (gJHM) in Indian pediatric populations (the other one being this)/ More importantly, the present article explores the link between the present of gJHM and malnutrition. The study found a a prevalence of 58.7% joint hypermobility in the children and a positive correlation between the presence of malnutrition and joint hypermobility.

The article compares the results of other Indian and international studies on the prevalence of joint hypermobility in different population groups. The comparison results are divided into two groups, based on the hypermobility assessment method used (Beighton score and other methods).

The study showed that in addition to known demographic (e.g., sex), pathologic (e.g., parathyroid dysfunction) and lifestyle (e.g., training) factors that influence joint hypermobility, moderate or severe malnutrition can influence joint hypermobility.

The authors conclude:
"Our study reiterates the belief of other workers that ‘It is time to take hypermobility seriously’ [Ref]. There is a strong association with musculoskeletal symptoms. Children complaining of these musculoskeletal symptoms do not get the attention they deserve, largely because of scant physician awareness." 

The article has been cited many times worldwide in relation to this relation between nutritional status and JHM, and an Italian geneticist, Dr. Marco Castori, citing the article writes

The understanding of epigenetic effects of dietary supplementations in both health and disease in humans is in its infancy. Nevertheless, a couple of papers in the field of gJHM put the basis for possible future studies. In particular, Hasija and et al. [2008] demonstrate a direct relationship between degree of generalized gJHM and nutritional status in Indian children. This study envisages that a healthy and balanced diet may improve the range of joint motion also in the symptomatic pediatric patient, with or without a pre-existing diagnosis of EDS.



Ref: GRAHAME R: Time to take hypermobility seriously (in adults and children). Rheumatology (Oxford) 2001; 40: 485-7