Öz
Amaç
Bu çalışmanın amacı, benign eklem hipermobilite sendromunun (BJHS) kemik mineral yoğunluğunu (KMY) etkileyip etkilemediğini incelemektir.
Gereç ve Yöntem
Çalışma kesitsel kontrollü tasarımda yürütüldü. Toplam 72 katılımcı değerlendirildi: BJHS tanısı alan 36 hasta (grup 1) ve 36 sağlıklı birey (grup 2). Çalışmaya ≥18 yaş bireyler dahil edildi. BJHS tanısı, Beighton kriterlerine göre ≥4 puan ile doğrulandı. Sekonder osteoporoz, enflamatuvar romatizmal hastalık, sistemik hastalık, gebelik, karaciğer veya böbrek yetmezliği, omurga veya kalça kırığı öyküsü, metal implant varlığı ve kemik metabolizmasını etkileyen ilaç kullanımı dışlama kriterlerini oluşturdu. Lomber omurga ve femur KMY ölçümleri çift enerjili X-ışını absorbsiyometrisi ile yapıldı ve mutlak değerler ile T ve Z-skorları olarak raporlandı.
Bulgular
Grup 1 ve grup 2’nin sırasıyla ortalama yaşları 29,74±7,97 ve 32,02±7,73 yıl, vücut kitle indeksi (VKİ) değerleri 23,51±2,84 ve 24,76±3,17 idi. Yaş, cinsiyet, VKİ ve biyokimyasal parametreler açısından gruplar arasında anlamlı fark saptanmadı. Tüm T ve Z-skorlarının BJHS grubunda sağlıklı kontrollere kıyasla anlamlı düzeyde daha düşük olduğu belirlendi (p<0,05).
Sonuç
BJHS’li hastalarda KMY’nin azalmış olması, hipermobilitenin kemik yapısını olumsuz etkileyebileceğini düşündürmektedir. Bu nedenle BJHS’li bireylerin rutin değerlendirme kapsamında osteopeni veya osteoporoz açısından taranması önerilir.
Anahtar Kelimeler:
Eklem hipermobilitesi, benign eklem hipermobilite sendromu, kemik yoğunluğu, çift enerjili X-ışını absorbsiyometrisi
Kaynaklar
1Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C Semin Med Genet. 2017;175:148-57.
2Gulbahar S, Şahin E, Baydar M, Bircan C, Kizil R, Dursun H. Hypermobility syndrome increases the risk for low bone mass. Clin Rheumatol. 2006;25:511-4.
3Carroll MB. Hypermobility spectrum disorders: a review. Rheumatol Immunol Res. 2023;4:60-8.
4Sahin N, Baskent A, Cakmak A, Salli A, Ugurlu H, Berker E. Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome. Rheumatol Int. 2008;28:995-1000.
5Stillman BC, Tully EA, McMeeken JM. Knee joint mobility and position sense in healthy young adults. Physiotherapy. 2002;88:55-60.
6Simpson MR. Benign joint hypermobility syndrome: evaluation, diagnosis, and management. J Am Osteopath Assoc. 2006;106:531-6.
7Hall MG, Ferrell WR, Sturrock RD, Hamblen DL, McNally EG. The effect of the hypermobility syndrome on knee joint proprioception. Br J Rheumatol. 1995;34:121-5.
8Coussens M, Calders P, Lapauw B, Celie B, Banica T, De Wandele I, et al. Does muscle strength change over time in patients with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorder? An eight-year follow-up study. Arthritis Care Res (Hoboken). 2021;73:1041-8.
9Rombaut L, Malfait F, De Wandele I, Taes Y, Thijs Y, De Paepe A, et al. Muscle mass, muscle strength, functional performance, and physical impairment in women with the hypermobility type of Ehlers-Danlos syndrome. Arthritis Care Res (Hoboken). 2012;64:1584-92.
10Voermans NC, Knoop H. Both pain and fatigue are important possible determinants of disability in patients with the Ehlers-Danlos syndrome hypermobility type. Disabil Rehabil. 2011;33:706-7.
11Voermans NC, Knoop H, van de Kamp N, Hamel BC, Bleijenberg G, van Engelen BG. Pain in Ehlers-Danlos syndrome is common, severe, and associated with functional impairment. J Pain Symptom Manage. 2010;40:370-8.
12Coussens M, Banica T, Lapauw B, De Wandele I, Rombaut L, Malfait F, et al. Bone parameters in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder: a comparative cross-sectional study. Bone. 2023;166:116583.
13Rombaut L, Malfait F, De Wandele I, Mahieu N, Thijs Y, Segers P, et al. Muscle-tendon tissue properties in the hypermobility type of Ehlers-Danlos syndrome. Arthritis Care Res (Hoboken). 2012;64:766-72.
14Tagliaferri C, Wittrant Y, Davicco MJ, Walrand S, Coxam V. Muscle and bone, two interconnected tissues. Ageing Res Rev. 2015;21:55-70.
15Rombaut L, Malfait F, De Wandele I, Thijs Y, Palmans T, De Paepe A, et al. Balance, gait, falls, and fear of falling in women with the hypermobility type of Ehlers-Danlos syndrome. Arthritis Care Res (Hoboken). 2011;63:1432-9.
16DiFrancisco-Donoghue J, Southard V, Margulies M, Jung MK, Allera A, Riley B. Assessment of gastrointestinal function and its effect on bone mineral density and body composition in hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome. J Clin Densitom. 2022;25:536-43.
17Dolan AL, Hart DJ, Doyle DV, Grahame R, Spector TD. The relationship of joint hypermobility, bone mineral density, and osteoarthritis in the general population: the Chingford Study. J Rheumatol. 2003;30:799-803.
18Guarnieri V, Castori M. Clinical relevance of joint hypermobility and its impact on musculoskeletal pain and bone mass. Curr Osteoporos Rep. 2018;16:333-43.
19Mishra MB, Ryan P, Atkinson P, Taylor H, Bell J, Calver D, et al. Extra-articular features of benign joint hypermobility syndrome. Br J Rheumatol. 1996;35:861-6.
20Banica T, Coussens M, Verroken C, Calders P, De Wandele I, Malfait F, et al. Higher fracture prevalence and smaller bone size in patients with hEDS/HSD: a prospective cohort study. Osteoporos Int. 2020;31:849-56.
21Luder G, Coussens M, De Wandele I, Malfait F, Rombaut L. Correlation of muscle and bone parameters, daily function and participation in women with generalized joint hypermobility: a descriptive evaluation. J Musculoskelet Neuronal Interact. 2022;22:15-26.
22Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32:413-8.
23Porter JL, Varacallo M. Osteoporosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
24Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175-91.
25Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175:8-26.
