Background Clinical impressions suggest that joint hypermobility, a condition in which range of motion is greater than normal at most joints, is associated with osteoarthritis (OA), but results vary across the few published cohort studies on this subject. To our knowledge, no prior cohort study has examined the association of hypermobility and ankle radiographic features and symptoms of OA.
Objectives This cross-sectional analysis examined the association of joint hypermobility and ankle OA outcomes in a large community-based cohort in the United States.
Methods Of the 863 participants with complete tibiotalar radiograph data collected during 2012–2015, 848 had Beighton (joint hypermobility) data available for analyses. The Beighton criteria determined the ability to complete nine maneuvers: passive dorsiflexion right/left fifth finger ≥90 degrees, passive apposition right/left thumbs to forearm, right/left elbow hyperextension ≥10 degrees, right/left knee hyperextension ≥10 degrees, and palms on floor during forward trunk flexion with knees extended. One point was assigned for each completed maneuver (total score: 0 [unable to perform any maneuver] to 9 [performed all maneuvers]). Joint hypermobility was defined as a Beighton score ≥4; we also focused on the knee maneuver since the knee and ankle are closely linked along the kinetic chain. Radiographs were read for tibiotalar osteophytes (OST) and joint space narrowing (JSN). Presence of ankle symptoms consistent with OA was based on an affirmative response to the question: “On most days of any one month in the last 12 months did you have pain, aching or stiffness in your left/right ankle?” Separate logistic regression models were used to estimate associations of ankle OST, JSN, and symptoms with hypermobility, adjusting for covariates of gender, race, age, body mass index (BMI), and history of ankle injury. Statistical interactions between hypermobility and covariates were examined at the 0.10 significance level.
Results The sample was 68% women and 33% African American with a mean age of 71 years and mean BMI of 31 kg/m2. Hypermobiltiy was present in 59 participants (7.0%), which was most common among those <55 years (12.1%); 643 (75.5%) participants had OST, 65 (7.5%) had JSN, and 146 (17.2%) had ankle symptoms. Although not statistically significant, the adjusted odds of OST and ankle symptoms were 87% and 55% higher, respectively, among participants with vs. without hypermobility (Table). The adjusted odds of ankle symptoms was over 4 times as high among participants able vs. unable to perform the knee maneuver. There were no statistically significant interactions of hypermobility by covariates, but the estimates of the hypermobility-OST association generally increased with age (<55 years: adjusted odds ratio [aOR] = 1.02; 55–<65 years: aOR = 2.20, 65+years: aOR=2.88), while the hypermobility-ankle symptoms estimates declined (<55 years: aOR = 2.02; 55–<65 years: aOR = 1.68, 65+ years: aOR = 0.82).
Conclusions Joint hypermobility may be associated with OST and symptoms of the ankle. Longitudinal studies are needed to determine the contribution of hypermobility to the incidence and progression of ankle OA outcomes.
Disclosure of Interest None declared