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AB1411-HPR Hypermobility and fibromyalgia: coexistence or mistaken identity?
  1. P Donohue1,
  2. S. Chavrimootoo2,
  3. S. Ramakrishnan2
  1. 1Department Of Physiotherapy
  2. 2Department of Rheumatology, Our Lady’s Hospital, Navan, Meath, Ireland


Background The 2010 classification of fibromyalgia (FM) has many overlapping features with hypermobility-Ehler Danlos Syndrome (hEDS) such as chronic widespread musculoskeletal pain, sleep disturbances, fatigue and anxiety.2, 4, 5 Indeed hEDS may be misdiagnosed as FM because of diffuse pain with a strong myofascial component.1 Chopra1 believes these should be considered as two distinct conditions which may co-exist. By classifying as one and ignoring the other are we doing our clients a disservice?

The five point questionnaire (5PQ) is a simple questionnaire used to detect hypermobility and is claimed to have good reproducibility in addition to satisfactory sensitivity and specificity.3 This audit examined the numbers of FM clients that also fulfilled the hEDS criteria according to the 5PQ.

Methods 66 clients with a consultant diagnosis of FM who attended the multidisciplinary FM education session were invited to fill in the 5PQ along with their fibromyalgia impact questionnaire (FIQ). 57 of the 66 completed both questionnaires over a 13 month period.

The cut off points of 2 out of 5 for the 5PQ and 50 on the FIQ were used.

The higher numbers on the 5PQ indicate increased likelihood of hypermobility.

Around 50 on the FIQ is typical for FM with higher values indicating increased severity.

The individual scores for the FIQ question on anxiety were also examined. Question 19 rates anxiety on a visual analogue scale from 0–10, the higher values indicating increased levels of anxiety.

Results 54 females and 3 males aged between 18 and 76, mean age 51.

15 of the 57 (26%) scored 2 or above on the 5PQ suggestive of hypermobility.

Of those 15, 10 (66%) scored greater than 50 on the FIQ thus meeting the criteria of FM also.

7 of the 15 (47%) scored 8 or above on the anxiety scale.

Conclusions From this audit 26% of FM clients also scored positively for hEDS as per the 5PQ. hEDS may account for some or all of their FM symptoms.

The 5PQ is a quick and easy tool to use. It may improve hEDS detection rates and could be used in a busy rheumatology clinic.

Further research is required to ascertain whether those with positive scores meet the physical criteria for hEDS.

References [1] Chopra P, Tinkle B, Hammonet C, Brock I, Gompel A, Bulbena A, Francomano C, 2017. Pain management in the Ehlers-Danlos Syndromes. Am. J. Med. Genet. PartC Semin. Med Genet. 175C:212–219.

[2] Hakim AJ, Keer R, Grahame R, 2010.Hypermobility, Fibromyalgia and Chronic Pain. Churchill Livingstone Elsevier.

[3] Hakim AJ, Grahame R, 2003. A simple questionnaire to detect hypermobility: an adjunct to the assessment of patients with diffuse musculoskeletal pain. Int. J. Clin. Pract. 57:163–166, 2003b.

[4] Tinkle B, Castori M, Berglund B, Choen H, Grahame R, Kazkaz H, Levy H. 2017Hypermobile Ehlers-Danlos Syndrome (a.k.a Ehlers-Danlos Syndrome Type III and Ehlers-Danlos Syndrome Hypermobility Type): Clinical Description and Natural History. Am J Med Genet Part C Semin Med Genet175C48–69.

[5] Wolfe F, Clauw DJ, Fitzcharles M, Goldenberg DL, Katz RS, Mease P, Russel AS, Russel IJ, Winfield JB, Yumus MB. 2010The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & ResearchVol. 62, No. 5, May 2010, pp 600–610.

Disclosure of Interest None declared

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