Question

What conditions are associated with ligamentous laxity first appearing in adulthood? Are there any specific treatments? Could use of nonsteroidal anti-inflammatory drugs (NSAIDs) aggravate the condition due to cartilaginous breakdown? Several of my active female patients have fibromyalgia-like symptoms seemingly triggered by exercise, associated with audible joint crepitance and demonstrable sacroiliac (SI) joint laxity.

Louise B. Andrew, MD

Response from Robert Terkeltaub, MD

This question touches on a "bread and butter" issue seen by clinicians, ie, differentiating benign joint hypermobility (including SI joint laxity) from potentially serious connective tissue disorders. In heritable connective tissue disorders associated with joint hypermobility (such as Marfan syndrome and Ehlers-Danlos syndrome types I-III, VII, and XI), the joint laxity usually is apparent before adulthood. However, age of onset and extent of joint laxity are variable in Marfan syndrome, and joint laxity may be confined to the hands alone, as in Ehlers-Danlos syndrome type IV.

An estimated 5% to 12% of the adult population has some degree of generalized joint hypermobility associated with ligamentous laxity, but not with features of Marfan or Ehlers-Danlos syndromes. The hypermobility syndrome appears to be familial in many cases and has a clear-cut female predominance, with symptoms first becoming evident in children or young adults. Such individuals are blessed with a potentially heightened aptitude for activities such as gymnastics, dancing, and playing musical instruments, but may have an increased susceptibility to dislocations, traumatic joint pain, tendinitis, and overuse injuries. This problem may present as a fibromyalgia-like syndrome triggered by exercise, and possibly similar to what the questioner is describing. It is unlikely that any effects of NSAIDs on cartilage metabolism would worsen such a problem. Some subjects with benign hypermobile joints may benefit from prophylactic splinting or taping of affected joints before injury-provoking physical activities.

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