Intended for healthcare professionals

Rapid response to:

Practice Easily Missed?

Joint hypermobility syndrome

BMJ 2011; 342 doi: (Published 20 January 2011) Cite this as: BMJ 2011;342:c7167

Rapid Response:

The relationship between Anxiety Disorders and Joint Hypermobility Syndrome is also easily missed

We are very interested in the paper by Ross and Grahame (1), which
reviewed diagnosis, prevalence, and clinical management of joint
hypermobility syndrome. We fully agree that joint hypermobility syndrome
is underrecognized and underdiagnosed. However, the relationship between
anxiety disorders and joint hypermobility syndrome, a very well-established clinical feature of the collagen condition, was also neglected
in the article.

A significant association has been found between joint hypermobility
syndrome and anxiety disorders (particularly panic, agoraphobia and social
phobia) in rheumatologic patients (2). Furthermore, joint hypermobility
syndrome has been found to be 16 times more likely in patients with panic
disorder than other outpatients after controlling for age and sex (3).

Interestingly, both joint hypermobility syndrome and anxiety disorders
have similar prevalence in the general population, between 10% and 15%,
and have similar female predominance (3:1).

Although there is still no simple explanation for this association,
it has been hypothesized that there is a common personality trait between
both conditions since a predisposing factor for trait anxiety was found in
subjects with joint hypermobility syndrome in general population samples
(4). There are now two active lines of research: one in cytogenetic
findings (which requires replication) (5) and another in the significant
high prevalence of autonomic nervous system symptoms (dysautonomia) in
joint hypermobility patients (6).

We strongly recommend to assess the lifetime prevalence of anxiety
disorders, especially panic disorder, in joint hypermobility patients.
Panic disorder is a proper medical condition, not merely a reaction caused
by another illness. These data could shed new light onto the challenging
and prevalent psychosomatic field.

1. Ross J, Grahame R. Joint hypermobility syndrome. BMJ. 2011;
342:275 -7.

2. Bulbena A, Dur? JC, Porta M, et al. Anxiety disorder in the joint
hypermobility syndrome. Psychiatry Res 1993;43:59-68.

3. Mart?n-Santos R, Bulbena A, Porta M, et al. Association between the
joint hypermobility syndrome and panic disorder. Am J Psychiatry

4. Bulbena A, Agullo A, Pailhez G, et al. Is joint hypermobility related
to anxiety in a non-clinical population also? Psychosomatics 2004;45:432-7.

5. Gratac?s M, Nadal M, Mart?n-Santos R, et al. A polymorphic genomic
duplication on human chromosome 15 is a major susceptibility genetic
factor for panic and phobic disorders. Cell. 2001;106:367-379.

6. Gazit Y, Nahir AM, Grahame R, Jacob G. Dysautonomia in the joint
hypermobility syndrome. Am J Med. 2003;115:33-40.

Competing interests: No competing interests

11 February 2011
Antonio Bulbena
Guillem Pailhez, Carolina Baeza, Andrea Bulbena-Cabre
Institute Neuropsychiatry Addictions Mar