THU0594 Shiari-javadi criteria for the diagnosis of generalised joint hypermobility in children
Authors: R. Shiari, V.J. Parvaneh
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Benign joint hypermobility syndrome (BJHS) is the occurrence of musculoskeletal symptoms in hypermobile individuals in the absence of systemic rheumatologic disease.<sup>1–3</sup>One of the most common criteria for the evaluation of generalised joint hypermobility is Beighton's criteria. However, Beighton criteria were designed for all ages not specifically for children group (according to the children physiological and growth characteristics). Inability to identify limited hypermobility, failure to differentiate generalised joint hypermobility from joint hypermobility syndrome and BJHS and the restrictions on the use of epidemiological studies are further limitations.<sup>4, 5</sup> <h3>Objectives</h3> Because of the disadvantages of the existing criteria and the high prevalence of generalised joint hypermobility in children, we decided to propose further modifications to Beighton criteria for the diagnosis of joint hypermobility. <h3>Methods</h3> A case–control study was designed with 200 participants from 3 to 16 years of age with 100 children with BJH (according to Beighton criteria) in case group and 100 age-sex matched children as control group. Cases were selected from outpatients Clinic of Rheumatology and the control group was selected from the emergency department of hospital. The case group consisted of children who had musculoskeletal pain complaints or were suspected to be hypermobile. The Beighton criteria were used as the gold standard, and all of cases fulfilled the Beighton criteria. In addition, the participants in the control group should be free of chronic disease or musculoskeletal complaints. For the determination of new criteria we performed literature review on the range of motion in different age and gender paediatric groups, studied the various existing criteria and their differences, and utilised our own clinical observations. Eight manoeuvres were set for examination (Fig 1). All were bilateral, except the neck hyperextension. <h3>Results</h3> There were 42 (42%) male children in each group. The mean age was 6.8 years. Table 2 compares the results of the new and Beighton criteria in both cases and controls. All cases were hypermobile, and two of the 100 controls were hypermobile with the new criteria. Based on these results, new proposed criteria had the sensitivity, specificity, positive predictive value and negative predictive value of 100%, 98%, 100% and 98% respectively. <h3>Conclusions</h3> Shiari–Javadi criteria appears to be useful for detecting hyper mobility. In addition, they have also overcome many of the disadvantages of the Beighton criteria, and are easier, more practical and more comprehensive to be used in children. However, further studies are required to validate this criteria. <h3>References</h3> [1] Al-Rawi ZS, Al-Rawi ZT. Joint hypermobility in women with genital prolapse. Lancet1982;1:1439–1441. [2] Birrell FN, Adebajo AO, Hazleman BL, Silman AJ. High prevalence of joint laxity in West Africans. Br J Rheumatol1994;33:56–59. [3] Klemp P, Williams SM, Stansfield SA. Articular mobility in Maori and European New Zealanders. Rheumatology. 2002;41:554–557. [4] Beighton PH, Grahame R, Bird HA, eds. In: Hypermobility of Joints 4th ed. Berlin: Springer 2012. [5] Ross J, Grahame R. Easily missed? Joint hypermobility syndrome. BMJ2011;342:7167. <h3>Acknowledgements</h3> We would like to extend our sincer gratitude to all members of Paediatric Rheumatology Ward in Mofid Children Hospital and speciall thanks to Miss Elham Musavi. <h3>Disclosure of Interest</h3> None declared