POS1149 HYPERMOBILITY SPECTRUM DISORDERS IN SEVERE CHRONIC PAIN SYNDROMES: EVALUATING THE PERFORMANCE OF BEIGHTON SCORE VERSUS CLINICAL ASSESSMENT
Authors: P. Ming Azevedo, J. Mettler, T. Hügle
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Research indicates an elevated prevalence of chronic pain (CP) in individuals with Hypermobility Spectrum Disorders (HSD) compared to the general population. The widely employed Beighton score (BS) serves as a primary method for screening joint manifestations in HSD, with age-related variations requiring adaptive cut-offs. Notably, patients with chronic pain syndromes (CPS) may experience decreased joint flexibility, potentially leading to an underestimation of the BS and consequent underdiagnosis of HSD within this population. <h3>Objectives:</h3> To evaluate the performance of BS compared to clinical assessment of hypermobility in a cohort of patients with severe CPS. <h3>Methods:</h3> This study included 318 patients with chronic pain syndromes (CPS) who completed a 2-week inpatient Multidisciplinary Pain Program (MMP) at a tertiary center in Lausanne, Switzerland. Comprehensive clinical and epidemiological data were collected at program entry, and patients were followed for three months. Of the participants, 294 (92.4%) underwent hypermobility assessments, with 209 evaluated by experienced physicians using BS adjusted to age according to The International Consortium on Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders guidelines and 285 through clinical anamnesis (CA). 200 patients were evaluated by both methods (Figure 1). CA involved reviewing medical records for prior HSD diagnoses, assessing joint hypermobility not included in the BS, considering personal histories of hypermobility-related indicators (recurrent joint dislocations and sprains, skin hyperextensibility, unexplained stretch marks, atrophic scarring, piezogenic papules of the heel, recurrent hernia or hernia in more than one site), and examining family histories for related disorders. Sensitivity, specificity, and Receiver Operating Characteristic (ROC) curve of the BS were determined using clinical history as a reference. Additionally, the study identified key clinical and epidemiological differences between subgroups assessed by the two methods. <h3>Results:</h3> The prevalence of hypermobility in our cohort of CPS is of 30.9% according to CA evaluation and 24.4% with BS. The ROC curve indicates a sensitivity and specificity respectively of of 63.6% and 98.4% for the BS. The area under de curve is 0.8, indicating a good performance of the BS in this severe CPS population (Figure 2). Notably, patients with HSD according to BS tended to have higher scores of the Pain Disability Index (PDI) questionary, reflecting greater functional impact (p=0.026), lower alexithymia levels (p=0.004), and a reduced use of SSRI antidepressants compared to hypermobile patients identified through CA (p=0.022). <h3>Conclusion:</h3> We confirm a high prevalence of hypermobility among this severe cohort of CPS patients consistently identified by two evaluation methods. Although it is possible that age adjusted-BS underdiagnoses HSD in this population, the method retains reasonable sensitivity and high specificity compared to a detailed CA. Patients with HSD by BS exhibited slightly distinctive clinical features in comparison with CA, emphasizing lower levels of alexithymia and functional disability according to PDI. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>