Jacqui Clinch

Obesity is a risk factor for musculoskeletal pain in adolescents: findings from a population-based cohort.

Summary Obesity is associated with the occurrence and severity of several musculoskeletal pain phenotypes, including knee pain and chronic regional pain in adolescents. Abstract Obesity is a risk factor for fibromyalgia in adults, but whether a similar relationship exists in children is uncertain. This study examined whether obesity is associated with reporting of musculoskeletal pain, including chronic regional pain (CRP) and chronic widespread pain (CWP), in adolescents, in a population‐based setting. A pain questionnaire was administered to offspring of the Avon Longitudinal Study of Parents and Children at age 17, asking about site, duration, and pain intensity, from which participants with different types of musculoskeletal pain were identified. Relationships between obesity and pain were examined by calculating odds ratios stratified by gender and adjusted for socioeconomic status as reflected by level of maternal education. A total of 3376 participants (1424 boys) with complete data were identified, mean age 17.8; 44.7% of participants reported any pain within the last month lasting 1 day or longer; 16.3% reported lower back pain, 9.6% shoulder pain, 9.4% upper back pain, 8.9% neck pain, 8.7% knee pain, 6.8% ankle/foot pain, 4.7% CRP, and 4.3% CWP; 7.0% of participants were obese. Obesity was associated with increased odds of any pain (odds ratio [OR] 1.33, P = .04), CRP (OR 2.04, P = .005), and knee pain (OR 1.87, P = .001), but not CWP (OR 1.10, P = .5). Compared with non obese participants, those with any pain, knee pain, and CRP reported more severe average pain (P < .01). Obese adolescents were more likely to report musculoskeletal pain, including knee pain and CRP. Moreover, obese adolescents with knee pain and CRP had relatively high pain scores, suggesting a more severe phenotype with worse prognosis.

Epidemiology of Generalized Joint Laxity (Hypermobility) in Fourteen-Year-Old Children From the UK: A Population-Based Evaluation

Objective Although diagnostic criteria for generalized ligamentous laxity (hypermobility) in children are widely used, their validity may be limited, due to the lack of robust descriptive epidemiologic data on this condition. The present study was undertaken to describe the point prevalence and pattern of hypermobility in 14-year-old children from a population-based cohort. Methods We performed a cross-sectional analysis using the Avon Longitudinal Study of Parents and Children, a large population-based birth cohort. Hypermobility among children in the cohort (mean age 13.8 years) was measured using the Beighton scoring system. Objective measures of physical activity were ascertained by accelerometry. Data on other variables, including puberty and socioeconomic status, were collected. Simple prevalence rates were calculated. Chi-square tests and logistic regression analyses were used to assess associations of specific variables with hypermobility. Results Among the 6,022 children evaluated, the prevalence of hypermobility (defined as a Beighton score of ≥4 [i.e., ≥4 joints affected]) in girls and boys age 13.8 years was 27.5% and 10.6%, respectively. Forty-five percent of girls and 29% of boys had hypermobile fingers. There was a suggestion of a positive association between hypermobility in girls and variables including physical activity, body mass index, and maternal education. No associations were seen in boys. Conclusion We have shown that the prevalence of hypermobility in UK children is high, possibly suggesting that the Beighton score cutoff of ≥4 is too low or that this scoring is not appropriate for use in subjects whose musculoskeletal system is still developing. These results provide a platform to evaluate the relationships between the Beighton criteria and key clinical features (including pain), thereby testing the clinical validity of this scoring system in the pediatric population.

Joint Hypermobility Is a Risk Factor for Musculoskeletal Pain During Adolescence: Findings of a Prospective Cohort Study

OBJECTIVE To determine whether joint hypermobility (JH) in childhood is a risk factor for the subsequent development of musculoskeletal pain. METHODS JH was determined according to the Beighton score at age 13.8 years in children from the Avon Longitudinal Study of Parents and Children (ALSPAC), using a cutoff of ≥6 for the presence of hypermobility. Musculoskeletal pain was evaluated by questionnaire at age 17.8 years. Logistic regression analysis was performed in 2,901 participants (1,267 boys and 1,634 girls) who had complete data. RESULTS A total of 4.6% of participants had JH at age 13.8 years. Moderately troublesome musculoskeletal pain at age 17.8 years was reported most commonly in the lower back (16.1%), shoulder (9.5%), upper back (8.9%), knee (8.8%), neck (8.6%), and ankle/foot (6.8%). JH was associated with an increased risk of at least moderately troublesome musculoskeletal pain at the shoulder (odds ratio [OR] 1.68 [95% confidence interval (95% CI) 1.04, 2.72]), knee (OR 1.83 [95% CI 1.10, 3.02]), and ankle/foot (OR 1.82 [95% CI 1.05, 3.16]) (adjusted for sex, maternal education, and body mass index). An equivalent relationship was not observed at other sites, including the spine, elbows, hands, and hips. In analyses examining interactions with obesity, associations between JH and knee pain showed higher ORs in obese participants (OR 11.01) as compared with nonobese participants (OR 1.57) (P=0.037 for the interaction of hypermobility and obesity). CONCLUSION JH represents a risk factor for musculoskeletal pain during adolescence, comprising a specific distribution, namely, the shoulder, knee, and ankle/foot. These relationships were strongest in the presence of obesity, which is consistent with a causal pathway whereby JH leads to pain at sites exposed to the greatest mechanical forces.

Hypermobility is a risk factor for musculoskeletal pain in adolescence: Findings from a prospective cohort study

OBJECTIVE To determine whether joint hypermobility (JH) in childhood is a risk factor for the subsequent development of musculoskeletal pain. METHODS JH was determined according to the Beighton score at age 13.8 years in children from the Avon Longitudinal Study of Parents and Children (ALSPAC), using a cutoff of ≥6 for the presence of hypermobility. Musculoskeletal pain was evaluated by questionnaire at age 17.8 years. Logistic regression analysis was performed in 2,901 participants (1,267 boys and 1,634 girls) who had complete data. RESULTS A total of 4.6% of participants had JH at age 13.8 years. Moderately troublesome musculoskeletal pain at age 17.8 years was reported most commonly in the lower back (16.1%), shoulder (9.5%), upper back (8.9%), knee (8.8%), neck (8.6%), and ankle/foot (6.8%). JH was associated with an increased risk of at least moderately troublesome musculoskeletal pain at the shoulder (odds ratio [OR] 1.68 [95% confidence interval (95% CI) 1.04, 2.72]), knee (OR 1.83 [95% CI 1.10, 3.02]), and ankle/foot (OR 1.82 [95% CI 1.05, 3.16]) (adjusted for sex, maternal education, and body mass index). An equivalent relationship was not observed at other sites, including the spine, elbows, hands, and hips. In analyses examining interactions with obesity, associations between JH and knee pain showed higher ORs in obese participants (OR 11.01) as compared with nonobese participants (OR 1.57) (P=0.037 for the interaction of hypermobility and obesity). CONCLUSION JH represents a risk factor for musculoskeletal pain during adolescence, comprising a specific distribution, namely, the shoulder, knee, and ankle/foot. These relationships were strongest in the presence of obesity, which is consistent with a causal pathway whereby JH leads to pain at sites exposed to the greatest mechanical forces.

Epidemiology of generalised joint laxity in 14 year old children from the UK: a population-based evaluation

Purpose Although diagnostic criteria for generalised joint laxity in children are widely used, they may have limited validity as robust descriptive epidemiology of this condition is lacking.Therefore, we used a large population-based birth cohort to describe the point prevalence and pattern of generalised joint laxity in children aged 14 years old from Bristol and the surrounding area in the South West UK.

Hypermobility is a risk factor for musculoskeletal pain in adolescence

OBJECTIVE To determine whether joint hypermobility (JH) in childhood is a risk factor for the subsequent development of musculoskeletal pain. METHODS JH was determined according to the Beighton score at age 13.8 years in children from the Avon Longitudinal Study of Parents and Children (ALSPAC), using a cutoff of ≥6 for the presence of hypermobility. Musculoskeletal pain was evaluated by questionnaire at age 17.8 years. Logistic regression analysis was performed in 2,901 participants (1,267 boys and 1,634 girls) who had complete data. RESULTS A total of 4.6% of participants had JH at age 13.8 years. Moderately troublesome musculoskeletal pain at age 17.8 years was reported most commonly in the lower back (16.1%), shoulder (9.5%), upper back (8.9%), knee (8.8%), neck (8.6%), and ankle/foot (6.8%). JH was associated with an increased risk of at least moderately troublesome musculoskeletal pain at the shoulder (odds ratio [OR] 1.68 [95% confidence interval (95% CI) 1.04, 2.72]), knee (OR 1.83 [95% CI 1.10, 3.02]), and ankle/foot (OR 1.82 [95% CI 1.05, 3.16]) (adjusted for sex, maternal education, and body mass index). An equivalent relationship was not observed at other sites, including the spine, elbows, hands, and hips. In analyses examining interactions with obesity, associations between JH and knee pain showed higher ORs in obese participants (OR 11.01) as compared with nonobese participants (OR 1.57) (P=0.037 for the interaction of hypermobility and obesity). CONCLUSION JH represents a risk factor for musculoskeletal pain during adolescence, comprising a specific distribution, namely, the shoulder, knee, and ankle/foot. These relationships were strongest in the presence of obesity, which is consistent with a causal pathway whereby JH leads to pain at sites exposed to the greatest mechanical forces.