Modest association of joint hypermobility with disabling and limiting musculoskeletal pain: results from a large-scale general population-based survey

Objective

To determine the population prevalence of joint hypermobility (JH) and to test the hypothesis that JH would be associated with reporting musculoskeletal pain.

Methods
We conducted a cross-sectional population survey in Aberdeen and Cheshire. A total of 45,949 questionnaires were mailed that assessed JH and the presence, distribution, duration, and severity of musculoskeletal pain. Based on their pain reports, participants were classified as having chronic widespread pain (CWP), some pain, or no pain. Multinominal logistic regression tested the relationship between JH and pain status. Associations were adjusted for age, sex, and other putative confounders. Participants with no pain were the referent category.

Results
A total of 12,853 participants (28.0%) returned a questionnaire with complete data; 2,354 participants (18.3%) were classified as hypermobile. A total of 2,094 participants (16.3%) had CWP, 5,801 participants (45.1%) had some pain, and 4,958 participants (38.6%) reported no pain. JH participants were significantly more likely to report CWP than non-JH participants (18.5% versus 15.8%; P < 0.001). After adjusting for age and sex, hypermobile participants were 40% more likely to report the most severe CWP (relative risk ratio [RRR] 1.4, 95% confidence interval [95% CI] 1.1–1.7; P < 0.00). After further adjustments for employment status, smoking, alcohol, and physical activity, JH remained significantly associated with the most severe CWP (RRR 1.6, 95% CI 1.3–2.1; P < 0.000) and some pain (RRR 1.3, 95% CI 1.02–1.6; P = 0.03).

Conclusion
JH was associated with severe pain; however, this relationship was not specific to CWP. The relationship was relatively modest and may be explained by unmeasured confounding factors such as psychological distress.