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JHS v EDS Hypermobility- Same Thing?

Posted By Alan Hakim, August 30, 2013

Is there a difference between Joint Hypermobility Syndrome (JHS) and Ehlers Danlos – Hypermobility Type (EDS-HM)?

The following opinion is a consensus view of the HMSA Medical Advisors

The most important thing to appreciate is that the investigations, management, and advice are exactly the same for both JHS and EDS-HM.

Joint Hypermobility Syndrome (JHS) and Ehlers Danlos Syndrome – Hypermobility Type (EDS-HM) are the most common of the hypermobility conditions. The terminology can get a little confusing because some experts will use them inter-changeably. Also EDS-HM was formerly called EDS-Type III, but the numbering nomenclature for the various types of EDS has changed.

The criteria for diagnosing JHS (the Brighton Criteria) arose from recognizing an association between hypermobility, injury to joints and soft tissues around joints, and pain. Initially it included things like mild variants of the skin changes described above, and the often-found body shape called the marfanoid habitus (see below). It then developed further over the last decade as associations with, for example, bowel, autonomic cardiovascular, and pelvic floor problems became clear. These new findings, however, are not yet incorporated into the formal criteria for JHS.

The criteria for EDS-HM are based on observation that one can find minor clinical features of the more rare variants of EDS in some people and that they are also hypermobile and may experience pain. These might include clinical findings such as severe dislocations, more florid skin signs and in particularly its elasticity, a large curvature of the spine (a scoliosis), prolapse of the mitral valve of the heart, or association with dental or gum disease. However, these patients will also exhibit the same findings as those described for JHS.

Also, currently there is no genetic test that can identify either condition or separate them.

Therefore, some experts now consider JHS and EDS-HM to be the same thing albeit derived from different clinical perspectives. Whether EDS-HM or JHS is diagnosed is a clinical judgement. There is no absolute medical consensus on this matter. A doctor might, for example, use one term rather than the other dependent on the type and severity of issues present. EDS-HM might be the preferred name to give an individuals’ condition if there are findings such as those described above (severe dislocations, more florid skin signs, etc.). However, again only for example, the term JHS might be the preferred term if the principle issue is one of joint pain around hypermobile non-dislocating joints with few other signs.

Dr Alan Hakim MA FRCP

Consultant Rheumatologist and Physician, Barts Health NHS Trust, London

Chief Medical Adviser and Trustee, HMSA

Written August 2013. Planned date of review 2016.


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