Hypermobility spectrum disorder — SCE Rheumatology MCQ

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ModerateOsteoarthritis and Soft Tissue RheumatologyHypermobility spectrum disorderSCE Rheumatology

A 23-year-old woman has recurrent ankle sprains, shoulder subluxations and diffuse musculoskeletal pain. Beighton score is 7/9. Skin is soft but without marked fragility or atrophic scarring. Echocardiogram is normal and inflammatory markers are normal. What is the most likely diagnosis?

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Correct answer: E — Hypermobility spectrum disorder

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · A = shown as D · C = shown as E

Hypermobility spectrum disorder is best because generalised joint hypermobility with subluxations and pain but no inflammatory features suggests hypermobility spectrum disorder. A is less suitable because ankylosing spondylitis causes inflammatory back pain and sacroiliitis; B is less suitable because dermatomyositis causes rash and weakness; D is less suitable because systemic sclerosis causes Raynaud's and skin thickening; E is less suitable because RA would cause persistent synovitis. Clinical pearl: hypermobility pain is mechanical and proprioceptive rather than synovitic.

Reference: Oxford Textbook of Rheumatology