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Flexible Joints a Curious Clue to Chronic Fatigue Syndrome

Children with the condition often have hyperflexible joints, researchers find

SUNDAY, Sept. 3, 2006 (HealthDay News) -- Chronic fatigue syndrome has been accepted as a medical condition for almost 20 years. Once passed off as a series of sometimes ambiguous complaints about pain in the joints and a general malaise -- primarily by females -- the condition was confirmed by medical researchers as bona fide in 1988.

But classifying a painful physical condition as real doesn't necessarily mean that there is a specific treatment to make it better. What follows is a good example:

The young girl had been receiving treatment for chronic fatigue syndrome for three years before anyone at the Johns Hopkins Children's Center noticed her special condition.

In evaluating the girl's condition, Dr. Peter Rowe thought he had looked at everything. Then, a lab clinician made an offhand observation that the girl also had joints that could bend and twist much more than normal.

"I was chagrined that my physical examination had not included that. So, we decided to look into it," said Rowe, a professor of pediatrics.

What he and other researchers found was puzzling, to say the least.

Sixty percent of the 60 children and teens they treated for chronic fatigue syndrome also had hypermobility in at least four of their joints. Only 20 percent of the general public has a single hyperflexible joint, such as being able to bend a pinkie 90 degrees backward, touch the thumb to the forearm, or bend at the waist and rest both hands flat on the ground.

"It was a surprise," Rowe said of the discovery. "Some of the kids would be able to put their leg behind their head in a seated position. Others could do the splits. Once we saw this over and over, we thought it was something that needed more study."

Their findings, which appeared in The Journal of Pediatrics, added a vexing wrinkle to the current thinking on chronic fatigue syndrome.

In the past, some doctors regarded the syndrome as a psychosomatic byproduct of depression. And those who saw it as a legitimate illness could find few physiological signs of it.

"In the past, you had a tremendous amount of skepticism about [the syndrome], which created a certain amount of stigma for people who have it," said Leonard Jason, a professor of psychology and director of the Center for Community Research at DePaul University in Chicago.

The recent study, he added, "could ultimately lead to us understanding the physiology of this condition."

The syndrome affects four adults per 1,000, but fewer children. To be diagnosed with it, a person must have a sudden onset of fatigue that lasts at least six months. There must also be four of the following eight symptoms: impaired memory, sore throat, tender neck or tender lymph nodes in the arm pit, muscle pain, joint pain, new headaches, troubled sleep and a feeling of malaise after exertion.

Rowe emphasized that having hyperflexible joints doesn't mean a person will have the syndrome. Just how the two are related is little more than a guess, Rowe and Jason agreed.

Children develop joint mobility in their early years, while the syndrome doesn't generally show itself until puberty. It is difficult to find a causal relationship between the two, because not everyone who has the syndrome also has joint hypermobility, Rowe said.

Still, he wondered whether flexible joints may stress the peripheral nerves in the arms and legs, thereby fatiguing the entire nervous system, or the excessive range of motion may indirectly cause the syndrome.

"For example, if you're prone to injury because of your joints, you might decrease your activity, which studies have shown can lead to [the syndrome]," Rowe said.

To find better treatments for chronic fatigue syndrome, Rowe wants to study hyperflexible joints in greater depth, and test whether they are also more common in adults with the syndrome.

Jason, though, said research should be aimed at genetics.

"I think there may be some genetic factors. We really should look at the parents. There could very well be a number of things passed on that make kids more prone to [the syndrome]," Jason said.

More information

For more about chronic fatigue syndrome, visit the U.S. National Institutes of Health.

SOURCES: Peter Rowe, M.D., professor, pediatrics, Johns Hopkins Children's Center, Baltimore; Leonard Jason, Ph.D., professor, psychology, and director, Center For Community Research, DePaul University, Chicago; September 2002, The Journal of Pediatrics
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