重新书写关节过度活动综合征/埃勒斯-当洛斯综合征(关节过度活动型)疼痛及相关症状的自然病史。

Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

机构信息

Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy.

出版信息

Am J Med Genet A. 2013 Dec;161A(12):2989-3004. doi: 10.1002/ajmg.a.36315. Epub 2013 Nov 6.

Abstract

Joint hypermobility syndrome (JHS) and Ehlers-Danlos syndrome, hypermobility type (EDS-HT) are two clinically overlapping connective tissue disorders characterized by chronic/recurrent pain, joint instability complications, and minor skin changes. Fatigue and headache are also common, although are not yet considered diagnostic criteria. JHS/EDS-HT is a unexpectedly common condition that remains underdiagnosed by most clinicians and pain specialists. This results in interventions limited to symptomatic and non-satisfactory treatments, lacking reasonable pathophysiologic rationale. In this manuscript the fragmented knowledge on pain, fatigue, and headache in JHS/EDS is presented with review of the available published information and a description of the clinical course by symptoms, on the basis of authors' experience. Pathogenic mechanisms are suggested through comparisons with other functional somatic syndromes (e.g., chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders). The re-writing of the natural history of JHS/EDS-HT is aimed to raise awareness among clinical geneticists and specialists treating chronic pain conditions about pain and other complications of JHS/EDS-HT. Symptoms' clustering by disease stage is proposed to investigate both the molecular causes and the symptoms management of JHS/EDS-HT in future studies.

摘要

关节过度活动综合征(JHS)和埃勒斯-当洛斯综合征,过度活动型(EDS-HT)是两种具有临床重叠的结缔组织疾病,其特征为慢性/复发性疼痛、关节不稳定并发症和轻微的皮肤改变。疲劳和头痛也很常见,尽管它们尚未被视为诊断标准。JHS/EDS-HT 是一种出乎意料的常见疾病,大多数临床医生和疼痛专家都未能对此做出正确诊断。这导致干预措施仅限于对症和不满意的治疗,缺乏合理的病理生理依据。本文通过对现有文献的回顾,以及基于作者经验对症状的临床病程描述,阐述了 JHS/EDS 中疼痛、疲劳和头痛的零碎知识。通过与其他功能性躯体综合征(如慢性疲劳综合征、纤维肌痛和功能性胃肠疾病)的比较,提出了发病机制的假设。重写 JHS/EDS-HT 的自然病史,旨在提高治疗慢性疼痛疾病的临床遗传学家和专家对 JHS/EDS-HT 的疼痛和其他并发症的认识。通过疾病阶段的症状聚类,拟在未来的研究中探讨 JHS/EDS-HT 的分子病因和症状管理。

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