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Beyond bones: The relevance of variants of connective tissue (hypermobility) to fibromyalgia, ME/CFS and controversies surrounding diagnostic classification: an observational study

Jessica A Eccles, Beth Thompson, Kristy Themelis, Marisa L Amato, Robyn Stocks, Amy Pound, Anna-Marie Jones, Zdenka Cipinova, Lorraine Shah-Goodwin, Jean Timeyin, Charlotte R Thompson, Thomas Batty, Neil A Harrison, Hugo D Critchley and Kevin A Davies
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DOI: https://doi.org/10.7861/clinmed.2020-0743
Clin Med January 2021
Jessica A Eccles
ABrighton and Sussex Medical School, Falmer, UK, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK and Sussex Partnership Foundation NHS Trust, Brighton, UK
Roles: clinical senior lecturer
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  • For correspondence: j.eccles@bsms.ac.uk
Beth Thompson
BBrighton and Sussex Medical School, Falmer, UK
Roles: medical student
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Kristy Themelis
CBrighton and Sussex Medical School, Falmer, UK
Roles: post-doctoral research fellow
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Marisa L Amato
DBrighton and Sussex Medical School, Falmer, UK
Roles: PhD student
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Robyn Stocks
BBrighton and Sussex Medical School, Falmer, UK
Roles: medical student
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Amy Pound
EBrighton and Sussex Medical School, Falmer, UK and Sussex Partnership Foundation NHS Trust, Brighton, UK
Roles: research assistant
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Anna-Marie Jones
FSussex Partnership Foundation NHS Trust, Brighton, UK
Roles: statistician
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Zdenka Cipinova
GBrighton and Sussex University Hospitals NHS Trust, Brighton, UK
Roles: research nurse
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Lorraine Shah-Goodwin
GBrighton and Sussex University Hospitals NHS Trust, Brighton, UK
Roles: research nurse
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Jean Timeyin
GBrighton and Sussex University Hospitals NHS Trust, Brighton, UK
Roles: research nurse
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Charlotte R Thompson
HBrighton and Sussex University Hospitals NHS Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK
Roles: senior lecturer in rheumatology
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Thomas Batty
IBrighton and Sussex Medical School, Falmer, UK and Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
Roles: medical education fellow
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Neil A Harrison
JBrighton and Sussex Medical School, Falmer, UK and Cardiff University Brain Research Imaging Centre, Cardiff, UK
Roles: professor
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Hugo D Critchley
KBrighton and Sussex Medical School, Falmer, UK, University of Sussex, Falmer and Sussex Partnership Foundation NHS Trust, Brighton, UK
Roles: chair in psychiatry
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Kevin A Davies
LBrighton and Sussex University Hospitals NHS Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK
Roles: chair in medicine
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    Fig 1.

    CONSORT diagram showing participant recruitment and flow through the study.

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    Fig 2.

    The significant interaction of meeting Brighton criteria for joint hypermobility syndrome on the association between patient group and interoceptive sensibility. a) Does not meet Brighton criteria for joint hypermobility syndrome. b) Meets Brighton criteria for joint hypermobility syndrome. SEM = standard error of the mean.

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    Summary

    What is known?
    Fibromyalgia and ME/CFS are poorly understood conditions with overlapping symptoms. Complexity may have contributed to consideration of both as functional or somatic disorders. Shared symptoms have fuelled debate as to whether they are manifestations of the same spectrum or separate entities. Both are associated with hypermobility.
    What is question?
    What is the contribution of variants in connective tissue (eg symptomatic joint hypermobility) to chronic pain and fatigue in fibromyalgia and ME/CFS? To what degree do these conditions overlap?
    What was found?
    From a research perspective, fibromyalgia and ME/CFS are almost indistinguishable. Variant connective tissue is highly prevalent and frequently overlooked in fibromyalgia and ME/CFS. Aspects of hypermobility diagnostic classification, particularly historical joint laxity, predict pain and fatigue symptomatology in these conditions.
    What is implication for practice now?
    All physicians will be facing the challenge of assessing possible ‘post-viral fatigue’ in the wake of COVID-19. Patients presenting with pain and fatigue should be assessed for hypermobility, particularly historical joint laxity in order to help inform multidisciplinary treatment targets and consideration of known comorbidities (eg autonomic dysfunction).

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Beyond bones: The relevance of variants of connective tissue (hypermobility) to fibromyalgia, ME/CFS and controversies surrounding diagnostic classification: an observational study
Jessica A Eccles, Beth Thompson, Kristy Themelis, Marisa L Amato, Robyn Stocks, Amy Pound, Anna-Marie Jones, Zdenka Cipinova, Lorraine Shah-Goodwin, Jean Timeyin, Charlotte R Thompson, Thomas Batty, Neil A Harrison, Hugo D Critchley, Kevin A Davies
Clinical Medicine Jan 2021, 21 (1) 53-58; DOI: 10.7861/clinmed.2020-0743

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Beyond bones: The relevance of variants of connective tissue (hypermobility) to fibromyalgia, ME/CFS and controversies surrounding diagnostic classification: an observational study
Jessica A Eccles, Beth Thompson, Kristy Themelis, Marisa L Amato, Robyn Stocks, Amy Pound, Anna-Marie Jones, Zdenka Cipinova, Lorraine Shah-Goodwin, Jean Timeyin, Charlotte R Thompson, Thomas Batty, Neil A Harrison, Hugo D Critchley, Kevin A Davies
Clinical Medicine Jan 2021, 21 (1) 53-58; DOI: 10.7861/clinmed.2020-0743
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