Rheumatology 2003; 42: 491
© 2003 British Society for Rheumatology
Letters to the Editor |
Hypermobility in New Zealand
Hypermobility Clinics, UCL Hospitals, 50–60 Tottenham Street, London WC1T 4NJ and Chapel Allerton Hospital, Leeds, West Yorkshire LS7 4SA, UK
SIR, The authors of the paper ‘Articular mobility in Maori and European New Zealanders' [1] are to be congratulated for accepting the challenge of conducting the first ever comparative ethnic epidemiological survey of hypermobility in New Zealand. While we accept the validity of their prevalence findings in respect of generalized hypermobility (GHM; Beighton score 
4/9), we are concerned that by excluding people with pauciarticular hypermobility (PHM; Beighton score <4/9), they may have introduced a serious bias into their study. It has been established that PHM has a far higher prevalence than GHM in the three populations in which it has so far been sought [2–4]. It follows that exclusion of PHM in the New Zealand study is likely to have seriously skewed the results and led to serious underestimation of the true prevalence of hypermobility and hypermobility syndrome in both the Maori and the European population.
The 1998 Brighton revised criteria for the Benign Joint Hypermobility Syndrome (BJHS) [5] takes account of the existence of PHM yet still permits a diagnosis of BJHS to be made provided other criteria are met. The authors acknowledge that the study was undertaken before the Brighton criteria were published. This does not, however, exonerate them from using outdated concepts and methods.
Notes
Correspondence to: R. Grahame. E-mail: rodneygrahame{at}aol.com 
References
- Klemp P, Willams SM, Stansfield SA. Articular mobility in Maori and European New Zealanders. Rheumatology 2002;41:554–7.
[Abstract/Free Full Text] - Larsson L-G, Baum J, Mudholkar GS, Kollia GD. Hypermobility: features and differential incidence between the sexes. Arthritis Rheum 1987;30:1426–30.[ISI][Medline]
- Verhoeven JJ, Tuinman M, van Dongen PW. Joint hypermobility in African non-pregnant nulliparous women. Eur J Obstet Gynecol Reprod Biol 1999;82:69–72.[Medline]
- Larsson L-G, Mudholkar GS, Baum J, Srivastava DK. Hypermobility: prevalence and features in a Swedish population. Br J Rheumatol 1993;32:116–9.
[Abstract/Free Full Text] - Grahame R, Bird HA, Child A et al. The British Society for Rheumatology Special Interest Group on Heritable Disorders of Connective Tissue Criteria for the Benign Joint Hypermobility Syndrome. The Revised (Brighton 1998) Criteria for the Diagnosis of the BJHS. J Rheumatol 2000;27:1777–9.[ISI][Medline]
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