> Dysautonomia Common in Joint Hypermobility Syndrome
>
> NEW YORK (Reuters Health) Jul 24 - Dysautonomia appears to be an
> extraarticular manifestation of joint hypermobility syndrome, according to
> results of a study conduced in Israel.
>
> To better understanding the pathophysiology of symptoms such as
orthostatic
> tachycardia and subjective hypohidrosis in patients with the syndrome, Dr.
> Giris Jacob, of Rambam Medical Center, Haifa, and colleagues evaluated the
> frequency of autonomic nerve system complaints and performed autonomic
> function tests in 48 consecutive patients and 30 sex- and age-matched
> healthy volunteers.
>
> According to their report in the American Journal of Medicine for July,
all
> 48 patients and 3 volunteers had at least five orthostatic symptoms for at
> least 6 months. Patients commonly experienced presyncopal symptoms,
> palpitations, chest discomfort, fatigue and heat intolerance.
>
> Even though there were no cardiovagal abnormalities, the patients
exhibited
> signs of dysregulated sympathetic nervous system control. For example, the
> drop in systolic blood pressure during hyperventilation averaged 11 mm Hg
in
> patients and 5 mm Hg in controls.
>
> Patients also exhibited hyperresponsive reactions to beta-1 and alpha-1
> adrenoreceptors, as evidenced by lower doses of isoproterenol and
> phenylephrine required to increase heart rate or systolic blood pressure.
>
> These patients generally don't require extensive autonomic function
testing,
> Dr. Jacob told Reuters Health. "The main thing is to get a complete
medical
> history regarding the autonomic nervous system, and hemodynamic data, such
> as blood pressure and heart rate in the supine position and after standing
> for 5 minutes."
>
> He believes that pharmacologic treatment is required only when quality of
> life is compromised significantly by the autonomic symptoms. "A high-salt
> diet, extra fluid intake, and physical therapy to strengthen the muscles
in
> the lower extremities proved to be very helpful," he said.
>
> He and his colleagues are now planning to do genetic studies in patients
> with hypermobile joint syndrome, and to look at the pathophysiology of
blood
> vessels.
>
> Am J Med 2003;115:33-40.
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>
>
> Reuters Health Information 2003. © 2003 Reuters Ltd.