Optimization of Therapy in Patients with Lower Back Pain Depending on the Presence of Benign Joint Hypermobility Syndrome

Lower back pain is pain that is localized in the lower back, buttocks, and sacroiliac area. Lower back pain is the most common reason for limiting physical activity in patients under 45 years of age. If we take into account both acute and chronic pain. Lower back pain is the most common complaint after colds and minor injuries. At the same time, even a thorough examination may not always reveal the cause of lower back pain. There is evidence of more frequent development of pain in the lower back on the background of benign joint hypermobility syndrome. Lower back pain in patients with benign joint hypermobility syndrome is usually assessed on the basis of visual analog scale data and is quite subjective. To assess the severity of changes in the lumbar spine, an ultrasound method can be used, one of the options of which is elastometry, which allows to determine the stiffness of the studied tissues, in particular to assess muscle tone. Muscle relaxants are commonly used for therapy, but it is usually not possible to assess their effect on actual muscle relaxation. The purpose of our study was to determine the effectiveness of using muscle relaxants in patients with lower back pain and benign joint hypermobility syndrome by performing elastometry of the iliopsoas muscles in these patients. Material and methods. To achieve this goal, we examined 65 patients with lower back pain aged 45.62±2.24 years, among them there were 32 women and 33 men. Patients with impaired limb sensitivity, muscle weakness, pelvic dysfunction, severe pain at night, fever and unmotivated weight loss, history of cancer, etc. were excluded from the study. To participate in the study, all patients underwent X-ray and ultrasound examination of the hip joints, in the presence of signs of osteoarthritis, patients were excluded from the study. Among the patients examined by the Bayton criteria, 26 patients were diagnosed with benign joint hypermobility syndrome, among them were 19 women and 7 men. We used shear wave elastometry to determine the stiffness of the distal lumbosacral muscle. A visual analog scale of pain with a gradation from 1 to 10 was used to determine the severity of the pain syndrome. After the diagnosis of lower back pain, patients were prescribed anti-inflammatory therapy in the form of 100 mg of diclofenac per day and tizanidine 4 mg 3 times a day for two weeks. After two weeks, the examination of patients was repeated. Results and discussion. In patients with lower back pain, the initial values of iliopsoas muscle stiffness were 11.85±1.37 kPa on the right and 12.1±1.45 kPa on the left, in patients with signs of benign joint hypermobility syndrome and lower back pain, the stiffness was iliopsoas muscle were 12.64±1.42 kPa on the right and 12.49±1.67 kPa on the left. No statistically significant difference was found between the studied groups. The severity of pain in the group of patients with lower back pain without benign joint hypermobility syndrome was 7.98±1.45, in patients with lower back pain and signs of benign joint hypermobility syndrome was 7.67±1.33 After 2 weeks of therapy in patients with lower back pain without signs of benign joint hypermobility syndrome, the lumbar-iliac muscle stiffness was 7.69±1.23 kPa on the right and 7.98±1.38 kPa on the left, the difference with the initial values was significant (p <0.05). In patients with signs of benign joint hypermobility syndrome and lower back pain after treatment, the lumbar-lumbar muscle stiffness was 10.29±1.97 kPa on the right and 10.89±1.75 kPa on the left. The difference was significant (p <0.05) both with the initial indicators and with the indicators of the group of patients with lower back pain without signs of benign joint hypermobility syndrome. The severity of pain on the visual analog scale in the group of patients with lower back pain without benign joint hypermobility syndrome after therapy was 3.49±1.98, in patients with lower back pain and signs of benign joint hypermobility syndrome was 5.21±1.43. The difference was significant (p <0.05) both with the initial indicators and with the indicators of the group of patients with lower back pain without signs of benign joint hypermobility syndrome and had a clear correlation with the indicators of lumbar-iliac muscle stiffness according to shear wave elastometry (r = 0.63, p = 0.032) Conclusion. Thus, the use of tizanidine in therapy can reduce the stiffness of the lumbosacral muscles of the back and reduce the intensity of pain in patients with lower back pain. At the same time, the patient's presence of benign joint hypermobility syndrome significantly reduced the degree of muscle relaxation and provoked greater resistance to pain therapy. The use of shear wave elastometry allows controling the quality of treatment in the dynamics. At the same time, there is a need to study the possibility of using this method of research in other spastic changes in the muscular system, which should be a prospect for further research

Indicators of Elasticity of the Iliopsoas Muscle in Patients with Pain in the Lower Part of the Back due to the Manifestation of the Benign Joint Hypermobility Syndrome

Pain in the lower back is a highly urgent problem that leads to a decrease in the quality of life of a large number of patients in the modern world. At the same time, the causes of pain in the lower back are different and their combination has not been sufficiently studied to date. It is known that the presence of benign joint hypermobility syndrome in a patient significantly worsens the course and manifestations of pain in the lower back. One of the components of pain in the lower back is changes in the iliopsoas muscle. This is psoas syndrome. At the same time, the diagnosis of psoas syndrome in practical medicine is complicated by the lack of specific laboratory tests and imaging techniques. The purpose of this work was to study the possibilities of determining the tension of the iliopsoas muscle using shear wave elastometry in patients with pain syndrome in the lower back and the difference between their tensions depending on the presence of benign hypermobility syndrome in patients. Material and methods. We examined 83 patients with lower back pain aged 42.31±1.54 years, 41 were female and 42 were male. To participate in the study, all patients underwent X-ray and ultrasound examination of the hip joints. Patients were excluded from the study in the presence of signs of osteoarthritis. To determine the presence of signs of hypermobility of the joints, we used the criteria of Baiton; the diagnosis was made on condition of obtaining more than 5 points. Among the patients examined by the Bayton criteria, 18 patients were diagnosed with benign joint hypermobility syndrome, among them 13 women and 5 men. As a control group, we selected 15 patients aged 45.6±1.74 years without complaints of pain in the lumbar region of the back and hips and without signs of benign joint hypermobility syndrome. We used shear wave elastometry to determine the stiffness of the distal parts of the lumbosacral muscle. A visual analog scale of pain (from 1 to 10) was used to determine the severity of the pain syndrome. Conclusion. We found that all patients with complaints of pain in the lower back had a significantly higher tension of the iliopsoas muscle in comparison with the group of conditionally healthy patients. The increase in tension had a strong correlation with the severity of pain syndrome according to the data of the visual analogue scale. Indicators of muscle tissue rigidity did not depend on the presence and severity of benign joint hypermobility syndrome

Association between Exposure to Beta 2 Agonists and Corticosteroids and Acquiring Benign Joint Hypermobility Syndrome among Asthmatic Patients: a Case-Control Study

Background:Beta2 (β2) agonists as relievers and corticosteroids as controllers are the mainstay drugs for asthma treatment. Benign Joint Hypermobility Syndrome (BJHS) is a connective tissue disorder with musculoskeletal symptoms.We had examined the possible association between the use of β2 agonists and corticosteroids and acquiring BJHS in asthmatic patients.Methods:This was a case-control, hospital-based study including a group of asthmatics who had BJHS (cases), compared with a matched group of asthmatics without BJHS (controls) for the β2 agonists and corticosteroids past and current pattern of use. Information was collected by face-to-face interview and clinical examination and from subjects’ medical records using pre-structured questionnaire. BJHS diagnosis was based on the revised Brighton criteria. Asthma severity was reflected by a score, which was calculated from the asthma questionnaire. Comparison of exposure was done by Calculation of Odds Ratio.Results:Development of BJHS was found to be significantly associated with chronicity of asthma of average duration of 13.2 years, and hence to prolonged use of β2 agonists and/or corticosteroids (OR 1.019; 95% CI 0.999 - 1.039, P=0.006)Exposure to β2 agonist and corticosteroid (87 and 79 cases and controls respectively P=0.05)high asthma score (42.9 ± 9.8 and 40.4 ± 8.3 among cases and controls respectively, P=0.011) were significantly associated with the development of BJHS.