Best Practice Case Studies-The Beighton Score as a Measure of Generalised Joint Hypermobility

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The Beighton Score (BS), a nine-point scoring system, is widely used to assess Generalised Joint Hypermobility (GJH). Initially developed as an epidemiological tool for large population screenings, it was later adopted for clinical diagnosis. However, its effectiveness and validity as a diagnostic tool have been questioned. The BS primarily focuses on upper limb joints, neglecting major joints, and fails to directly assess GJH. Studies show that the BS fails to identify hypermobility in joints outside its scoring range, indicating that it should not be the primary tool for differentiating between localized and general hypermobility or used alone to exclude GJH presence.<br /><br />The BS originated in 1964, devised by Carter and Wilkinson to explore associations with congenital hip dislocation. Beighton et al. subsequently modified it for epidemiological use in Africa. Despite its unchanged form since 1973, concerns arise due to its exclusion of several major joints and its reliance on an "all or nothing" scoring system. Additionally, the BS provides no guidance on testing method details, like whether to measure active or passive joint movements. Due to poor validation for adults and potential joint specificity, the BS's diagnostic capacity is questioned.<br /><br />Alternatives to the BS include the Rotès–Quérol and Hospital Del Mar scoring systems, although they are more time-consuming and less frequently used in practice. Research suggests the BS lacks correlation with several joint types, including shoulders and lower limbs, whereas it shows better correlation with upper limb joints. Various studies have demonstrated moderate intra- and inter-examiner reliability, but not consistently enough for clinical reliability.<br /><br />Demographic factors such as race, age, and sex influence BS cut-off points. The prevalence of hypermobility is higher in younger individuals and females, diminishing with age. As hypermobility diminishes, the risk of underdiagnoses increases, prompting discussions on adjusting cut-off values.<br /><br />In conclusion, while the BS remains a popular screening tool, it should not be solely relied upon for diagnosing GJH. Greater emphasis should be placed on clinical judgment and comprehensive assessments of additional joints, with the BS serving as an initial but not definitive tool. There is a clear need for a standardized diagnostic marker for hypermobility disorders.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 49

Topic Rheumatology

Keywords

3rd Edition, CASE 49

3rd Edition

Rheumatology

Beighton Score

Generalised Joint Hypermobility

diagnostic tool

epidemiological tool

joint assessment

upper limb joints

clinical diagnosis

joint specificity

alternative scoring systems

demographic factors