شیوع سندرم شلی مفصلی مشترک و اختلال پانیک: کنترل مورد مطالعه

A significant association between joint hypermobility syndrome (JHS) and panic disorder was observed in a sample of rheumatology outpatients. Objective The aim of this study was to assess whether JHS is more frequent in panic-disorder than in control subjects. Method The authors conducted a case–control study comparing 55 untreated patients with panic disorder and three matched-control groups: psychiatric patients, fibromyalgia patients, and healthy persons. Results JHS was more frequent among panic-disorder than among psychiatric patients, the healthy group, or the fibromyalgia group. In the panic-disorder group, there was a significant correlation between severity of JHS and anxiety. Conclusion The strong association between JHS and panic disorder points to a genetic association. There is also a possibility that JHS and mitral valve prolapse, another condition frequently associated with panic disorder, share a common pathophysiological mechanism.

Joint hypermobility syndrome (JHS) is a highly hereditary clinical condition characterized by increased distensibility of joints in passive movements and hypermobility in active movements.1 Its prevalence in the general population appears to range between 10% and 15%, and it is more common in women than in men.1 Although JHS often goes unnoticed, affected individuals may suffer from repeated injuries of the musculoskeletal system,2 so its early diagnosis is recommended to avoid these complications. A significant association between JHS and panic disorder was observed in a sample of rheumatology outpatients.3,4 There is also a report on the high association of panic disorder and/or agoraphobia with JHS (the odds ratio [OR] compared with psychiatric control subjects was 18.6, and the OR compared with medical control subjects was 14.7).5 Also, another study relates JHS to both state and trait anxiety (the former with less intensity) in the general population.6 The magnitude of the JHS and panic disorder association, uncommon in medical research, points to a causal connection between these two conditions. Gratacós et al.7 identified an interstitial duplication of the human chromosome 15q24–26 (named DUP25), which was significantly associated with panic/agoraphobia/social phobia/joint laxity in families, and with panic disorder in nonfamilial cases. Mosaicism, different forms of DUP25 within the same family, and absence of segregation of 15q24–26 markers with DUP25, and the associated psychiatric phenotypes, suggest a non-Mendelian mechanism of diseasecausing mutation. These authors7 proposed that DUP25, which is present in 7% of the control subjects, is a susceptibility factor for a clinical phenotype that includes panic and phobic disorders and joint laxity. However, this genetic finding was not confirmed by two other research groups, who achieved different results.8,9

The strong association between JHS and panic disorder points to a genetic association. There is also a possibility that JHS and mitral valve prolapse, another condition frequently associated with panic disorder, share a common pathophysiological mechanism.