Joint hypermobility syndrome, commonly known as biarticular syndrome, can be a common but underrecognized disorder in adults that is difficult to diagnose and often mistaken for fibromyalgia or other conditions.

So said Matthew B. Carroll, MD, board certified rheumatologist at Singing River Health System, Ocean Springs, Mississippi, during a presentation on hypermobility at the American College of Physicians San Diego 2023 Annual Internal Medicine Meeting.

According to Carroll, the concept of dual joint hypermobility spectrum disorder (HSD) is relatively new and is not part of the accepted nomenclature.

“One of the frustrations with HSD is that there aren’t really any good theories” as to why some people with hypermobility get the syndrome and others don’t, Carroll said.

Hypermobility is determined by the presence of joints who are freer than usual. Examples of this include excessive extension of the forearm at the elbow or pressing the thumb against the surface of the forearm.

About 20% of the adult population has hypermobility that affects women more often than men and is more common in younger people. In children aged 3 to 19 years, 32% girls and 18% of boys are hypermobile.

But this condition is not a diagnosis, “it’s a description of a finding that you notice on a physical examination,” Carroll said.

When flexibility is a problem

Although hypermobility is often benign and rarely leads to more serious health problems, HSD can cause symptoms such as recurrent dislocations, joint pain, and other degenerative changes. Recent evidence suggests that hypermobility may also be accompanied by abnormal bleeding.

A 2013 survey in the United Kingdom found that about 3% of respondents reported pain due to their hypermobility. Carroll hypothesized that up to a quarter of people diagnosed with hypermobility have some associated pain.

“We kind of think of hypermobility as either a benign behavior or you have it as a kid and grow out of it,” Carroll said. “But the reality is that many of our patients retain this into adulthood and may have problems as a result.”

Because some of the symptoms of HSD, such as abdominal pain and fatigue, mimic other pain sensations throughout the body, especially fibromyalgia, Carroll said it’s probably underdiagnosed.

“I think a lot of these patients have been diagnosed with fibromyalgia,” Carroll said. “We need to start looking into some of these nuances, or at the very least ask a rheumatologist to help you and others figure out where you can go with these patients and their health.”

Causes of GDM

HSD can be both genetic and environmental in nature; You should also consider sports injuries, spontaneous dislocations and fear of injuries leading to a sedentary lifestyle. The state may overlap with Ehlers-Danlos syndromesa rare group of hereditary conditions that affect tissue connectivity.

The management of patients with HSD requires a multidisciplinary approach, including primary care, rheumatology, genetics, and orthopedics. If primary care physicians suspect that their patient has hypermobility, they should investigate this possibility before moving on to another diagnosis. Determination of the presence or absence of joint mobility in an adult through a series of simple questions:

• Can you bend your thumb to touch your forearm?

• As a child, did you entertain your friends by giving your body weird shapes?

• Do you consider yourself two-faced?

“It gets very confusing and it’s really hard to understand, but I think it’s something that takes time in an iterative process to understand,” Carroll said.

Treatment options for HSD are limited. There are no pharmacological agents available to treat diseases, and interventions in general lack rigorous research to support their use. Carroll recommends anti-inflammatory drugs and physical therapy as first line approaches. He also emphasized that lifestyle changes, especially exercise and weight loss, are essential. The role of surgery is currently unclear and is used only in extremely select cases. An appointment with a geneticist may also be necessary to review family history and identify Ehlers-Danlos syndromes.

“You’re going to need several different specialists to try and really help our patients get back to normal,” he said.

Carroll reported no relevant financial relationship.

2023 American College of Physicians (ACP-IM) Internal Medicine Meeting Submitted April 28, 2023

Robert Fulton is a journalist based in Los Angeles.

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CNN
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Is it time for another Covid-19 booster vaccine? Many people are asking this question to their doctors given what happened last week – the U.S. Food and Drug Administration has amended its authorization to allow a second bivalent booster for certain individuals most vulnerable to severe effects from Covid. -19. Subsequently, the U.S. Centers for Disease Control and Prevention approved the FDA update and added additional clinical considerations to guide healthcare professionals and patients.

I have a lot of questions. Who is eligible for second bivalent boosters? Is the composition of the booster the same as before? If someone got a booster now, can they get another booster in the fall? What if someone is not in any of these high-risk groups but lives with a high-risk family member? And how has the guidance changed for people who have not yet received their first booster and those who remain unvaccinated?

To find answers to some questions, I contacted CNN Medical Analyst, Dr. Jones. Lena Ven. Emergency Physician and Professor of Health Policy and Management at the Milken Institute School of Public Health, George Washington University. She previously served as Baltimore’s Health Commissioner.

CNN: Can you give us a major update – who is now eligible for a second? divalent booster?

Dr. Leana Wen: There are two groups that can now receive a second bivalent booster.

First, these are people aged 65 and over. From the beginning of the pandemic, we have known that the elderly are among those most exposed to the severe effects of Covid-19. These people may receive a second bivalent booster if at least 4 months have passed since their first bivalent injection.

Secondly, these are people with a weakened immune system. New CDC guidance says that anyone 6 years of age or older with moderate or severe immunodeficiency can receive a second bivalent revaccination if at least two months have passed since the first. They should also consult with their physicians; Depending on their specific medical circumstances, they may receive a bivalent booster dose every two months.

CNN: Is the composition of the booster the same as before?

To whom: The bivalent booster I’m talking about is an updated booster that first became available in the fall of 2022 and targets both the original coronavirus strain and the BA.4/BA.5 omicron sub-variants. Studies have shown that this booster continues to be effective against widely circulating strains when it comes to important indicators of reducing severe disease. Those who were recently eligible for a second try will receive this bivalent booster again. It is not possible to select the original mono shot, and no other type of booster is available.

CNN: If someone gets a booster now, can they get another booster in the fall?

To whom: Perhaps an updated version of the booster will be released in the fall that will more specifically target the dominant variants in circulation. Individuals who have recently become eligible for a second bivalent booster dose are vulnerable individuals who will almost certainly be the same first groups eligible for another Covid-19 vaccine in the fall. All of this is to say that people should not be discouraged from revaccinating now, thinking that this will prevent them from using another vaccine in the future.

CNN: What if someone is not in any of these high-risk groups but lives with a high-risk family member?

To whom: This man himself would not have the right. There are vaccines for Covid-19 very well reduces the risk of hospitalization and death for a person who has been vaccinated. For a short time, it reduces the risk of infection, but this effect is muted and temporary. Federal health officials did not allow family members or caregivers of high-risk individuals to receive a second bivalent booster, and I think this is the right decision based on scientific evidence.

There are other ways to reduce the risk of contracting Covid-19 and passing it on to someone close to you. These methods include regular testing, especially when symptoms are present or after contact with an infected person, and wearing a high-quality mask in crowded areas.

CNN: How has the guidance changed for people who haven’t had their first booster yet, and for those who remain unvaccinated?

To whom: it’s actually quite a lot has changed. The CDC aims to simplify vaccine recommendations and has made several important changes.

To begin with, the bivalent vaccine will be the only vaccine available. The original monovalent vaccine will no longer be used, even in people who have not yet been vaccinated. This will help simplify the administration of vaccines, as pharmacies no longer need to keep both types of vaccines in stock.

In addition, unvaccinated people aged 6 years and older will be considered vaccinated if they have received only one dose of a Pfizer-BioNTech or Moderna bivalent booster dose. The thought here is that most unvaccinated people in this age group have already contracted Covid-19, and one dose of a refreshed booster dose is enough to provide additional protection.

People who have previously received a coronavirus vaccine will still need at least one dose of a bivalent booster dose to be considered up-to-date. That is, even if a person received three or more doses of the original monovalent vaccines, they are still not considered up-to-date unless they received at least one bivalent dose. This is an important point as CDC data show that less than one in five people eligible for the first bivalent dose have received it; This means that, according to their new definition, less than one in five Americans previously considered fully vaccinated are actually up to date with their Covid-19 vaccines.

CNN: What’s the bottom line – should people who are newly eligible for boosters do so right away?

To whom: I think people who have recently qualified for the program should talk to their doctors about what is right for them. The CDC has issued a so-called permissive recommendation, which means people can opt for an extra booster dose if they so choose. A generally healthy 65-year-old man who has recently recovered from Covid-19 may wait until autumn to receive another booster. But an 89-year-old man with kidney disease, a history of stroke, and a history of heart attacks who is not eligible to take Paxlovid antiviral treatment may need every possible level of protection, including an additional booster dose.

In my opinion, this lenient approach to supplemental boosters is in line with the situation we are in at this stage of the Covid-19 pandemic: people should choose the level of protection that is best for them based on their individual medical circumstances.

Egypt has accused Netflix of distorting history by casting a black woman as Cleopatra, the most famous historical character, in the new series.

‘Queen Cleopatra’, which comes out May 10, starring Adele James, is a casting decision that the streaming giant speaks is “an homage to the centuries-old talk about the race of the ruler,” but officials in Cairo dismissed it as “a blatant historical error.”

A government statement released Thursday marked an escalating feud that sparked demands for the show to be canceled amid a broader debate over popular culture representation.

The eight-episode docudrama is executive produced by Jada Pinkett-Smith.

But the Egyptian Ministry of Tourism and Antiquities argued that the documentary nature of the film “requires those responsible for its production to verify accuracy and rely on historical and scientific facts.”

Coins and statues of that time depict a fair-skinned woman, which corresponds to the Macedonian Greek origin of Cleopatra.

Dr. Mostafa Waziri, Secretary General of the High Council of Antiquities, said in a statement that Cleopatra’s appearance in the show was “a falsification of Egyptian history and a blatant historical error”.

He added that his complaint is “far from ethnic racism, emphasizing full respect for African civilizations and for our brothers on the African continent, which unites us all.”

The portrayal of historical figures on screen has sparked heated debate around the world, but especially in a country as rich in history as Egypt, which has made its ancient past a huge part of its modern national identity and tourism industry.

The famous queen who was crowned by Cleopatra VII and reigned from 51 to 30 BC. as its last ruler. She was a direct descendant of Ptolemy I Soter, bodyguard of Alexander the Great and founder of the Greek-speaking Ptolemaic kingdom.

After her much-discussed and staged death – self-inflicted snakebite, according to popular legend. Egypt became a Roman colony.

Roman writers, including Plutarch and Cassius Dio, famous for their chronicles of the Roman and Greek world during the reign of Cleopatra, said that Cleopatra was fair-skinned and of Macedonian origin.

Other scientists argued perhaps she could have been a quarter Egyptian.

“The Egyptians didn’t have the traits of sub-Saharan Africans,” the doctor said. Samia Al-Mirgani, former director general of the Center for Research and Preservation of Antiquities, in a statement citing data from anthropological studies and DNA tests.

The inscriptions on ancient tombs and statues, she argued, “depict [ancient] Egyptians with features as close as possible to modern Egyptians. However, she acknowledged that there was “great diversity” among the Egyptians due to the changing, international nature of the kingdom.

One of Egypt’s most famous archaeologists and twice minister of antiquities, Zahi Hawass, was adamant: Cleopatra was not black.

“If we see the statues and forms of her father and brother, we will not find any evidence to support this claim that she was black,” the statement said.

Hawass added that Egypt during the reign of Cleopatra ruled over the Kingdom of Kush, also known as Nubia, in what is now Sudan and southern Egypt, with its distinctive black African culture. “But they have nothing to do with the civilization of the pharaohs,” he said.

A change.org petition calling for the show to be canceled said it had over 100,000 signatures before its launch. disabled without warning. NBC News reached out to Change.org to find out if the petition was taken down, and if so, why.

Both Netflix and Nutopia, the production company behind Queen Cleopatra, did not immediately respond to requests for comment.

Egyptian lawmaker Sabura al-Sayed this week echoed an earlier call for a nationwide ban on Netflix.

This is not the first time the casting for the role of Cleopatra has been controversial. Israeli actress Gal Godot made headlines in 2020 when she was cast in an upcoming film, sparking accusations of “white wash.”

Writing in Variety last week, director of the upcoming show Tina Garani wrote that as a child she watched Elizabeth Taylor’s Hollywood portrayal of Cleopatra but always questioned the accuracy of the casting: “I was fascinated, but even then I felt the portrayal was wrong.” . That she really has such white skin?

She states that while the queen was a descendant of a Macedonian, “Cleopatra was eight generations from these Ptolemaic ancestors, making the possibility of her being white somewhat unlikely.”

Garani wrote that the casting of the black actress was a political act that resulted in her being the target of an online hate campaign.

“Why shouldn’t Cleopatra be a melanized sister? And why do some people want Cleopatra to be white? Her affinity for white seems to give her value, and for some Egyptians, that really matters,” she said.

James, the actress who plays the iconic queen, lashed out at critics in a recent post on twitter with screenshots of offensive comments containing racist slurs. “If you don’t like casting, don’t watch the show,” she said.