Pain in patients with Ehlers-Danlos syndrome (EDS) due to arthritis in the joint that attaches the thumb to the hand can be successfully managed with surgery, according to researchers from the Mayo Clinic.
Their study, “Thumb carpometacarpal arthritis in patients with Ehlers-Danlos Syndrome: non-operative and operative experiences,” was published in the Journal of Hand Surgery.
EDS is a genetic connective tissue disorder characterized by joints that easily move beyond the normal range, a condition called hyperlaxity or joint hypermobility.
Previous studies have reported that patients with hyperlaxity syndromes, including EDS, tend to develop hypermobility or even small dislocations in the carpometacarpal (CMC) joint, located at the base of the thumb where it’s attached to the hand.
Instability in the CMC joint predisposes patients to develop arthritis, which is mainly characterized by joint pain and stiffness.
Despite this clinical scenario, little evidence exists to support treatment choices or even discuss the prognosis of EDS-related CMC arthritis.
Researchers conducted a retrospective analysis of patients with CMC thumb arthritis and a coexisting EDS diagnosis who were followed at a medical center from 1999 to 2016.
In total, the study analyzed data from nine patients and 14 thumbs; eight of these patients were diagnosed with EDS. Patients were followed for an average of 5.9 years. Six thumbs were treated surgically, and eight thumbs were treated nonsurgically.
Nonsurgical management of the patient’s symptoms was based on prescribed rest and anti-inflammatory medications. But this approach failed to bring significant improvements in grip strength, pinch, or self-reported pain between the initial consult and the final follow-up.
Those who were managed with surgery showed a significant improvement in their pain after surgery — 83% of the patients in the preoperative period reported severe pain, compared to 0% (none of the patients) in the postoperative period.
There was also a trend toward increased grip strength in this group of patients compared to those who weren’t treated with surgery.
Researchers also pinpointed several risk factors for CMC arthritis, such as aging, female gender, and heavy labor status. One of the nine patients analyzed was a heavy labor worker, while eight out of nine patients were female, suggesting that female gender is more predisposed to CMC arthritis in the EDS population.
The results suggest that patients who develop EDS-associated CMC arthritis and are refractory to conservative approaches can be successfully managed with surgical intervention, resulting in pain relief and increased hand strength.
According to the Mayo Clinic team, “since this study represents the most extensive description of the operative and non-operative course of patients with EDS-associated thumb CMC arthritis, we believe these findings can help guide and inform clinicians discussing treatment and prognosis with these relatively uncommon patients.”
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