Study of the prevalence of musculoskeletal abnormalities, particularly arthritis, in children with Down’s syndrome in the Glasgow population

Todd, Maureen Ann (2015) Study of the prevalence of musculoskeletal abnormalities, particularly arthritis, in children with Down’s syndrome in the Glasgow population. MSc(R) thesis, University of Glasgow.

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Down’s syndrome (DS) is associated with multiple musculoskeletal (MSK) features, including
hypermobility and inflammatory arthritis. MSK disorders are not included in the screening
programme for these children and correct diagnosis of MSK problems can be missed or delayed.
This study aimed to identify and examine the population of children with DS resident in Greater
Glasgow to determine the frequency of musculoskeletal disorders and the levels of associated
physical disability, particularly hypermobility, podiatric disorders, arthritis and obesity levels.
Between Jan 2011-2012 147 children with DS, aged between two and sixteen years and resident in
Greater Glasgow and Clyde Health Board by postcode were identified from the Glasgow Thyroid
and community paediatricians’ register. They were invited to a single study visit encompassing
musculoskeletal and podiatric examinations, anthropometric measurements and completion of
study questionnaires. Focus groups were carried out to establish knowledge of MSK disorders in
professionals likely to encounter this population.
Seventy three children participated in the study. A high level of hypermobility was identified,
characterized by predominance in the weight bearing joints of the lower limbs, especially hips
(77%), ankles (56%) and feet (59%). Standard measures of hypermobility failed to identify the
extent and severity of hypermobility in these children, identifying only 15% of children as having
hypermobility syndrome. No new cases of arthritis were identified in the study cohort. Families
reported a lack of expression of pain. Ten percent of the cohort were obese, compared to 20% in
the UK cohort from which DS growth charts are derived. Focus groups identified concerns from
professionals about knowledge and skills in identifying musculoskeletal problems in these children,
and challenges in ascribing an appropriate diagnosis.
This study identified barriers to care for a range of MSK pathologies in DS which targeted
education and disease specific structuring of services could address. Rheumatologists found that
expectations for MSK functioning in this population were low. Education focusing on the
recognition and accurate assessment of altered or deteriorating MSK function is required. Severe
and extensive hypermobility combined with altered expression of pain were found in this
population, adding diagnostic challenges. Current MSK examination tools for hypermobility and
hypotonia did not perform well in this population. Current health screening structures, the
education and expectations of those providing health screening were identified as further barriers to
MSK diagnosis. Facilitating early and accurate MSK diagnosis through the development of MSK
examination tools, targeted education and structuring services for this population are important for
the MSK and broader health of these children.

Item Type: Thesis (MSc(R))
Qualification Level: Masters
Keywords: Musculoskeletal, Down's syndrome, hypermobility, JIA
Subjects: R Medicine > RJ Pediatrics
Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
Supervisor's Name: Gardner-Medwin, Dr. Janet
Date of Award: 2015
Depositing User: Mrs Maureen A Todd
Unique ID: glathesis:2015-6225
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 01 Apr 2015 08:40
Last Modified: 01 Apr 2015 11:35

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