Ask the Doctors June 2005 Issue

Ask Dr. Marks: 06/05

I can hyperextend my elbows and my wrists. Iíve been told I may have joint hypermobility syndrome. Is it anything to worry about?

A hypermobile joint is a joint that moves beyond its normal range of motion. Although it is estimated that 10 to 15 percent of normal children have hypermobile joints, they usually grow up with normal joint function. A subgroup of people with loose joints, however, have hypermobility joint syndrome. There is a tendency for the condition to run in families. People who have it, because their joints are less stable, are more prone to sprains and dislocations, and an injured joint that is poorly aligned can lead to early arthritis. They are also more likely to have curvature of the spine (scoliosis).

Joint hypermobility syndrome is usually considered to be a relatively benign condition that does not require specific treatment. The condition can be helped, however, by keeping muscles adjacent to a loose joint as strong as possible to protect the joint against injury.


I have gout and have been told I should avoid purines. What foods contain purines?

Purines are found in large quantities in liver, kidney, brains, and other organ meats. More important to an American diet are the purines found in seafood, such as herring, mackerel, and anchovies; other meats, fish, beans, and vegetables contain smaller amounts of purines. Purines should be avoided in patients with a history of gout because they can be converted to uric acid by the body (gout is either the overproduction of uric acid or the underexcretion of uric acid, leading to hyperuricemia). In addition to avoiding foods that contain purines, you should avoid alcohol, since it can also trigger a gout attack.

To a large extent, gout is determined by genetics and gender. Premenopausal woman rarely have an attack of gout, but after† menopause women are at the same risk as men.

The role of purines has been downplayed in recent years, since dietary management is very restrictive and has been of limited value. The treatment of gout currently depends on medications that decrease the inflammation (NSAIDs), reduce the production of uric acid (allopurinal), or increase the excretion of uric acid (probenecid).


What can you tell me about Stillís Disease? Iíve had rheumatoid arthritis since childhood, and with it has come Stillís Disease, which I understand is difficult to diagnose. When it flares, it attacks my internal organs and lasts approximately seven months. It usually doesnít affect my joints, but it is accompanied by extremely high fever.

Stillís Disease in children is more commonly called ďsystemic juvenile rheumatoid arthritis.Ē The adult form of this disease is very uncommon. In this condition, the patient can experienceóin addition to high feveróa rash and sometimes joint pain. It may be accompanied by inflammation of the covering of the heart, which is called pericarditis, or inflammation of the lining of the lungs, which is pleurisy. There may also be an enlargement of the lymph nodes, liver, or spleen.

Stillís Disease is diagnosed by excluding other diseases that exhibit similar symptoms. Similarly to rheumatoid arthritis, it is treated with NSAIDs, prednisone, and, in some cases, immunosuppressive medications. Fifty percent of patients will develop chronic arthritis after one or more attacks of Stillís Disease.