Joint Hypermobility and Associated Factors in Patients With Lipedema

Joint Hypermobility and Associated Factors in Patients With Lipedema: Turkish Population Data

The aim of this observational study is to determine the prevalence of joint hypermobility in female patients with lipedema compared to healthy volunteers. Additionally, the study investigates how the presence of hypermobility in lipedema patients relates to the clinical and ultrasonographic stage of the disease, regional pain severity, pain sensitivity, postural status (such as genu valgum and foot overpronation), quality of life, and physical activity levels. The study includes 65 female patients clinically diagnosed with lipedema and 65 healthy female volunteers matched for age and body mass index.

Study Overview and Design This research is designed as a cross-sectional, case-control observational study to investigate the prevalence of joint hypermobility in female patients with lipedema. The study cohort is divided into two matched groups: female patients clinically diagnosed with lipedema and a control group of healthy female volunteers strictly matched for age and Body Mass Index (BMI).

Primary and Secondary Objectives The primary objective of this study is to evaluate and compare the prevalence of generalized joint hypermobility (GJH) between the lipedema group and the healthy control group using the validated Beighton Scoring System.

The secondary objective focuses exclusively on the lipedema cohort to analyze the potential biomechanical and clinical impacts of hypermobility. It aims to determine the relationship between hypermobility status and various clinical parameters, including regional pain severity, pressure pain thresholds, lower extremity postural deviations, subcutaneous tissue thickness, and overall health-related quality of life.

Clinical Evaluations and Outcome Measures:

• Lipedema Staging and Ultrasonography: Patients undergo clinical staging (Stages 1 to 3) and typing (Types I to V) based on the anatomical distribution of the pathological adipose tissue. Subcutaneous adipose tissue thickness is measured bilaterally using a 7-11 MHz linear ultrasound probe at 6-8 cm proximal to the medial malleolus.
• Joint Hypermobility: Assessed globally using the Beighton Score. A threshold score of 5 or higher out of 9 is utilized to indicate the presence of generalized joint hypermobility.
• Pain Assessment: Evaluated through two distinct methods. Subjective pain intensity is recorded using a Visual Analog Scale (VAS, 0-10) across six bilateral anatomical regions (entire leg, thigh, knee, calf, ankle, and foot sole). Objective pain sensitivity is measured via pressure pain thresholds (kg/cm²) using a digital algometer applied bilaterally to the most painful areas of the lower extremities.
• Biomechanical and Postural Assessment: Static observational assessments are conducted to identify the presence of lower extremity mechanical deviations, specifically genu valgum and foot overpronation.
• Quality of Life and Physical Activity: Health-related quality of life is measured using the Nottingham Health Profile (NHP). The participants' physical activity levels and sedentary behaviors are quantified using the International Physical Activity Questionnaire - Short Form (IPAQ-SF).

Statistical Analysis:

Data analysis will be performed using IBM SPSS Statistics. Group comparisons for continuous variables will utilize independent samples t-tests or Mann-Whitney U tests, depending on data normality. Categorical variables will be analyzed using Chi-Square or Fisher's Exact tests. Correlation analyses will be conducted using Pearson or Spearman tests, and logistic regression models may be applied to evaluate independent factors associated with hypermobility.

Inclusion Criteria:

• For Lipedema Group:

Aged between 18-65 years. Diagnosed with lipedema. Willing to participate in the study. Having a socio-cultural level suitable for study participation.

• For Control Group:

Aged between 18-65 years. Willing to participate in the study. Having a socio-cultural level suitable for study participation.

Exclusion Criteria:

• For Lipedema Group:

Uncontrolled thyroid dysfunction. Chronic venous insufficiency and/or lymphedema (Stage 4 lipedema). Acute or chronic renal failure. Heart failure. Active cancer or ongoing cancer treatment. Presence of neurological disease. Presence of rheumatological disease. History of liposuction or major surgery for lipedema within the last 6 months. Visual or hearing impairment severe enough to affect study compliance. Illiteracy or cognitive impairment preventing the ability to give written informed consent.

• For Control Group:

Previous diagnosis of lipedema, lymphedema, chronic venous insufficiency. History of rheumatologic, neurologic, endocrinologic, or cardiovascular diseases.

Uncontrolled thyroid dysfunction. History of acute or chronic renal failure, heart failure, active cancer, or ongoing cancer treatment.

Orthopedic problems affecting lower extremities, trauma, or history of liposuction/major surgery within the last 6 months.

Regular use of medications that may affect pain threshold (e.g., systemic corticosteroids, antidepressants, anticonvulsants, etc.).

Physical barriers affecting pain assessment (algometry, VAS) or postural observation (e.g., severe vision/hearing loss, local skin lesions, amputation, etc.).

Cognitive impairment or lack of literacy preventing written informed consent. Psychiatric illness preventing compliance with the study process or communication problems affecting cooperation.