Cracks in the Diagnosis: A Case of Hypermobility Spectrum Disorder as a Mechanical Mimic of Spondyloarthritis With a Brief Review
Abstract
Adolescents commonly present with chronic back and knee pain, and distinguishing mechanical from inflammatory causes is a frequent challenge in general and pediatric practice. Juvenile spondyloarthritis (jSpA) is a chronic inflammatory disease affecting joints, entheses, and potentially the axial skeleton that may require prolonged immunosuppression to prevent structural joint damage. Generalized joint hypermobility (GJH) and hypermobility spectrum disorder (HSD) can present with overlapping musculoskeletal symptoms, including chronic joint pain and back stiffness, and may therefore be mistaken for inflammatory disease. Sacroiliac joint bone marrow edema on magnetic resonance imaging (MRI), although an important feature of axial spondyloarthritis, may also be seen in healthy individuals, athletes, postpartum women, and mechanically stressed joints, particularly when interpreted without adequate clinical correlation. This case report and brief review aim to illustrate how GJH can mimic jSpA and how overinterpretation of sacroiliac MRI findings may lead to unnecessary immunosuppression in adolescents. A 17-year-old male from Bangladesh presented for an independent pediatric rheumatology evaluation after a prior diagnosis of jSpA based on reported sacroiliac MRI abnormalities, partial response to nonsteroidal anti-inflammatory drugs (NSAIDs), and intermittent gastrointestinal symptoms. His inflammatory markers were persistently normal, HLA-B27 testing was negative, and his back…
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