“I’m really bendy and my joints keep dislocating and aching, I bruise easily and I’m exhausted — someone mentioned Ehlers-Danlos”

Generalised JOINT HYPERMOBILITY with recurrent joint pain, subluxations/dislocations, soft/stretchy skin, easy bruising, poor wound healing, fatigue and often autonomic (dizziness/palpitations) and GI symptoms suggests a HYPERMOBILITY SPECTRUM DISORDER / hypermobile EHLERS-DANLOS SYNDROME (hEDS) — assessed for hypermobility with the BEIGHTON score (5 or more between puberty and 50 in the 2017 criteria, international); there is no genetic test for hEDS, which is a clinical diagnosis the GP can often make, and marked skin stretch with atrophic scars points instead to classical EDS. It is often under-recognised and patients are frequently dismissed, so take it seriously and recognise the MULTISYSTEM picture and comorbidities (chronic pain, fatigue, PoTS/autonomic dysfunction — a sustained rise of 30 beats per minute or more within 10 minutes of standing, checked with a lying-to-standing test — GI dysmotility, anxiety/depression, easy bruising needing FBC and a clotting screen, poor healing). Be alert to RED FLAGS suggesting rare but SERIOUS EDS subtypes needing specialist/genetics referral — in particular VASCULAR EDS (risk of arterial, bowel or uterine rupture; thin translucent skin, easy bruising, a family history of arterial events/sudden death) and marfanoid/aortic features — which substantially change risk and management. Manage holistically: validate the experience; physiotherapy is the cornerstone (joint stabilisation, graded strengthening, proprioception, pacing to avoid deconditioning); use a chronic-pain approach (simple analgesia; NICE NG193 advises against starting opioids for chronic primary pain; pacing, psychological support); and manage associated PoTS (fluids/salt/compression), GI symptoms and mood, with lifestyle and occupational support (the condition may be a disability under the Equality Act 2010). Refer appropriately — rheumatology/hypermobility service for MDT care where pathways allow, and clinical genetics if a serious subtype is suspected — avoiding the common pitfall of dismissing the patient.