Monday, May 6, 2013

What is Ehlers-Danlos Syndrome

From the Ehlers Danlos National Foundation
Written by Mark C. Martino

More than 1.5 million people around the world have Ehlers-Danlos syndrome (EDS). Someone with EDS is born at least every half hour, and many won’t know what’s wrong with them until it's too late for them to be helped. EDS occurs in between one in 2,500 and one in 5,000 men and women, of every race and ethnicity. EDS was named less than 100 years ago, and it remains largely unknown. Recent evidence indicates it may be one of the most under-diagnosed disorders, because there is no cure and many doctors consider EDS too rare for anyone to have. They fail to see that diagnosis is important, not just in accurately assessing how many have EDS, but in getting help to their patients for the many problems known to be caused by EDS.

Ehlers-Danlos syndrome is a group of disorders. Each type of EDS is defined as a distinct genetic problem in making or using one of the types of collagen. Collagen is used by the body to provide strength and elasticity to tissue; normal collagen is a strong protein that allows tissue to be stretched, but not past its limit, and then is safely returned to normal. WIth badly built or processed collagen, some of the soft tissue can be pulled further than is safe, causing damage. Collagen is the body's most abundant protein and can be found almost anywhere, in skin, muscles, tendons and ligaments, blood vessels, organs, gums, eyes, and so on.

Vascular Type EDS is particularly destructive because of potential arterial or organ rupture; life expectancy is shortened with a majority of individuals living only into their forties. Arterial or intestinal rupture commonly presents as acute abdominal or flank pain that can be diffuse or localized. Spontaneous arterial rupture is most likely to occur in a person’s twenties or thirties, but can occur at any point in life. Cerebral arterial rupture may present with altered mental status and be mistaken for drug overdose. Mid-size arteries are commonly involved. Arterial, intestinal, or uterine fragility or rupture usually arise in EDS Vascular type, but should be investigated for any EDS type.

There is a very wide range of symptoms because of how widespread in the body collagen is, and it is still unclear why one collagen defect can be expressed so differently in people, even in the same family. EDS can cause systemic weakness and instability throughout the body, resulting in many and unexpected effects. Some can be seen, but not all; EDS is largely invisible. Pain, for instance, can be widespread—collagen makes up the fascia, the tissue sheet that holds everything together and wraps around your entire body—but the pain will not show up in MRIs or X-rays, and will be probably be out-of-proportion to any findings. While EDS is not curable, many symptoms can be prevented or treated as they arise: joint hypermobility (loose or unstable joints that slip or dislocate); early osteoarthritis; tissue fragility, skin that tears and bruises easily, blood vessels and internal organs such as intestines that can rupture easily; eye problems and gum disease; spine problems that may also involve the cerebellum and cerebrospinal fluid pressure.

Collagen is found throughout the body. Ehlers-Danlos syndromes come down to a structural problem. An analogy. If you build a house with bad materials, say weak wood or cheap nails, you know you'll have problems. Some problems are more likely to show up than others, but because the bad materials were used everywhere and aren't necessarily visible, you can be surprised by a problem. So the problems resulting from being built out of a protein that doesn't behave the way it should can be widespread, in a wide range of severities, and maybe even show up in places you wouldn't think are related until it occurs to you that collagen is used there, too.

Each doctor you see is going to look at things differently. Endocrinologists see hormones as the problem, or CFS. Rheumatologists in the US think fibromyalgia's the problem. Surgeons see weaknesses that need surgery. And if none of them are remembering that EDS is the root cause, and maybe their solution won't work in that environment of your body, they may be inappropriately treating you. There are some medical specialists, and more with each generation of doctors, but the best suggestion for the longterm health of someone with EDS is to learn everything you can about EDS and what/how it affects you, so you can educate those doctors and nurses who are willing to admit they don't know everything and are willing to learn.

More than a quarter century of experience, free information and resources from Ehlers-Danlos National Foundation can be found at or reaching the foundation on Facebook. "So You Think You May Have EDS?" is an introduction to EDS written by EDNF members at, where you can also discover many links to professional and patient publications and web pages through the "EDS Guides" and "EDS Knowledge" menus on the left side, throughout the web site. EDNF holds a national conference, usually each year.