To the Editor:

My colleagues and I would like to thank Drs. Remvig and Juul-Kristensen for their interest in our research. We agree that EDS could have been mentioned early in the main body of the text. More importantly, we believe that the research community is now at an ideal stage to further evaluate and understand EDS in the developing musculoskeletal system.

The Beighton score cutoff of ≥4 is the most widely used in the pediatric literature and within the pediatric rheumatology community. We agree that international consensus on examining children for joint laxity is lacking. We would go a step further and state that, as a pediatric community, we need to understand more fully the relationship between joint laxity and disease, thereby allowing the clinician to confidently identify the minority of children who need further evaluation while reassuring the majority. The relationship between joint pain (the main symptom that brings children to the clinic) and range of movement is another important area that now needs to be robustly explored in the general population of children in the UK. Our research group concurs wholeheartedly with the last statement in the letter from Drs. Remvig and Juul-Kristensen.

Jacqui Clinch MRCP, FRCPCH*, * Bristol Royal Hospital for Children, Bristol, UK.