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OBJECTIVES: To determine whether joint hypermobility (JH) in childhood is a risk factor for the subsequent development of musculoskeletal pain. METHODS: JH was determined by Beighton score at age 13.8 years in children from the Avon Longitudinal Study of Parents and Children (ALSPAC), using a cut-off of >6. Musculoskeletal pain was evaluated by questionnaire at age 17.8 years. Logistic regression analysis was performed in 2901 participants (1267 boys and 1634 girls) with complete data. RESULTS: 4.6% of participants were hypermobile at age 13.8 years. Moderately troublesome musculoskeletal pain at age 17.8 was reported most commonly at the lower back (16.1%), upper back (8.9%), neck (8.6%), shoulder (9.5%), knee (8.8%) and ankle/foot (6.8%). JH was associated with an increased risk of at least moderately troublesome musculoskeletal pain at the shoulder (1.68; 1.04, 2.72), knee (1.83; 1.10, 3.02) and ankle/foot (1.82; 1.05, 3.16) (ORs with 95%CI, adjusted for gender, maternal education and BMI). An equivalent relationship was not observed at other sites including the spine, elbows, hands and hips. In analyses examining interactions with obesity, associations between JH and knee pain showed higher ORs in obese participants (1.6 and 11.0 in non-obese and obese participants respectively, P=0.04 for obesity interaction). CONCLUSIONS: JH represents a risk factor for musculoskeletal pain in adolescence, comprising a specific distribution namely the shoulder, knee and ankle/foot. These relationships were strongest in the presence of obesity, consistent with a causal pathway whereby JH leads to pain at sites exposed to the greatest mechanical forces. © 2012 American College of Rheumatology.