Clinical and radiographic assessment of peripheral joints in controlled acromegaly

Abstract

Purpose Acromegalic arthropathy is a well-known phenomenon, occurring in most patients regardless of disease status. To date, solely hips, knees, hands, and spinal joints have been radiographically assessed. Therefore, this study aimed to assess the prevalence of joint symptoms and radiographic osteoarthritis (OA) of new, and established peripheral joint sites in well-controlled acromegaly. Methods Fifty-one acromegaly patients (56% female, mean age 64 ± 12 years) in long-term remission for 18.3 years (median, IQR 7.2–25.4) were included. Nineteen patients currently received pharmacological treatment. Self-reported joint complaints were assessed using standardized interviews. Self-reported disability of the upper and lower limbs, and health-related quality of life (HR-QoL) were evaluated using validated questionnaires. Radiographic OA [defined as Kellgren & Lawrence (KL) ≥ 2] was scored using (modified) KL methods. Results Radiographic signs of OA were present in 46 patients (90.2%) with ≥ 2 joints affected in virtually all of these patients (N = 44; 95.7%). Radiographic MTP1 OA was as prevalent as radiographic knee OA (N = 26, 51.0%), and radiographic glenohumeral OA was similarly prevalent as hip OA [N = 21 (41.2%) vs. N = 24 (47.1%)]. Risk factors for radiographic glenohumeral OA were higher pre-treatment IGF-1 levels [OR 1.06 (1.01–1.12), P = 0.021], and current pharmacological treatment [OR 5.01 (1.03–24.54), P = 0.047], whereas no risk factors for MTP1 joint OA could be identified. Conclusion Similar to previously-assessed peripheral joints, clinical and radiographic arthropathy of the shoulder and feet were prevalent in controlled acromegaly. Further studies on adequate management strategies of acromegalic arthropathy are needed.

Skeletal complications in acromegaly

“…In a study evaluating acromegalic arthropathy using MRI, a unique phenotype was found [56]. Compared to subjects with primary OA, patients with acromegaly Fig.…”

“…Previously, the most frequently reported OA changes concerned knees and hips. Additionally, radiographic OA of the first metatarsophalangeal joint (MTP1) might be as prevalent as radiographic knee OA (approximately 50% of patients), whereas radiographic glenohumeral OA might be as common as hip OA (40%) [56]. Pain or stiffness is most frequently reported in knees, hands, shoulders and hips.…”