Progression of acromegalic arthropathy in long-term controlled acromegaly patients: 9 years of longitudinal follow-up

Abstract

Context Joint complaints in patients with acromegaly are common, although the long-term disease course is largely unknown. Objective To evaluate the long-term course of acromegalic arthropathy. Design and setting Prospective longitudinal cohort study of controlled acromegaly patients followed at a tertial referral center, with three study visits: baseline, and after a median of 2.6 and 9.1 years. Patients Thirty-one patients with biochemically controlled acromegaly for ≥2 years (49% female, median age 60 years) at baseline. Main outcome measures Radiographic arthropathy of the knee, hip, hand, and cervical and lumbar spine were evaluated using Kellgren and Lawrence (KL) scores, developed for assessment of primary osteoarthritis (OA). Radiographic progression was defined as a KL increase above the smallest detectable change (SDC). Joint symptoms were assessed using self-reported questionnaires. Progression was defined on existing clinically important cut-off values. Risk factors for progression were investigated using a multivariate model. Results All patients had definite radiographic OA at ≥1 joint at baseline. Radiographic progression was observed in 29%, 48%, 84%, and 94% of patients in the knees, hips, hands and axial joints, respectively. Deterioration in hand-related pain and function was observed in 10 (32.3%) and 11 patients (35.5%), respectively. Solely baseline KL scores of the hip were associated with hip OA progression (OR 1.88 (95% CI 1.09-3.16)). Conclusions Acromegalic arthropathy showed significant radiographic progression over 9.1 years of follow-up in patients in remission, whereas clinical progression was observed less frequently. Future studies should focus on adequate prevention and treatment strategies of acromegalic arthropathy.

State of the Art of Patient-reported Outcomes in Acromegaly or GH Deficiency: A Systematic Review and Meta-analysis

“…A major drawback of the included studies and an unmet need in the field of endocrinology is the lack of interpretation of the PRO results, separately as well as in the context of the biochemical outcomes. Minimal important clinical differences were reported by only 2 ( 39 , 40 ) of the included studies, limiting assessment of clinical relevance besides assessment of statistical significance. A minimal important clinical difference can not only be used to assess a difference in mean scores between groups but also, more importantly, to determine the percentage of patients who report having experienced a clinically relevant benefit from treatment in terms of HRQoL.…”

Low prevalence of neuropathic-like pain symptoms in long-term controlled acromegaly

“…Forty-four patients with well-controlled acromegaly with complete neuropathic pain questionnaires were included in the present study. Twenty-five patients in remission that participated in our long-term follow-up study on musculoskeletal acromegalic complications (using data from the last study visit—details published prior [ 13 , 24 ]) were combined with nineteen additional patients in remission that were consecutively included at the time of the last study visit from new referrals to our expertise center.…”

“…Briefly, disease remission was defined as normal glucose-suppressed serum GH and IGF-1 levels (corrected for age and sex) [ 1 , 9 – 11 , 16 , 25 – 31 ]. Hypopituitarism was treated according to available guidelines [ 13 , 24 , 32 ].…”

Clinical and radiographic assessment of peripheral joints in controlled acromegaly

“…Additionally, upon radiographic evaluation, acromegalic arthropathy displays a unique phenotype with severe osteophytosis (OP), and distinctive joint space widening (JSW), differing signi cantly from primary osteoarthritis (OA) that is characterized by joint space narrowing (JSN) due to cartilage loss [9][10][11][12]. Progression of arthropathy, clinically or radiographically, has been reported for a signi cant proportion of patients, independent of disease remission [13][14][15]. Patients with higher age, higher baseline IGF1 levels, treatment with somatostatin (SMS) analogs required for disease control [13], and patients with increased severity of OA at baseline [15] were at increased risk for radiological OA progression.Previous studies on acromegalic arthropathy investigated hips, knees, hands, and spine joints [2, 3, 7, 6,[13][14][15], whereas literature on other joints, e.g.…”

“…Progression of arthropathy, clinically or radiographically, has been reported for a signi cant proportion of patients, independent of disease remission [13][14][15]. Patients with higher age, higher baseline IGF1 levels, treatment with somatostatin (SMS) analogs required for disease control [13], and patients with increased severity of OA at baseline [15] were at increased risk for radiological OA progression.Previous studies on acromegalic arthropathy investigated hips, knees, hands, and spine joints [2, 3, 7, 6,[13][14][15], whereas literature on other joints, e.g. shoulders and feet, is scarce.…”