Twelve months of treatment with octreotide-LAR reduces joint thickness in acromegaly

Abstract

Objective: To evaluate the role of age, gender, duration and control of acromegaly on the reversibility of arthropathy. Patients and design: 30 de novo patients with active acromegaly, 30 cured patients and 30 healthy subjects were studied in a tranverse and an open longitudinal study design. Methods: Shoulder, wrist and knee thickening was measured by ultrasonography at study entry in all 90 subjects and after 12 months of treatment with octreotide-LAR (OCT-LAR) at a dose of 10-40 mg every 28 days in the 30 de novo patients.Results: Thickness at all joint sites was greater in the active than in the cured patients and controls ðP , 0:001Þ; and was greater in the cured patients than in the controls ðP , 0:001Þ: There was no gender difference, but joint thickness was less in the patients with disease duration . 10 years. Age significantly correlated with wrist ðr ¼ 20:55; P , 0:001Þ; right knee ðr ¼ 20:45; P ¼ 0:01Þ; and left knee thickness ðr ¼ 20:42; P ¼ 0:02Þ in patients with active disease, and with wrist thickness ðr ¼ 0:88; P , 0:0001Þ in controls. Twelve months of OCT-LAR treatment led to disease control in 18 patients (60%). There was a decrease in the thickness of the shoulder ð15:1^3:2%Þ; wrist ð20:53 :1%Þ; right knee ð22:2^3:4%Þ and left knee ð18:2^2:8%Þ in all patients but the reduction in joint thickness at all sites was greater in the patients with controlled disease after OCT-LAR treatment than in the uncontrolled patients ðP , 0:01Þ: Shoulder and right knee thickening normalized in respectively 11 (61.1%) and 16 (88.9%) well-controlled patients. Conclusions: Growth hormone and insulin-like growth factor-I (IGF-I) suppression by 12 months' OCT-LAR treatment is accompanied by a significant decrease in the thickness of both weight-bearing and non-weight-bearing joints (mainly in patients whose disease is controlled) regardless of disease duration. These findings suggest that tissue hypertrophy in the context of the acromegalic arthropathy can be improved by suppressing IGF-I levels.

High prevalence of arthropathy, according to the definitions of radiological and clinical osteoarthritis, in patients with long-term cure of acromegaly: a case–control study

“…Both weight-and non-weight-bearing joints are affected, including the shoulders, wrists, knees, hip and spine (1,(3)(4)(5). Two steps are encountered in the pathogenesis of arthropathy in acromegaly.…”

“…Radiological changes in this phase are joint space widening and periarticular soft tissue hypertrophy. These early changes are at least partially reversible with adequate disease control (1)(2)(3)6). Secondly, the altered joint geometry results in repeat intra-articular trauma and exuberant reparative reactions, which leads to scar, cyst and osteophyte formation with further deterioration of joint geometry.…”

“…Limited reversibility of the joint complications was observed after treatment resulting in partial biochemical remission. The effect of shortterm successful biochemical treatment with somatostatin (SMS) analogues on cartilage thickness was evaluated by ultrasonography (1)(2)(3). Cartilage thickness decreased after treatment, but did not normalize.…”

Impact of musculoskeletal disease on quality of life in long-standing acromegaly

“…Control of IGF1 and GH by somatostatin agonists has been shown to reduce joint thickness in acromegaly by ultrasonography (10,11). High levels and long duration of excess growth mediators alone have not been shown to correlate with greater joint damage (1,3,12).…”

Manifestation of Rheumatoid Arthritis after Transsphenoidal Surgery in a Patient with Acromegaly

“…Controversial data have been reported on the possibility that acromegalic arthropathy may be modified by GH-suppressing treatment [12]. Treatment with octreotide was shown to improve symptoms and signs of acromegalic arthropathy [11,21]. Moderate improvements in pain, crepitus, and range of motion were also observed in the majority of patients treated with octreotide.…”