Progression of Acromegalic Arthropathy Observed in Long-Term Study

Radiographic arthropathy progresses significantly in patients with long-term, well-controlled acromegaly, according to a study recently published in The Journal of Clinical Endocrinology & Metabolism.

Researchers led by Iris C. M. Pelsma, MD, MSc, of Leiden University Medical Center in The Netherlands, point out that one of the long-term complications of acromegaly is acromegalic arthropathy, which can significantly reduce quality of life. Acromegalic arthropathy resembles primary osteoarthritis (OA), at least partly, according to the authors, so it’s regarded as a degenerative joint disorder. In a previous short-term study, progressive OA was observed in more than 70% of long-term controlled patients with acromegaly after 2.6 years of persistent remission, but to date, data on long-term progression is scarce. “The Leiden acromegaly cohort is a unique cohort with respect to long-term longitudinal data on arthropathy,” the authors write. “In the present follow-up study, we evaluated the 9-year clinical and radiographic course of arthropathy and its risk factors in a cohort of long-term, well-controlled acromegaly patients.”

The researchers evaluated 31 patients with biochemically controlled acromegaly for two or more years at baseline, all of whom had definite radiographic OA at one or more joints at baseline. “Radiographic progression was observed in 29%, 48%, 84%, and 94% of patients in the knees, hips, hands, and axial joints, respectively,” the authors write. “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).”

The authors go on to write that the highest progression rates were observed in facet and hand joints, whereas the progression rate in the knees was lowest. Furthermore, all joint sites, further structural joint deterioration was observed in the second follow-up period, indicating continuous deterioration of radiological OA during prolonged remission.

The researchers conclude that significant progression of radiographic arthropathy was observed in patients with long-term, well-controlled acromegaly, whereas the course of joint symptoms varied per joint site, showing deterioration of hand function. “The radiographic progression in prolonged remission appears to be less dependent on acromegaly disease parameters, but more on preexistent degenerative changes,” the authors write. “Further studies are needed to examine optimal acromegaly-specific assessment methods and a treatment strategy for arthropathy.”

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