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CLINICAL STUDY
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
M J E Wassenaar1, N R Biermasz1, N van Duinen1, A A van der Klaauw1, A M Pereira1, F Roelfsema1, J W A Smit1, H M Kroon2, M Kloppenburg3,4 and J A Romijn1
Departments of1 Endocrinology and Metabolic Diseases C4-R2 Radiology3 , Epidemiology4 Rheumatology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
(Correspondence should be addressed to N R Biermasz; Email: Dit e-mailadres is beschermd tegen spambots. U heeft JavaScript nodig om het te kunnen zien. )
Objective: To evaluate the prevalence and rheumatological and radiological characteristics of arthropathy in patients after long-term cure of acromegaly in comparison with age-matched controls.
Design: Case–control study.
Patients: We compared 89 patients with adequate biochemical control of acromegaly (mean 14 years) and 67 age-matched controls.
Measurements: Study parameters were the results of symptom questionnaires, structured physical examination and radiographs of the spine, hip, knee and hand. The diagnosis of osteoarthritis was based on a) radiological osteoarthritis determined by Kellgren and Lawrence and b) clinical osteoarthritis determined by the American College of Rheumatology (ACR) criteria. For the radiological comparison with controls, a Dutch reference group was used.
Results: Pain/stiffness at 
1 joint site was reported by 72% of patients, most frequently in the spine and hands. Radiological osteoarthritis at 1 joint site was present in 99% of patients, most frequently in the spine and hip, and increased at all joint sites in comparison with controls (odds ratios: 2–20). Despite long-term cure of acromegaly, the characteristic widening of joint spaces was still present. In addition, severe osteophytosis was present. Representative radiographs of these typical features are included in the manuscript. According to the ACR criteria, clinical osteoarthritis at 1 joint site was present in 63% of patients, most frequently in the spine and hand. Patients had a higher prevalence of osteoarthritis than controls at all joint sites according to all scoring methods and at a younger age.
Conclusions: Prior GH excess has irreversible, deleterious late effects on the clinical and radiological aspects of joints in patients with long-term cure of acromegaly
