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High prevalence of arthropathy in patients with longterm cure of acromegaly

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Eur J Endocrinol Wassenaar et al. 160 (3): 357. (355K)

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 wordt beveiligd tegen spambots. JavaScript dient ingeschakeld te zijn om het te bekijken. Dit e-mailadres is beschermd tegen spambots. U heeft JavaScript nodig om het te kunnen zien. ) Objective: To evaluate the prevalence and rheumatological and radiologicalcharacteristics of arthropathy in patients after long-term cureof acromegaly in comparison with age-matched controls.Design: Case–control study.Patients: We compared 89 patients with adequate biochemical control ofacromegaly (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 basedon a) radiological osteoarthritis determined by Kellgren andLawrence and b) clinical osteoarthritis determined by the AmericanCollege of Rheumatology (ACR) criteria. For the radiologicalcomparison 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 osteoarthritisat ≥1 joint site was present in 99% of patients, most frequentlyin the spine and hip, and increased at all joint sites in comparisonwith controls (odds ratios: 2–20). Despite long-term cureof acromegaly, the characteristic widening of joint spaces wasstill present. In addition, severe osteophytosis was present.Representative radiographs of these typical features are includedin the manuscript. According to the ACR criteria, clinical osteoarthritisat ≥1 joint site was present in 63% of patients, most frequentlyin the spine and hand. Patients had a higher prevalence of osteoarthritisthan controls at all joint sites according to all scoring methodsand at a younger age.Conclusions: Prior GH excess has irreversible, deleterious late effects onthe clinical and radiological aspects of joints in patientswith long-term cure of acromegaly