Endocrine Abstracts

Background: Leiden University Medical Center, Leiden, The Netherlands; ²Leiden University Medical Center, Leiden, The Netherlands; ³Leiden University Medical Center, Leiden, The Netherlands

Background: Arthropathy is an invalidating complication of acromegaly, despite persisting biochemical disease control, which has a high impact on the quality of life (QoL). The prognosis and determinants are currently unknown.

Objectives: To investigate radiographic progression of arthropathy during 2.5-year follow-up and to assess determinants of outcome in patients with long-term well-controlled acromegaly.

Methods: Fifty-eight patients (mean age 62, women 41%) with controlled acromegaly for a mean of 17.6years were included in a prospective cohort study. 40 patients(69%) were cured by surgery and, if necessary, additional radiotherapy, 18 (31%) patients were controlled by somatostatin (SMS) analogs. Radiographic progression of joint disease was defined by the Osteoarthritis Research Society International (OARSI) classification as a one point increase in joint space narrowing (JSN) or osteophyte scores on radiographs of the hands, knees, and hips obtained at the first study visit and after 2.5 years. Potential risk factors for progression were assessed.

Results: Progression of osteophytes and JSN was observed in 72% and 74% of patients, respectively. Higher severity of radiographic arthropathy features at the first study visit was associated with more radiographic progression over 2.5years. Higher age and presence of d3-GH receptor (d3-GHR) polymorphism predisposed for osteophyte progression. Patients with biochemical control by SMS analogs had more progression of osteophytosis than surgically cured patients (OR=18.9, p=0.025), independently of age, sex, BMI, insulin-like growth factor1 (IGF1) SDS at baseline and d3-GHR. This was also evident for progression of JSN, as were higher age and higher baseline IGF1 SDS.

Conclusions: Acromegalic patients have progressive arthropathy according to both osteoarthritis (OA) features, despite long-term biochemical control. Parameters reflecting GH/IGF1 activity were associated with progressive joint disease. Remarkably, biochemical control by SMS analogs was associated with more progression than surgical cure, which may indicate insufficient GH control according to current criteria and the need of more aggressive therapy.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.