Claessen K M J A, Ramautar S R, Pereira A M, Romijn J A, Kroon H M, Kloppenburg M, Biermasz N R
Department of Endocrinology and Metabolic Diseases C4-R and Center for Endocrine Tumors Leiden, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands,
Pituitary. 2014 Feb;17(1):44-52. doi: 10.1007/s11102-013-0464-6.
Arthropathy is an invalidating complication of acromegaly. This arthropathy deteriorates radiographically despite long-term disease control. However, the clinical course and its relationship to the radiographic course are currently unknown. We aimed to investigate the clinical course of arthropathy during follow-up and its relationship to radiographic progression in long-term controlled acromegaly patients. Prospective follow-up study. We studied 58 patients (mean age 62 years, women 41 %) with controlled acromegaly for a mean of 17.6 years. Clinical progression of joint disease was defined at baseline and after 2.6 years, by the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and Australian/Canadian Osteoarthritis Index (AUSCAN) questionnaires for lower limb and hand OA, respectively, and performance tests. Potential risk factors for progression were assessed. The clinical course of arthropathy was related to the radiographic course. On average, hand and lower limb function deteriorated during follow-up, despite large interindividual variations. Joint pain was stable over time. High levels of pain and functional impairment at baseline were related to clinical progression of hand pain and functional limitations. High baseline BMI was a risk factor for functional deterioration in the lower limb. The changes in symptoms and radiographic progression during follow-up were not related. In treated acromegaly patients, joint function deteriorates during prolonged follow-up, despite biochemical disease control, although there was interindividual variation. Clinical and radiographic course of arthropathy were not related. Therefore, in clinical practice, a combination of clinical and radiographic assessment is necessary to evaluate the course of acromegalic arthropathy.
关节病是肢端肥大症的一种致残性并发症。尽管疾病得到长期控制，但这种关节病在影像学上仍会恶化。然而，其临床病程及其与影像学病程的关系目前尚不清楚。我们旨在研究长期病情得到控制的肢端肥大症患者在随访期间关节病的临床病程及其与影像学进展的关系。前瞻性随访研究。我们研究了58例病情得到控制的肢端肥大症患者（平均年龄62岁，女性占41%），平均随访17.6年。分别通过用于评估下肢和手部骨关节炎的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）问卷以及澳大利亚/加拿大骨关节炎指数（AUSCAN）问卷，在基线时和2.6年后定义关节疾病的临床进展情况，并进行功能测试。评估进展的潜在风险因素。关节病的临床病程与影像学病程相关。尽管个体差异较大，但平均而言，随访期间手部和下肢功能恶化。关节疼痛随时间保持稳定。基线时的高水平疼痛和功能障碍与手部疼痛的临床进展和功能受限有关。高基线体重指数是下肢功能恶化的一个风险因素。随访期间症状变化与影像学进展无关。在接受治疗肢端肥大症患者中，尽管生化指标显示病情得到控制，但在长期随访期间关节功能仍会恶化，尽管存在个体差异。关节病的临床和影像学病程无关。因此，在临床实践中，需要结合临床和影像学评估来评估肢端肥大症关节病的病程。
