Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, ZA, Leiden, the Netherlands.
Department of Neurosurgery, Leiden University Medical Center, ZA, Leiden, the Netherlands.
J Clin Endocrinol Metab. 2021 Jan 1;106(1):188-200. doi: 10.1210/clinem/dgaa747.
Joint complaints in patients with acromegaly are common, although the long-term disease course is largely unknown.
This study aims to evaluate the long-term course of acromegalic arthropathy.
A prospective longitudinal cohort study was conducted in controlled acromegaly patients followed at a tertial referral center, with 3 study visits: at baseline and after a median of 2.6 and 9.1 years.
We included 31 patients with biochemically controlled acromegaly for 2 or more years (49% female; median age, 60 years) at baseline.
Radiographic arthropathy of the knee, hip, hand, and cervical and lumbar spine were evaluated using Kellgren and Lawrence (KL) scores, developed for assessment of primary osteoarthritis (OA). Radiographic progression was defined as a KL increase above the smallest detectable change. Joint symptoms were assessed using self-reported questionnaires. Progression was defined using existing clinically important cutoff values. Risk factors for progression were investigated using a multivariable model.
All patients had definite radiographic OA at 1 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. 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).
Acromegalic arthropathy showed significant radiographic progression over 9.1 years of follow-up in patients in remission, whereas clinical progression was observed less frequently. Future studies should focus on adequate prevention and treatment strategies of acromegalic arthropathy.
肢端肥大症患者常出现关节问题，但长期疾病过程尚不清楚。
本研究旨在评估肢端肥大性关节病的长期病程。
对在三级转诊中心接受控制良好的肢端肥大症患者进行前瞻性纵向队列研究，在基线和中位随访 2.6 年和 9.1 年后进行 3 次研究访问。
我们纳入了 31 名基线时至少有 2 年生化控制良好的肢端肥大症患者（49%为女性；中位年龄为 60 岁）。
使用专为评估原发性骨关节炎（OA）而开发的 Kellgren 和 Lawrence（KL）评分评估膝关节、髋关节、手部以及颈椎和腰椎的放射学关节病。放射学进展定义为 KL 评分高于最小可检测变化。通过自我报告问卷评估关节症状。采用现有临床重要的截定点定义进展。使用多变量模型研究进展的危险因素。
所有患者在基线时至少有 1 个关节存在明确的放射学 OA。在膝关节、髋关节、手部和轴向关节中，分别有 29%、48%、84%和 94%的患者出现放射学进展。10 名（32.3%）和 11 名（35.5%）患者分别出现手部相关疼痛和功能恶化。仅基线髋关节 KL 评分与髋关节 OA 进展相关（OR 1.88；95%CI，1.09-3.16）。
缓解后的肢端肥大症患者在 9.1 年的随访中出现显著的放射学进展，而临床进展则较少见。未来的研究应侧重于肢端肥大性关节病的充分预防和治疗策略。
