Long-term biochemical control of acromegaly does not prevent progression of acromegalic arthropathy in many patients, report researchers from The Netherlands.

Arthropathy is a complication of acromegaly that impairs quality of life both physically and psychologically. Cross-sectional studies had previously shown a high prevalence of arthropathy in patients with long-term biochemical control of acromegaly. “However, the disease course of acromegalic arthropathy during prolonged follow-up is unknown in treated patients,” explains lead author Kim Claessen of Leiden University Medical Center. “Therefore, the aim of the present study was to assess the course of acromegalic arthropathy in a cohort of patients under long-term biochemical control and to identify potential risk factors for progression over 2.6 years of prospective follow-up.”

The researchers studied 58 patients with acromegaly who had been in biochemical remission of the disease for a mean duration of 15 years. The investigators obtained radiographs of the knees, hips and hands of the patients at two study visits a mean interval of 2.6 years apart. Radiographic progression of arthropathy from baseline to follow-up was defined as ≥1 point increase in the score from 0 to 3 for osteophytes or joint space narrowing according to the Osteoarthritis Research Society International atlas.

Radiographic progression of osteophytes and joint space narrowing at any joint site was observed in 42 (72%) and 43 (74%) patients, respectively. Surprisingly, patients whose disease was biochemically controlled by somatostatin analogues had a higher risk of osteophyte progression than patients cured by surgery or additional radiotherapy.

The findings might indicate insufficient control of growth hormone in patients with acromegaly treated with somatostatin analogues, the researchers suggest. “Further studies, preferably randomized controlled trials, with longer follow-up duration are required to explore whether more aggressive treatment is beneficial for the outcome of acromegalic arthropathy,” concludes Claessen.