Increased clinical symptoms of acromegalic arthropathy in patients with long-term disease control: a prospective follow-up study K. M. J. A. Claessen • S. R. Ramautar • A. M. Pereira • J. A. Romijn • H. M. Kroon • M. Kloppenburg • N. R. Biermasz Ó Springer Science+Business Media New York 2013 Abstract 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 acro- megaly patients. Prospective follow-up study. We studied 58 patients (mean age 62 years, women 41 %) with con- trolled acromegaly for a mean of 17.6 years. Clinical pro- gression 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 radio- graphic 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 deteri- oration 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. Clin- ical 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. Keywords Acromegaly Á Osteoarthritis Á IGF-1 Á Progression Á Symptoms Introduction In active acromegaly, patients have pathologically high growth hormone (GH) and insulin-like growth hormone-1 (IGF-1) levels, caused by a GH-producing pituitary ade- noma in most cases. The increased GH/IGF-1 activity is associated with a variety of complaints, increased mor- bidity and mortality, resulting in reduced quality of life (QoL). Reversal of GH excess ameliorates clinical symp- toms and life expectancy. However, other acromegalic features persist due to irreversible changes, for instance in bone and cartilage [1]. One of the most invalidating complications of acro- megaly, which is at least partially irreversible, is arthrop- athy [2]. Joint-related complaints, such as pain, stiffness or functional limitations, present at very young ages, K. M. J. A. Claessen (&) Á S. R. Ramautar Á A. M. Pereira Á J. A. Romijn Á N. R. Biermasz 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 e-mail: K.M.J.A.Claessen@lumc.nl J. A. Romijn Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands H. M. Kroon Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands M. Kloppenburg Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands 123 Pituitary DOI 10.1007/s11102-013-0464-6