Background Acromegaly is frequently complicated by axial and peripheral joint abnormalities. Although usually mild, severe handicap is not infrequent. In addition soft tissue, cartilage and bony proliferation make acromegaly a peculiar model of non-inflammatory joint disease, which is reflected by clinical and radiological findings.
Objectives The aim of this study was to compare the clinical and radiographic features of Italian acromegalic patients with the well- known literature studies.
Methods We studied 20 patients (10 men and 10 women) with acromegaly, admitted to our Department. The diagnosis of acromegaly and the status of the disease were based on clinical, hormonal and radiological features. The duration of disease was assumed as the interval between the clinical onset and the time of the diagnosis and was 5.43 ± 2.76 year for men and 8.50 ± 5.66 year for women. Physical examination of peripheral and axial joints and radiological assessment of hands, wrists, shoulders, spine, pelvis hips and knee was performed. Moreover a ultrasonographyc shoulder’s study in 8 patients was carried out. All the patients were submitted to a global self assessment of disease status or activity with WOMAC.
Results We found 70% of acromegalic gave a history of peripheral joint pain, often mild and intermittent and 65% described spine involvement. At the examination 12 patients described spine pain, mostly mild and poorly localised, 9 shoulder pain with severely disabling symptoms, 4 mild localised knee joint pain, 2 hip pain. Only 2 patients reported hand pain. Over 50% of patients presented joint hypermobility. We are able to find a correlation between the severity of peripheral joint or spinal abnormalities, WOMAC physical function and stiffness scale score and activity of acromegaly (GH and IGF-1 blood levels) (p < 0.001). In our patients the shoulder represents one of the most painful and disabling joint. Radiographic abnormalities included narrowing of glenohumeral joint, beak-like osteophytes and, in 4 patients, a destructive arthropathy with oval deformation of humeral head. Ultrasonographic studies were carried out in 8 patients and revealed tendons involvement in all the patients, even without radiological abnormalities. We found supraspinatus tendon tear in 3 patients, rotator cuff and bicipital tendinitis in 7 patients and subacromial bursitis in 2 patients.
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