Acromegalic arthropathy (AA) denotes a chronic degeneration of axial or peripheral joints because of acromegaly, which is caused by an excessive production of growth hormones. Early AA is noninflammatory and gradually develops typical osteoarthritic symptoms in later stages. Long-lasting joint pain in hips, shoulders, knees, hands or elbows, as well as a backache and unexplained headache, may indicate an early stage of AA.
Early recognition of AA is imperative since joint degenerations are irreversible in later stages and can only be partly reversed by growth hormone regulation therapies.
Acromegalic arthropathy often runs unnoticed for a long time in patients with diffuse and unspecific pain in axial or peripheral joints and in the back. General morning stiffness is also frequently reported. Pain episodes can last from weeks to months. Back pain is typically located in the lumbosacral part with rare involvement of the thoracic and cervical parts  .
The pain sensation is caused by persistently elevated somatotropin and insulin-like growth factor 1 (IGF-1) levels . The reason for elevated growth hormone levels is often a pituitary tumor or in rare cases an ectopic source of growth hormone production. AA usually persists after tumor removal. AA is progressive and only reversible in early stages. In the initial phase, patients may present with bone, cartilage and soft tissue hypertrophy, peripheral nerve enlargement and carpal tunnel syndrome. Arthropathic symptoms are usually the first indication for acromegaly. 70% of cases suffer from AA complaints at the time of the diagnosis. AA is often diagnosed together with diabetes mellitus, hypertension and arthritis  .
In principle, all bones and joints can be affected by the endocrine disorder. However, most frequent degenerations involve hips, shoulders, knees, hands or elbows. Excess growth hormone in AA victims leads to an increased bone mineral density (BMD), which may be related to a reduced fracture risk . In the further progression of AA, irreversible joint degeneration leads to a significant impairment of the patient's joint mobility. However, back mobility has been reported to be spared and sometimes even enhanced in AA .
Entire Body System
Regarding clinical presentation: 17 (35.4%) were asymptomatic, 10 (20.8%) presented knee pain, ten arthralgias, 5 (10.4%) shoulder knee pain, other being more rare. [endocrine-abstracts.org]
It should be realized that the most of these fractures were asymptomatic. Fractures were also evident in men, especially in the presence of hypogonadism. [link.springer.com]
Patients may be asymptomatic between attacks. During an attack the Achilles tendon is warm, erythematous, swollen, and tender to palpation. [what-when-how.com]
Magnetic resonace imaging (MRI) shows an increase in the amplitude and intensity of the median nerve signal in the patients with symptomatic carpal tunnel syndrome compared to asymptomatic patients [ 16 ]. [ojrd.biomedcentral.com]
Osteoporosis accounts for approximately 1.5 million fractures in the United States each year Osteoporosis: Approximately 1/3 of all vertebral fractures are painful but 2/3 are asymptomatic Hip fractures are assoc w/ permanent disability in nearly 50% [rheumpearls.com]
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. [ncbi.nlm.nih.gov]
See When Hand Pain Is Osteoarthritis Exercise-induced compartment syndrome – this condition causes pain over the front of the shinbone, usually occurring after periods of activity. [arthritis-health.com]
Wooley, MD Advances and diagnostic imaging in a surgical technique have changed the approach to mitral valve regurgitation. This chapter provides an expert's perspective. [books.google.de]
Complications: Increased cardiovascular morbidity and mortality from hypertension, cardiomyopathy, heart failure, or valvular regurgitation. [rheumaknowledgy.com]
Treatment should be stopped if echocardiography shows new or worsened valvular regurgitation, valvular restriction or valve leaflet thickening [ 11 ]. [patient.info]
[…] control also results in better control of hypertension and cardiac function, reducing the use of antihypertensive drugs. 33 Furthermore, we recently observed 34 that somatostatin analogues did not significantly modify the incidence and severity of valve regurgitation [touchendocrinology.com]
Also Read Identifying The Symptoms Of Joint Arthritis Signs And Symptoms Of Joint Arthritis The Various Causes Of Joint Arthritis Enlarged Tongue Enlarged tongue is yet another significant symptom of Acromegalic arthropathy. [findarthritistreatment.com]
We describe 2 cases of acromegaly presenting with rheumatologic manifestations, the first resembling seronegative rheumatoid arthritis, the second, post traumatic low back syndrome. [ncbi.nlm.nih.gov]
AA is often diagnosed together with diabetes mellitus, hypertension and arthritis. In principle, all bones and joints can be affected by the endocrine disorder. However, most frequent degenerations involve hips, shoulders, knees, hands or elbows. [symptoma.com]
Track disease progression and treat patients more effectively with the information on genetic findings, imaging outcomes, cell and biologic therapies, rheumatoid arthritis, and SLE. [books.google.com]
[…] osteomyelitis Sarcoidosis Sarcoidose Saturnine gout Saturnine gigt Scheuermann's osteochondritis Scheuermanns osteochondritis Scleroderma Sklerodermi Septic arthritis Septisk arthritis Seronegative arthritis Seronegative gigt Shigella arthritis Shigella [k10.dk]
RESULTS: Progression of osteophytes and JSN was observed in 72 and 74% of patients respectively. Higher age predisposed for osteophyte progression. [ncbi.nlm.nih.gov]
Kloppenburg, Arthropathy in long-term cured acromegaly is characterised by osteophytes without joint space narrowing: a comparison with generalised osteoarthritis. Ann. Rheum. Dis. 70, 320–325 (2011) PubMed CrossRef Google Scholar 2. N.R. [link.springer.com]
A reported combination of persisting and long-lasting joint pain, unspecific back pain and unexplained headache episodes should guide the clinical investigations. [symptoma.com]
Later in life, the patient may be prone to back pain due to osteoarthritis. [arthritis-health.com]
It can result in a loss of height, severe back pain, and change in posture. [disabled-world.com]
Approximately half of the patients with acromegaly experience back pain, which is predominantly lumbosacral. Hypermobility of the spine may be a contributing factor in back pain. [what-when-how.com]
Articular overgrowth of synovial tissue and arthropathy leading to arthralgia and osteoarthritis in 24%, back pain and kyphosis. Visceral hypertrophy - eg, heart, thyroid (with a multinodular goitre), liver and spleen. [patient.info]
[…] changes in acromegaly represent a peculiar arthropathy, which is characterized by prominent, proboscis-like medial osteophytes, moderate chronic lymphoplasmacytic synovitis, an irregular pitting of the subchondral bone observed roentgenographically, and osteopenia [ncbi.nlm.nih.gov]
Radiographs may show juxtaarticular osteopenia and cystic lesions. Large bone cysts have been noted in a few patients. Xanthoma and bone cysts are also observed in other lipoprotein disorders. [what-when-how.com]
[…] obstruction Metabolic:    Insulin resistance Impaired glucose metabolism Diabetes mellitus Visceral:   Organ enlargement Colon polyps Fluid retention Renal failure Musculoskeletal:  Arthropathy/osteoarthritis Carpal tunnel syndrome Osteopenia [physio-pedia.com]
Almost all hip fractures occur as a result of falls Patients on steroids fracture at a higher T-score than do patients with other types of osteoporosis Radiographic signs of Gaucher disease include bone infarcts, osteopenia and â œErlenmeyer flaskâ [rheumpearls.com]
General morning stiffness is also frequently reported. Pain episodes can last from weeks to months. Back pain is typically located in the lumbosacral part with rare involvement of the thoracic and cervical parts. [symptoma.com]
Patients with OA typically have morning stiffness lasting for OA most commonly affects the hips, knees, and hands (PIP and DIP joints). If used, intra-articular steroid i... [5minuteconsult.com]
Patients may experience morning stiffness. Joint tenderness and periarticular hyperesthesia may also be present, as may synovial thickening. [what-when-how.com]
Face, Head & Neck
We report a short, elderly female developing acromegalic facies for last 10 years without acral overgrowth. She is a patient of primary hypothyroidism, well controlled for last 20 years. [ijem.in]
Characteristic facial features include a long, narrow face; a high forehead; flushed (reddened) cheeks; and a small, pointed chin. In addition, the outside corners of the eyes may point downward (down-slanting palpebral fissures). [icdlist.com]
Acromegalic arthropathy diagnosis is based on the thorough history, physical examination, radiography and laboratory tests.
A reported combination of persisting and long-lasting joint pain, unspecific back pain and unexplained headache episodes should guide the clinical investigations. An immediate assessment of joint swelling, crepitus, tissue tenderness near the affected joint and joint mobility is indicated because a thickening of periarticular tissues is often described  .
Bone hypertrophy can be assessed with radiography. Increased cartilage thickness, widened joint spaces and the observation of osteophytosis near joint margins in knees and hips and in the intracondylar notch of knees. Osteophytosis has also been reported in thoracic and lumbar vertebrae along with frequent dorsal kyphosis. Synovial effusion is rare but possible .
Diagnosis must be finalized with irrefutable proof of elevated serum growth hormone (GH) and IGF-1 levels. Only a random GH value of less than 0.04 µg/l can definitely rule out AA. The best evidence is provided by the inability to suppress GH secretion to less than 1 µg/l within 2 hours after an oral glucose load of 75 g. Further endocrinological workup may be required to control excess growth hormone production   .
Joint Space Narrowing
Radiographic progression of joint disease was defined by the Osteoarthritis Research Society International classification as a 1-point increase in joint space narrowing (JSN) or osteophyte scores on radiographs of the hands, knees, and hips obtained at [ncbi.nlm.nih.gov]
However, persistent abnormal GH secretion despite somatostatin analogs is not a straight forward explanation, since active acromegaly is associated with joint space widening, rather than with joint space narrowing. [link.springer.com]
A comparison between patients with and without joint space narrowing (JSN). Growth Horm IGF Res 2013;23:159-164. [karger.com]
With breakdown and loss of cartilage,the joint space narrows, and subchondral sclerosis and osteophytes appear on radiographs. Joint examination reveals marked crepitus and hypermobility.Joint fluid is noninflammatory. [what-when-how.com]
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