Is every joint symptom related to acromegaly?
G Oruk1, F Tarhan1, M Argin2 & M Ozmen3
Introduction: Acromegaly is a chronic endocrinopathy characterized by hypersecretion of GH and insulin-like growth factor 1 (IGF1). Musculoskeletal pain is a frequent problem encountered in acromegaly and is associated with a reduction in quality of life. In this study we investigated the presence of inflammatory, rheumatologic and degenerative disease retrospectively.
Methods: Fourty acromegaly patients who were in remission as laboratory findings but whose joint symptoms had not subsided and were referred to the rheumatology clinic with complaints of joint pain between 20062010 were evaluated in the study. Clinical, radiologic and laboratory data were examined.
Results: Mean age of the acromegalic patients were 47.1 (2275). All patients were in remission as clinically and laboratory findings. When the radiologic data were evaluated, bilateral sacroilitiis was found at sacroiliac joint graphy and magnetic resonance imaging (MRI) in 1 patient and degenerative joint changes in 24 patients; however, there was no pathology at the radiologic data of 15 patients. Laboratory data revealed antinuclear antibody (ANA) positivity (3 nucleolar, 1 homogeneous) in 4 patients, rheumatoid factor (RF) positivity in 4 patients and cyclic citrullin peptid (CCP) positivity in 1 patient. After the evaluation of the patients with clinical, laboratory and radiologic methods, 3 patients were diagnosed as inflammatory rheumatologic disease (rheumatoid arthritis (RA), ankylosing spondylitis (AS), undifferentiated connective tissue diseases (UCTDs)) and 6 patients were diagnosed as Diffuse Idiopathic Skeletal Hyperostosis (DISH). Their symptoms subsided after the medical treatment for inflammatory joint disease.
Conclusion: While degenerative joint disease was observed frequently in our patient group similar to the literature, inflammatory rheumatologic disease was also discovered in three patients. Distinguishing these two joint disease is important, because response to medical treatment is dramatically good in inflammatory disease than the degenerative disease. A multidisciplinary approach involving endocrinology and rheumatology is imperative for appropriate management of these patients.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.