Introduction: Musculoskeletal system is widely affected in acromegalic patients which might cause difficulties in the diagnosis and treatment of inflammatory rheumatological diseases. Here, we report coexistent rheumatoid arthritis (RA) in three acromegalic patients presenting with continuing joint and back pain although acromegalic state was in remission.
Case 1: A 64 years old female patient with acromegaly and macroadenoma had undergone transsphenoidal surgery 11 years ago and radiosurgery 7 years ago because of clinical and laboratory evidence of disease. The patient got into remission 3 years after radiosurgery. Because she had morning stiffness and symmetrical pain and swelling in interphalangeal joints, she was consultated with rheumatology and diagnosed as seronegative RA. Her complaints improved dramatically at the second month of methotrexate, prednisolone and indomethacin treatment.
Case 2: A 62 years old female had undergone transsphenoidal surgery for acromegaly 12 years ago. She had been treated with conventional radiotherapy and radiosurgery 4 and 10 years after diagnosis, respectively because remission could not be achieved by medical treatment which had been stopped about a year after radiosurgery. She had symmetrical pain, swelling and deformities in interphalangeal and metacarpal joints. Seronegative RA was diagnosed and methotrexate and prednisolone were started.
Case 3: Acromegaly had been detected 13 years ago in a 57 years old female. Because she had refused surgery, she had been treated with conventional radiotherapy and cure had been achieved in a year. She complained morning stiffness, back pain and pain and swelling in hand joints. She was diagnosed to have seropositive RA and treated with methotrexate, sulfosalazine and indomethasine.
Conclusion: Symptoms related with RA might be confused with musculoskeletal symptoms seen in acromegaly. Detailed rheumatological physical examination and immunological evaluation might be helpful to display concomitant rheumatological disease in acromegalic patients with ongoing musculoskeletal complaints despite achievement of treatment targets.
20 May 2017 - 23 May 2017