Distribution, Severity and Management of Joint Pain in Patients with Acromegaly

Objective
The acromegaly-associated arthropathy (AcAA) is a determinant of long-term impaired quality of life. There are limited data assessing the impact of arthropathy, determinants of future arthropathy, and current management.

Design
Multicentre cross-sectional questionnaire study of arthropathy in six UK endocrine centres.

Methods
The study incorporated questionnaires relating to distribution of arthralgia, severity of pain, and clinical management of AcAA. Demographics and laboratory data were extracted from medical records.

Results
We enrolled 411 patients (210 female, median 60, IQR 50–69 years) and median 13 (IQR 6–22) years since diagnosis. Joint pain was reported by 82.5%, with 43.3% and 13.1% experiencing moderate and severe joint pain respectively. The most frequently affected joints were knees (54.7%), lower back (47.7%), hips (38.9%) and shoulders (38.6%). 247 (60.1%) were taking at least one analgesic, 137 (33.3%) at least two classes of analgesics. 109 (26.5%) patients had at least one joint injection (median 2, 1-20). Seventy (17.0%) had at least one joint prosthesis (median 2, 1-6), at median age 59 (32–82) years. A similar percentage (17.0%) had other forms of joint surgery. Patients aged <50 years experienced less pain, required fewer joint injections and less joint surgery, but a similar prevalence of analgesic use, with 36.4% and 10.3% reporting moderate or severe pain.

Conclusion
This study therefore highlights the burden of arthropathy in patients with acromegaly, estimates the need for therapeutic interventions, and the impact on health services.