Objective: Arthropathy is an invalidating complication of acromegaly. Although acromegalic arthropathy shares features with primary osteoarthritis, joint spaces are widened rather than narrowed in... Show moreObjective: Arthropathy is an invalidating complication of acromegaly. Although acromegalic arthropathy shares features with primary osteoarthritis, joint spaces are widened rather than narrowed in patients with long term cure of acromegaly. The late effects of acromegaly on hand joints have not been characterized. Therefore the objective of the current study was to assess joint space widths of hand joints in patients with long-term control of acromegaly and to identify factors associated with joint space width.Design: Cross-sectional studyMethods: Cross-sectional study in 89 patients(age 58±12yr, 49% women) with long-term controlled acromegaly and 471 controls without hand symptoms(age 46±12yr, 42% women). Radiological joint space widths of individual hand joints were measured by automated image analysis.Results: Patients had wider mean joint spaces than controls: MCP-joints were ~24%, PIP-joints ~21%, and DIP-joints ~20% wider (patients vs controls; p<0.001 for all joints). Mean joint space width exceeded the 95th percentile of the values obtained in controls in 64% of patients. Higher IGF-1 and GH concentrations at diagnosis were associated with larger joint space widths (adjusted ß for pretreatment GH in tertiles:0.09(95%CI 0.03-1.84) and for IGF-1 in tertiles 0.14(95%CI 0.05-0.23) at the MCP-joints in acromegalic patients. In male, but not in female, patients increased joint space widths were associated with more self-reported pain(p=0.02).Conclusions: Using a new semi-automated image analysis of hand radiographs, acromegalic patients with long-term disease control appeared to have increased joint spaces of all hand joints. Joint space widths were positively related to disease activity at diagnosis, but not to duration of follow-up, suggesting irreversible cartilage hypertrophy. Irreversible cartilage hypertrophy may partly explain persisting hand complaints, despite long-term disease control. Show less
OBJECTIVE To investigate the validity of joint space width (JSW) measurements in millimeters (mm) in hand osteoarthritis (OA) patients by comparison to controls, grading of joint space narrowing ... Show moreOBJECTIVE To investigate the validity of joint space width (JSW) measurements in millimeters (mm) in hand osteoarthritis (OA) patients by comparison to controls, grading of joint space narrowing (JSN), and clinical features. METHODS Hand radiographs of 235 hand OA patients (mean age 65 years, 83% women) and 471 controls were used. JSW was measured with semi-automated image analysis software in the distal, proximal interphalangeal and metacarpal joints (DIPJs, PIPJs and MCPJs). JSN (grade 0-3) was assessed using the osteoarthritis research society international (OARSI) atlas. Associations between the two methods and clinical determinants (presence of pain, nodes and/or erosions, decreased mobility) were assessed using Generalized Estimating Equations with adjustments for age, sex, body mass index (BMI) and mean width of proximal phalanx. RESULTS JSW was measured in 5631 joints with a mean JSW of 0.98 mm (standard deviation (SD) 0.21), being the smallest for DIPJs (0.70 (SD 0.25)) and largest for MCPJs (1.40 (SD 0.25)). The JSN=0 group had a mean JSW of 1.28 mm (SD 0.34), the JSN=3 group 0.17 mm (SD 0.23). Controls had larger JSW than hand OA patients (P-value<0.001). In hand OA, females had smaller JSW than men (β -0.08, (95% confidence interval (95% CI) -0.15 to -0.01)) and lower JSW was associated with the presence of pain, nodes, erosions and decreased mobility (adjusted β -0.21 (95% CI -0.27, -0.16), -0.37 (-0.40, -0.34), -0.61 (-0.68, -0.54) and -0.46 (-0.68, -0.24) respectively). These associations were similar for JSN in grades. CONCLUSION In hand OA the quantitative JSW measurement is a valid method to measure joint space and shows a good relation with clinical features. Show less
