title: Automated image analysis of hand radiographs reveals widened joint spaces in patients with long-term control of acromegaly: relation to disease activity and symptoms.
abstract: OBJECTIVE
  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 (JSWs) of hand joints in patients with long-term control of acromegaly and to identify factors associated with JSW.
  
  
  METHODS
  A cross-sectional study was carried out in 89 patients (age 58 ± 12 years, 49% women) with long-term controlled acromegaly and 471 controls without hand symptoms (age 46 ± 12 years, 42% women). Radiological JSWs of individual hand joints were measured by automated image analysis.
  
  
  RESULTS
  Patients had wider mean joint spaces than controls: metacarpo-phalangeal (MCP) joints were ~24%, proximal interphalangeal joints ~21%, and distal interphalangeal joints were ~20% wider (patients vs controls; P < 0.001 for all joints). Mean JSW exceeded the 95th percentile of the values obtained in controls in 64% of patients. Higher IGF1 and GH concentrations at diagnosis were associated with larger JSWs (adjusted β for pretreatment GH in tertiles: 0.09 (95% confidence interval (CI) 0.03-1.84) and for IGF1 in tertiles: 0.14 (95% CI 0.05-0.23) at the MCP joints in acromegalic patients. In male patients, but not in female patients, increased JSWs 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. JSWs 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.
authors.affiliation: Department of Endocrinology and Metabolism C4-R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: N R
authors.initials: NR
authors.lastname: Biermasz
authors.forename: R
authors.initials: R
authors.lastname: van 't Klooster
authors.forename: M J E
authors.initials: MJ
authors.lastname: Wassenaar
authors.forename: S H
authors.initials: SH
authors.lastname: Malm
authors.forename: K M J A
authors.initials: KM
authors.lastname: Claessen
authors.forename: R G H H
authors.initials: RG
authors.lastname: Nelissen
authors.forename: F
authors.initials: F
authors.lastname: Roelfsema
authors.forename: A M
authors.initials: AM
authors.lastname: Pereira
authors.forename: H M
authors.initials: HM
authors.lastname: Kroon
authors.forename: B C
authors.initials: BC
authors.lastname: Stoel
authors.forename: J A
authors.initials: JA
authors.lastname: Romijn
authors.forename: M
authors.initials: M
authors.lastname: Kloppenburg
mesh_terms: D000172:Acromegaly / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000517:prevention & control; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000000981:diagnostic imaging; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors