Ultrasonographic evidence of joint thickening reversibility in acromegalicpatients treated with lanreotide for 12 months

BACKGROUND A major cause of morbidity and functional disability in acromega ly is represented by axial and peripheral arthropathy. OBJECTIVE The effect of a 12-month treatment with lanreotide (LAN) on arthr opathy in 12 untreated acromegalic patients has been evaluated. Twelve heal thy subjects served as controls. STUDY DESIGN Open prospective. STUDY PROTOCOL Articular cartilage thickness of shoulder, wrist and knee, a s well as the size of the heel tendons, was measured by ultrasonic (USG) ex amination before, monthly for the first 3 months and quarterly thereafter, during treatment with 60-90 mg/month of LAN. The achievement of safe GH and IGF-1 levels was considered when fasting GH was below 5 mU/l and IGF-1 lev els were normalized for age. RESULTS Before treatment, thickening of shoulder, wrist and knee cartilages , and of heel tendons, was found in ail patients compared with controls (P< 0.01). During the first 3 months of LAN treatment, a significant decrease i n circulating GH (from 86.8 +/- 19.8 to 25.6 +/- 9.8 mU/l) and IGF-1 levels (from 624 +/- 47.8 to 412.2 +/- 44.5 mu g/l) was observed. Overall, a slig ht decrease was noted in all the articular sites examined, but it reached s tatistical significance only at the right shoulder (P<0.001). However, a no table improvement of joint pain and active and passive articular mobility w ere recorded in all patients, as well as of weakness, soft tissue swelling, hyperhydrosis and headache. After 6 months of LAN treatment, a further sig nificant decrease was observed at the level of the right shoulder (P<0.01) and the right knee (P<0.01). Eight patients achieved safe GH and IGF-1 leve ls. After 12 months of LAN treatment, a significant decrease was observed a t the level of all the articular sites examined (P<0.01), as well as at the level of both heel tendons (P<0.01). Safe GH and IGF-1 levels were achieve d in all but one of the patients who, similarly, had a significant decrease in shoulder, wrist and both heel tendon thicknesses. The thickness reducti on of right shoulder cartilage, a non-weight-bearing joint, was significant ly greater than that observed at the level of the right and left knee carti lages and heel tendons (37.4 +/- 4.4% vs. 18 +/- 6.1%, 19.3 +/- 4.4%, 16.5 +/- 4.2%, and 13.7 +/- 5.5%, respectively, P<0.01). No difference was found in thickness decrease of all sites examined between the eight patients ach ieving safe GH levels after 3-6 months, and the remaining four patients, or between patients with estimated disease duration below (n=6) or above 10 y ears (n = 6). CONCLUSIONS Improvement in articular and periarticular soft tissue hypertro phy of the shoulder and wrist, two non-weight-bearing joints, but also of t he knees, two weight-bearing joints, and heel tendons, was obtained by supp ressing GH and IGF-1 levels for 12 months with LAN treatment, although comp lete reversal of joint thickening was not achieved. Since no difference in the response to treatment, in terms of joint size decrease, was found betwe en patients with short or long disease duration, treatment longer than 12 m onths may be needed to reverse the acromegalic arthropathy completely.