Progression of acromegalic joint and psychological complications according to sex, treatments, and disease control

Background: Articular and psychological complications of acromegaly are known to impair patients' quality of life (QoL). This multicenter prospective observational study aimed to (1) identify clinical predictors of the progression of these complications, (2) evaluate their progression in relation to disease activity, and (3) assess their impact on QoL. Materials and methods: Ninety-five patients with acromegaly were enrolled, excluding those with inflammatory rheumatic diseases. Clinical history, hormonal, and physical exams were collected at baseline and after 42 months. Specific questionnaires assessing joint and psychological discomfort (WOMAC, AIMS, VAS) and QoL (AcroQoL) were administered. Results: A regression model identified clinical predictors of progression. Female sex was significantly associated with worsening joint symptoms (VAS P = .0302; AIMS symptoms P = .0328), as was prior radiotherapy (AIMS P = .0071). Use of dopamine agonists (DAs) was linked to higher AIMS depression scores (P = .0224). Interestingly, patients with disease recurrence showed lower joint pain scores compared with baseline. In contrast, mood scores improved with disease remission. Notably, suicide emerged as a relevant cause of death in this cohort, underscoring the need for comprehensive psychological care. Conclusions: Female sex and prior radiotherapy emerged as predictors of progressive joint symptom worsening. Changes in depression and joint complaints alongside disease course suggest a complex involvement of IGF1. Dopamine agonists may negatively affect mood, though further studies are needed. Overall, joint disease had a greater and independent negative impact on QoL compared to mood disorder. Articular and psychological complications remain a significant burden, particularly in women with acromegaly.