Relative value of some radiographic measurements of the hand in the diagnosis of acromegaly

The sesamoid index in psoriatic arthropathy

OBJECTIVE

The sesamoid index was originally described as an aid to the diagnosis of acromegaly. We performed this study to assess the value of the thumb sesamoid index in the diagnosis of psoriatic arthropathy.

DESIGN

Retrospective measurement of the sesamoid index (length x width of the medial thumb sesamoid), along with the age and sex were recorded for patients as described below. Patients with psoriasis were subdivided into those with or without radiographic evidence of hand arthropathy.

PATIENTS

Fifty-nine consecutive patients attending rheumatology clinics with arthralgia and psoriasis were studied. Comparison groups with radiographic evidence of rheumatoid arthritis (52 patients), osteoarthritis (44) or normal hands (55) were also recorded.

RESULTS

Twenty-one of 59 patients with psoriasis and arthropathy had a sesamoid index>40, compared with two of 52 with rheumatoid arthritis, none of 44 with osteoarthritis and none of 55 normals.

CONCLUSIONS

Psoriatic arthropathy is a recognised cause of bone enlargement, usually in the phalanges due to periostitis and proliferative enthesopathy. We have confirmed that psoriatic hand arthropathy can cause significant enlargement of the thumb sesamoids, a feature which is easily quantified and may assist diagnosis.

Growth Hormone/Insulin-Like Growth Factor–I System and Connective Tissues: Basic Aspects and Clinical Implications

This article reviews basic and clinical aspects of the effects of growth hormone and insulin-like growth factor-I on the connective tissues.

Is soft tissue radiology useful in acromegaly?

Twenty-six acromegalics had measurements of serum growth hormone (GH) levels during a glucose tolerance test, X rays of the heel for heel pad thickness, and of the hand for bone/soft tissue ratio. These measurements were performed before and between 2 and 7 years after treatment, which was by transethmoidal hypophysectomy, external irradiation or a combination of the two. Neither the heel pad thickness nor bone/soft tissue ratio correlated with the mean serum GH nor with each other before and after treatment. The nine patients who were assessed as showing a good clinical response to treatment showed a significantly greater fall in mean serum GH than the 17 patients who were assessed as unchanged or partial responders (40.1 +/- 20 mmu/l compared with 9.9 +/- 14.0 mmu/l, p = 0.02). However, there were no significant differences in changes of heel pad thickness nor bone/soft tissue ratio between these groups. It is concluded that these radiological measurements of soft tissues are unhelpful in the follow-up of acromegalic patients.

Radiogrammetry of the soft tissue at the index finger in acromegaly

Measurements of the soft-tissue width and phalanx width at the index finger were made in 30 acromegalic patients and compared with values obtained in a large control population. The width of the phalanx, total finger width and soft-tissue thickness are significantly larger than expected and the soft-tissue index values are significantly lower than expected. An important overlap between normal and acromegalic values is found for the soft-tissue index and width of the proximal phalanx. The measurement which best discriminates acromegalics from normal is the total finger width. The soft-tissue thickness parameter is also very sensitive for the detection of acromegalic changes and has the advantage of not being sex and age dependent.

Soft-tissue measurements at the index finger: age and sex characteristics

Measurements of the soft-tissue width and phalanx width of the index finger were made in 402 normal individuals (270 women and 132 men, age range 20--89 years) in order to establish age-sex characteristics. Men have a significantly larger total finger and phalanx width than women in all age groups. In both sexes a statistically significant increase with age in phalanx width and total finger width is found. The soft-tissue index and soft-tissue thickness is not influenced by age.

Rheumatic syndromes in endocrine disease

It is not widely appreciated that endocrine disease may present primarily as rheumatic syndromes, sometimes spectacular in onset, more commonly insidious and subtle, making their true recognition difficult. The underlying hormonal, biochemical, and metabolic events have understandable reflection in the structure and function of bone, joint, and muscle.