Structured Physiotherapy Improves Functional Outcomes in Acromegalic Arthropathy After Biochemical Remission: A Prospective Controlled Study

BACKGROUND: Musculoskeletal symptoms frequently persist in acromegaly despite biochemical remission, yet the impact of structured physiotherapy on pain, stiffness, and function remains poorly defined. OBJECTIVE: To evaluate the effects of a standardized knee-focused physiotherapy program in controlled acromegaly and to identify clinical predictors of treatment responsiveness. METHODS: Thirteen patients with acromegaly in remission and 13 age-, gender-, and BMI-matched individuals with primary knee osteoarthritis completed a 15-session physiotherapy program. Outcomes were assessed pre- and post-intervention using the Brief Pain Inventory (BPI) and WOMAC. Minimal clinically significant difference (MCID) thresholds (≥2 for BPI, ≥10 for WOMAC) determined meaningful improvement. Correlation analyses examined associations between clinical variables and Δ scores. RESULTS: Acromegaly patients showed significant improvements in all BPI and WOMAC domains (p<0.001). MCID was achieved by 85% for BPI and 100% for WOMAC Total. Pain and function improved most, whereas stiffness showed limited responsiveness. Compared with osteoarthritis controls, acromegaly patients demonstrated smaller Δ changes; baseline-adjusted analyses (ANCOVA) indicated that this attenuated response was largely explained by greater baseline severity in the control group, whereas the persistently greater stiffness in acromegaly remained significant even after adjustment. BMI correlated positively with improvements in BPI Total (r = 0.63) and BPI Pain Severity (r = 0.69), while adenoma size correlated negatively with both measures (r = -0.57 and -0.60). BMI showed a negative association with WOMAC Total improvement (r = -0.59). Stiffness changes were strongly negatively correlated with pretreatment IGF-1 (r = -0.77). CONCLUSION: Structured physiotherapy yields clinically meaningful improvements in pain and function in acromegaly, while stiffness appears less reversible and more structurally driven. Early musculoskeletal assessment and physiotherapy integration may enhance long-term management.