Document Detail

A prospective study of aromatase inhibitor-associated musculoskeletal symptoms and abnormalities on serial high-resolution wrist ultrasonography.
MedLine Citation:
PMID:  20549827     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Nearly half of women treated with aromatase inhibitors (AI) develop AI-associated musculoskeletal symptoms (AIMSS) such as arthralgias, but to the authors' knowledge the etiology is unclear. The upper extremities are frequently affected, especially the wrists, hands, and fingers. AI use may also increase the risk of developing carpal tunnel syndrome. Tendon sheath fluid and tenosynovial changes have been demonstrated by imaging symptomatic patients who were treated with AIs. The authors hypothesized that these abnormalities are correlated with AIMSS.
METHODS: Thirty consecutive patients in whom adjuvant therapy with letrozole or exemestane was initiated on a prospective clinical trial enrolled in a pilot study evaluating tendon and joint abnormalities at baseline and after 3 months of AI therapy. Patients underwent high-resolution ultrasonography of the wrists bilaterally and completed the Health Assessment Questionnaire (HAQ) and pain Visual Analog Scale (VAS). AIMSS were defined as an increase in the HAQ or VAS score during AI therapy that exceeded a predefined cutoff.
RESULTS: Twenty-five patients completed both the baseline and 3-month assessments. During the first 12 months of AI therapy, 15 patients developed AIMSS, and 13 discontinued therapy because of musculoskeletal symptoms. There was a trend toward an association between the presence of tendon sheath abnormalities on wrist ultrasound at baseline and the development of AIMSS (P = .06).
CONCLUSIONS: Clinically relevant musculoskeletal symptoms develop in women treated with AIs, leading to treatment discontinuation in a substantial percentage of these patients. However, in the current study, patient-reported symptoms were not found to be associated with changes visible on wrist ultrasonography.
N Lynn Henry; Jon A Jacobson; Mousumi Banerjee; Jill Hayden; Jeffrey B Smerage; Catherine Van Poznak; Anna Maria Storniolo; Vered Stearns; Daniel F Hayes
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Cancer     Volume:  116     ISSN:  0008-543X     ISO Abbreviation:  Cancer     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-09     Completed Date:  2010-10-20     Revised Date:  2013-02-15    
Medline Journal Info:
Nlm Unique ID:  0374236     Medline TA:  Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4360-7     Citation Subset:  AIM; IM    
Copyright Information:
© 2010 American Cancer Society.
Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109-5419, USA.
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MeSH Terms
Aged, 80 and over
Antineoplastic Agents, Hormonal / adverse effects*
Aromatase Inhibitors / adverse effects*
Arthralgia / ultrasonography
Body Mass Index
Middle Aged
Musculoskeletal Diseases / chemically induced*,  ultrasonography*
Pilot Projects
Prospective Studies
Ultrasonography / methods
Withholding Treatment
Wrist / ultrasonography*
Grant Support
Reg. No./Substance:
0/Antineoplastic Agents, Hormonal; 0/Aromatase Inhibitors

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