induced joint complaints-- quantified
Prospective study to assess fluid accumulation and tenosynovial changes in the aromatase inhibitor-induced musculoskeletal syndrome: 2-year follow-up data
A. Lintermans1,*, A. Laenen2,3, B. Van Calster3,4, M. Van Hoydonck5, S. Pans6, J. Verhaeghe1, R. Westhovens5, N. L. Henry7, H. Wildiers8,9, R. Paridaens8,9, A. S. Dieudonné1, K. Leunen1,9, L. Morales9, K. Verschueren5, D. Timmerman1, L. De Smet10, I. Vergote1,3, M. R. Christiaens1,9 and P. Neven1,9
+ Author Affiliations
1Department of Obstetrics and Gynecology, KU Leuven, Leuven
2Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven
3Leuven Cancer Institute (LKI), KU Leuven, Leuven
4Department of Development and Regeneration, KU Leuven, Leuven
5Department of Rheumatology, KU Leuven, Leuven
6Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
7Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
8Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven
9Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven
10Orthopedic Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
↵*Correspondence to: Prof. P. Neven, Department of Gynecologic Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel: +32-16-344634; Fax: +32-16-344629; E-mail:
patrick.neven@uzleuven.be
Received April 23, 2012.
Revision received July 4, 2012.
Accepted July 4, 2012.
Abstract
Background Aromatase inhibitors (AIs) frequently lead to the AI-induced musculoskeletal syndrome (AIMSS). Looking into its pathophysiology, 6 months of AI therapy thickens the tendon sheath with intra-articular fluid (IAF) retention and loss of grip strength. We here report 24-month follow-up data.
Patients and methods A prospective cohort study of 33 postmenopausal breast cancer patients received adjuvant endocrine therapy; 27 received an AI and 6 received tamoxifen. At baseline, 6 and 24 months patients had a rheumatologic examination, including a grip strength test, and magnetic resonance imaging of both hands and wrists. The primary end point was tenosynovial changes; secondary end points were changes in morning stiffness, grip strength and IAF.
Results Twenty-three AI and 5 tamoxifen patients completed all investigations. Between month 6 and 24, IAF further increased in AI users (P = 0.04) but not in tamoxifen users, and grip strength further decreased in both groups. The worsened tenosynovial changes were strongly correlated with a decrease in grip strength. At 24 months, morning stiffness continued to be present in over a third of AI users.
Conclusion AIMSS represents a substantial problem in breast cancer patients. It is associated with tenosynovial changes, IAF retention, joint stiffness and loss of grip strength that do not improve with prolonged use.
Key words
aromatase inhibitors breast cancer magnetic resonance imaging tamoxifen tenosynovial abnormalities
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