jojo
10-09-2005, 07:46 PM
Joint Pain and Estrogen Deprivation
http://www.rheumatology.org/press/2005/estrogenarthritis0905.asp
Press Release
Arthritis & Rheumatism News Alert
Recent evidence suggests caution in prescribing
hormone therapy for breast cancer and sheds new light on “menopausal arthritis”
One of the most effective new treatments for
breast cancer is a hormone therapy. Aromatase
inhibitors work by powerfully blocking the
conversion of androgen precursors into estrogens,
which lowers estradiol levels in the bloodstream
and estrogen levels in peripheral tissues.
Because aromatase inhibitors reduce the rates of
recurrence in women with early-stage
postmenopausal breast cancer, these agents are
not only becoming widely used in breast cancer
treatment, but also being explored for their
potential to prevent the disease in women at high
risk. While focusing on this therapy's promise,
advocates have tended to downplay one of its
drawbacks. Women treated with aromatase
inhibitors often experience joint pain and
musculoskeletal aching*severe enough, in some
cases, to make them stop the treatment.
Two noted researchers, David T. Felson, M.D., of
Boston University Clinical Epidemiology Unit, and
Steven R. Cummings, M.D., of California Pacific
Medical Center Research Institute and University
of California, San Francisco, have thoroughly
examined the evidence linking aromatase
inhibitors and, more broadly, estrogen
deprivation joint pain. In the September 2005
issue of Arthritis & Rheumatism (
http://www.interscience.wiley.com/journal/arthritis),
they share their insights to alert oncologists,
primary care physicians, and other health care
professionals to this widely overlooked, potential problem for women.
“Estrogen's effects on inflammation within the
joint are not well known,” Dr. Felson and Dr.
Cummings observe. Yet, as they note, estrogen has
well-established tissue-specific effects on
inflammatory cytokines. Estrogen's role in joint
inflammation could account for the increased
sensitivity to pain that some women suffer with
estrogen depletion. Citing studies of
pharmacological suppression of estrogen and
studies of natural menopause, the authors offer a
look at compelling evidence associating estrogen
deprivation with joint pain, including:
• Aromatase inhibitors have been linked to
higher rates of joint and muscle pain than
tamoxifen and placebo in various clinical trials
for breast cancer treatment and prevention. One
example: In a National Cancer Institute of Canada
study, 5,187 postmenopausal women who completed a
5-year course of tamoxifen therapy for breast
cancer were randomized to a further 5 years
receiving the aromatase inhibitor letrozole or a
placebo. 21 percent of women taking letrozole
reported joint pain compared with 16 percent of the women receiving placebo.
• In a study of leuprolide, a hormonal agent
used to treat infertility and a variety of
gynecological disorders, 102 premenopausal women
experienced symptoms of estrogen deprivation,
such as vaginal dryness, after 2 weeks of
treatment, and suffered joint pain between weeks
3 and 7 of treatment. Overall, 25 percent of the
women developed persistent joint pain, affecting
the knees, elbows, ankles, and other areas,
during the study. The pain was resolved in all
women between 2 and 12 weeks after stopping the leuprolide therapy.
• In a postmenopausal estrogen/progestin
intervention trial, women who received estrogen
had a significantly decrease chance of
musculoskeletal symptoms*between 32 and 38
percent*compared with women randomly assigned
placebo. Symptoms reported in the placebo group
included joint pain, muscle stiffness, and skull
and neck aching. In other studies, however,
estrogen replacement therapy had no beneficial effect on musculoskeletal pain.
Dr. Felson and Dr. Cummings also highlight recent
data showing that Asian women undergoing
menopause have lower estradiol levels than
Caucasian women and seem to be more vulnerable to
a syndrome commonly known as “menopausal
arthritis.” They also note the high rate of both
osteoarthritis and rheumatoid arthritis in
postmenopausal women. They conclude by stressing
the need for further research into the
contribution of estrogen deficiency to arthritis,
as well as for recognizing the risks of
musculoskeletal syndrome when prescribing
aromatase inhibitors and other estrogen-depleting treatments.
# # #
Article: “Aromatase Inhibitors and the Syndrome
of Arthralgias With Estrogen Deprivation,” David
T. Felson and Steven R. Cummings, Arthritis &
Rheumatism, September 2005; 52:9; pp. 2594-2598.
http://www.rheumatology.org/press/2005/estrogenarthritis0905.asp
Press Release
Arthritis & Rheumatism News Alert
Recent evidence suggests caution in prescribing
hormone therapy for breast cancer and sheds new light on “menopausal arthritis”
One of the most effective new treatments for
breast cancer is a hormone therapy. Aromatase
inhibitors work by powerfully blocking the
conversion of androgen precursors into estrogens,
which lowers estradiol levels in the bloodstream
and estrogen levels in peripheral tissues.
Because aromatase inhibitors reduce the rates of
recurrence in women with early-stage
postmenopausal breast cancer, these agents are
not only becoming widely used in breast cancer
treatment, but also being explored for their
potential to prevent the disease in women at high
risk. While focusing on this therapy's promise,
advocates have tended to downplay one of its
drawbacks. Women treated with aromatase
inhibitors often experience joint pain and
musculoskeletal aching*severe enough, in some
cases, to make them stop the treatment.
Two noted researchers, David T. Felson, M.D., of
Boston University Clinical Epidemiology Unit, and
Steven R. Cummings, M.D., of California Pacific
Medical Center Research Institute and University
of California, San Francisco, have thoroughly
examined the evidence linking aromatase
inhibitors and, more broadly, estrogen
deprivation joint pain. In the September 2005
issue of Arthritis & Rheumatism (
http://www.interscience.wiley.com/journal/arthritis),
they share their insights to alert oncologists,
primary care physicians, and other health care
professionals to this widely overlooked, potential problem for women.
“Estrogen's effects on inflammation within the
joint are not well known,” Dr. Felson and Dr.
Cummings observe. Yet, as they note, estrogen has
well-established tissue-specific effects on
inflammatory cytokines. Estrogen's role in joint
inflammation could account for the increased
sensitivity to pain that some women suffer with
estrogen depletion. Citing studies of
pharmacological suppression of estrogen and
studies of natural menopause, the authors offer a
look at compelling evidence associating estrogen
deprivation with joint pain, including:
• Aromatase inhibitors have been linked to
higher rates of joint and muscle pain than
tamoxifen and placebo in various clinical trials
for breast cancer treatment and prevention. One
example: In a National Cancer Institute of Canada
study, 5,187 postmenopausal women who completed a
5-year course of tamoxifen therapy for breast
cancer were randomized to a further 5 years
receiving the aromatase inhibitor letrozole or a
placebo. 21 percent of women taking letrozole
reported joint pain compared with 16 percent of the women receiving placebo.
• In a study of leuprolide, a hormonal agent
used to treat infertility and a variety of
gynecological disorders, 102 premenopausal women
experienced symptoms of estrogen deprivation,
such as vaginal dryness, after 2 weeks of
treatment, and suffered joint pain between weeks
3 and 7 of treatment. Overall, 25 percent of the
women developed persistent joint pain, affecting
the knees, elbows, ankles, and other areas,
during the study. The pain was resolved in all
women between 2 and 12 weeks after stopping the leuprolide therapy.
• In a postmenopausal estrogen/progestin
intervention trial, women who received estrogen
had a significantly decrease chance of
musculoskeletal symptoms*between 32 and 38
percent*compared with women randomly assigned
placebo. Symptoms reported in the placebo group
included joint pain, muscle stiffness, and skull
and neck aching. In other studies, however,
estrogen replacement therapy had no beneficial effect on musculoskeletal pain.
Dr. Felson and Dr. Cummings also highlight recent
data showing that Asian women undergoing
menopause have lower estradiol levels than
Caucasian women and seem to be more vulnerable to
a syndrome commonly known as “menopausal
arthritis.” They also note the high rate of both
osteoarthritis and rheumatoid arthritis in
postmenopausal women. They conclude by stressing
the need for further research into the
contribution of estrogen deficiency to arthritis,
as well as for recognizing the risks of
musculoskeletal syndrome when prescribing
aromatase inhibitors and other estrogen-depleting treatments.
# # #
Article: “Aromatase Inhibitors and the Syndrome
of Arthralgias With Estrogen Deprivation,” David
T. Felson and Steven R. Cummings, Arthritis &
Rheumatism, September 2005; 52:9; pp. 2594-2598.