no, your joint complaints are not "in your head" eye-opening article on AI

[Lani]

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
© The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com

[sassy]

Maybe everyone who has "disbelieving" oncs should print this and take it to them!

Mine was a believer, so I was lucky.

"AI therapy thickens the tendon sheath with intra-articular fluid (IAF) retention "

I guess this supports my years of advocating Lasix to help with side effects!

One day I plan to write "My Journey through AIs" detailing the different side effects I experienced on each of the three AIs during my own private study with the blessing of my onc.

Just one more thing I plan to do..............

[Jackie07]

Way to go! Sassy! I'll be ready to grab the first copy... :)

Thanks, Lani, for posting this excellent article. [Good timing (allow me to be selfish for just once :) as I'd just started Exemestane (Aromasin) 3 months ago!] I hope they will soon publish articles on how to improve the condition/relieve the symptoms.

[karen z]

Very interesting and informative.


Rhonda,
You know I will want an autographed copy !

[KristinSchwick]

Thanks for posting this, I wonder if it includes faslodex? Did anyone read the article?
It seams to not have those side effects.

[v-ness]

it's nice to see something in print and that someone studied it. it makes such total sense. the pain in my shoulders was so intense i wasted money on massages and painkillers and thought i needed a new bed. off the Aromasin and BANG, no more pain. back on Tamoxifen and so happy. i never thought you'd hear me saying that.

....and right in the middle of this post i get a phonecall that yet another woman i know just diagnosed with breast cancer.

v

[Laurel]

V,

I HEAR ya about departing the AIs and going back on Tamoxifen! Love the new avatar! You have a sly little "Mona Lisa" smilething going on there! LOL!

[BonnieR]

Glad to see "proof" to back up what we already knew! I am still annoyed at the social worker/cancer specialist who contradicted me in a group meeting telling me chemo brain did not exist. It was a figment of my imagination, so to speak!
Keep the faith, everyone!