A prospective study of aromatase inhibitor-associated musculoskeletal symptoms and abnormalities on serial high-resolution 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

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)4360-4367
Number of pages8
JournalCancer
Volume116
Issue number18
DOIs
StatePublished - Sep 15 2010

Fingerprint

Musculoskeletal Abnormalities
Aromatase Inhibitors
Wrist
Ultrasonography
Prospective Studies
Tendons
exemestane
letrozole
Musculoskeletal Development
Therapeutics
Carpal Tunnel Syndrome
Health
Arthralgia
Pain Measurement
Visual Analog Scale
Upper Extremity
Fingers
Hand
Joints
Clinical Trials

Keywords

  • Aromatase inhibitor
  • Arthralgia
  • Breast cancer
  • Musculoskeletal
  • Ultrasonography

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Henry, N. L., Jacobson, J. A., Banerjee, M., Hayden, J., Smerage, J. B., Van Poznak, C., ... Hayes, D. F. (2010). A prospective study of aromatase inhibitor-associated musculoskeletal symptoms and abnormalities on serial high-resolution wrist ultrasonography. Cancer, 116(18), 4360-4367. https://doi.org/10.1002/cncr.25385

A prospective study of aromatase inhibitor-associated musculoskeletal symptoms and abnormalities on serial high-resolution wrist ultrasonography. / Henry, N. Lynn; Jacobson, Jon A.; Banerjee, Mousumi; Hayden, Jill; Smerage, Jeffrey B.; Van Poznak, Catherine; Storniolo, Anna Maria; Stearns, Vered; Hayes, Daniel F.

In: Cancer, Vol. 116, No. 18, 15.09.2010, p. 4360-4367.

Research output: Contribution to journalArticle

Henry, NL, Jacobson, JA, Banerjee, M, Hayden, J, Smerage, JB, Van Poznak, C, Storniolo, AM, Stearns, V & Hayes, DF 2010, 'A prospective study of aromatase inhibitor-associated musculoskeletal symptoms and abnormalities on serial high-resolution wrist ultrasonography', Cancer, vol. 116, no. 18, pp. 4360-4367. https://doi.org/10.1002/cncr.25385
Henry, N. Lynn ; Jacobson, Jon A. ; Banerjee, Mousumi ; Hayden, Jill ; Smerage, Jeffrey B. ; Van Poznak, Catherine ; Storniolo, Anna Maria ; Stearns, Vered ; Hayes, Daniel F. / A prospective study of aromatase inhibitor-associated musculoskeletal symptoms and abnormalities on serial high-resolution wrist ultrasonography. In: Cancer. 2010 ; Vol. 116, No. 18. pp. 4360-4367.
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AU - Hayden, Jill

AU - Smerage, Jeffrey B.

AU - Van Poznak, Catherine

AU - Storniolo, Anna Maria

AU - Stearns, Vered

AU - Hayes, Daniel F.

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N2 - 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.

AB - 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.

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