Aromatase Inhibitor Musculoskeletal Syndrome
Defining the aromatase inhibitor musculoskeletal syndrome: A prospective study
Article first published online: 28 NOV 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 12, pages 1910–1918, December 2012
How to Cite
Singer, O., Cigler, T., Moore, A. B., Levine, A. B., Hentel, K., Belfi, L., Do, H. T. and Mandl, L. A. (2012), Defining the aromatase inhibitor musculoskeletal syndrome: A prospective study. Arthritis Care Res, 64: 1910–1918. doi: 10.1002/acr.21756
- Issue published online: 28 NOV 2012
- Article first published online: 28 NOV 2012
- Accepted manuscript online: 21 JUN 2012 09:14AM EST
- Manuscript Accepted: 1 JUN 2012
- Manuscript Received: 5 MAR 2012
- Clinical Translational Science Center, NIH. Grant Number: UL1-RR024996
- NY Community Trust. Grant Number: 53273220
- Anne Moore Breast Cancer Fund
- NIH Mentored Patient-Oriented Research Career Development Award (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Grant Number: K23-AR050607
- American College of Rheumatology/Research and Education Foundation Physician Scientist Development Award
To define the musculoskeletal syndrome associated with use of aromatase inhibitors (AIs), specifically, to describe its incidence, time to onset, risk factors, and clinical presentation.
Postmenopausal women with hormone-sensitive, nonmetastatic breast cancer starting AI therapy were enrolled in this prospective cohort study. They underwent complete rheumatologic evaluation and contrast-enhanced magnetic resonance imaging (MRI) of the hands and wrists prior to starting AI, at 3 and 6 months. The primary outcome was change in grip strength.
Twenty-eight (54%) of 52 women reported new or worsening musculoskeletal symptoms. Two discontinued AIs due to pain. Mean time to symptom onset was 6 weeks (range 2–18 weeks), and 75% of symptomatic patients developed symptoms by 8 weeks. Later-stage cancer and worse quality of life (QOL) pretreatment were significantly associated with symptom development. Sixty-eight percent of symptomatic subjects had involvement of the hands; however, there was no difference in the mean change in grip strength (−2.9 kg versus −1.3 kg; P = 0.6). Among symptomatic subjects, 46% had evidence of focal tenosynovitis of the hands and feet on examination. Although some symptomatic subjects had new MRI abnormalities, Rheumatoid Arthritis Magnetic Resonance Imaging Scoring did not significantly change.
The incidence of AI-associated musculoskeletal syndrome is more than 50%, with most women developing symptoms by 8 weeks. The key finding in symptomatic women was focal tenosynovitis of the hands and feet, without evidence of autoimmune disease or systemic inflammation. Later-stage cancer and poorer QOL were predictive of symptom development.