Therefore, a medication that decreases this swelling, such as non-steroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen) or a coxib (such as celecoxib, or Celebrex), may help with pain relief. On the flip side, taking tamoxifen before an AI may reduce the likelihood of developing joint symptoms.
This includes pain, shoulder issues, fatigue, joint pain from aromatase inhibitors, and other issues. All content © 2020 Trustees of the University of Pennsylvania.
Research continues to identify factors that could help better predict each woman's risk.First and foremost, patients should talk with their oncology team if they develop joint symptoms.
Clin Breast Cancer 7:775-778, 2007. These joint symptoms, often called arthralgias, can interfere with quality of life and are often the cause of a woman stopping therapy early.Studies have found joint symptoms most often develop within the first 3 months on therapy, though some cases continue to develop after 3 months. Breast Cancer Res Treat 111:365-72, 2008Henry NL, Giles JT, Stearns V: Aromatase inhibitor-associated musculoskeletal symptoms: etiology and strategies for management. After menopause, estrogen is mainly produced by converting androgens (sex hormones produced by the adrenal glands) into estrogens, which occurs in fat cells (as opposed to in the ovaries before menopause). Additional pain relieving medications, including acetaminophen and opioids, can be added for those patients who do not get relief with an anti-inflammatory alone or for those who cannot tolerate the anti-inflammatory medications.While there are no studies to confirm the effectiveness of changing to another drug, some practitioners will switch to another AI or tamoxifen when symptoms are unmanageable and may lead to the patient stopping therapy altogether. SNPs are associated with musculoskeletal pain. The findings will appear in the “Many women stop taking aromatase inhibitors due to the accompanying joint pain,” said James Ingle, M.D., Mayo Clinic oncologist and senior author of the study, in a Postmenopausal women with early stage breast cancer most commonly use aromatase inhibitors as adjuvant therapy. Unfortunately, musculoskeletal symptoms are often presented in patients treated with aromatase inhibitors (AIs), and, although the pathogenesis is unknown, postulated mechanisms have been described.
There may also be an increased risk for those with pre-existing joint symptoms, such as rheumatoid arthritis. Symptoms typically affect the fingers, hands, wrists, elbows, shoulders, knees and ankles. While the agents are associated with slightly improved survival outcomes when compared to tamoxifen alone, bone and musculoskeletal side effects are substantial and often lead to discontinuation of therapy. One common theory is that the rapid drop in estrogen levels may be responsible for joint pain for two reasons:Unfortunately, a poor understanding of the cause makes it difficult to prevent this side effect. Some studies have shown that having received prior chemotherapy, prior hormone replacement therapy, prior taxane chemotherapy (paclitaxel, taxotere) and having had their last menstrual period within 5 years may predict increased risk. Insulin-like growth factor 1 and musculoskeletal pain among breast cancer patients on aromatase inhibitor therapy and women without a history of cancer.
Patterns and risk factors associated with aromatase inhibitor related arthralgia among breast cancer survivors. All rights reserved. Cancer 115:3631-9, 2009Muslimani AA, Spiro TP, Chaudhry AA, et al: Aromatase inhibitor-related musculoskeletal symptoms: is preventing osteoporosis the key to eliminating these symptoms?
Women should be advised about this side effect when starting an AI, and encouraged to report these symptoms to the healthcare team.
They point out that symptoms are usually transient and resolve with estrogen therapy or when the aromatase inhibitor is discontinued.If a patient's joint pain appears due to aromatase-inhibitor treatment, Felson advises treating with NSAIDs.Janis Kelly is a freelance writer for Medscape. Aromatase inhibitor efficacy and safety.
It is well documented that the aromatase inhibitors (AIs) are superior to tamoxifen as adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive breast cancer. However, compared with tamoxifen, an elevated incidence of arthralgia has been observed during AI treatment. The joint pain is sometimes invalidating and affects treatment compliance1. J Cancer Res Clin Oncol.
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