Originally published as JCO Early Release 10.1200/JCO.2007.15.4005 on May 12 2008

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Prospective Study to Assess Short-Term Intra-Articular and Tenosynovial Changes in the Aromatase Inhibitor–Associated Arthralgia Syndrome

Leilani Morales, Steven Pans, Kilian Verschueren, Ben Van Calster, Robert Paridaens, Rene Westhovens, Dirk Timmerman, Luc De Smet, Ignace Vergote, Marie-Rose Christiaens, Patrick Neven

From the Departments of Obstetrics and Gynecology, Radiology, Rheumatology, Electrical Engineering, Orthopedic Surgery, Medical Oncology, and the Multidisciplinary Breast Center, Leuven Kanker Instituut, Katholieke Universiteit Leuven, University Hospitals KU, Leuven, Belgium

Corresponding author: Patrick Neven, MD, Department of Obstetrics and Gynecology, Division of Gynecological Oncology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium; e-mail: Patrick.Neven{at}uz.kuleuven.ac.be

Purpose Arthralgia is an adverse class effect of aromatase inhibitors (AIs). To date, its exact mechanism remains unclear. The purpose of this study was to investigate the changes in clinical rheumatologic features and magnetic resonance imaging (MRI) of hands and wrists in AI and tamoxifen users.

Patients and Methods This is a prospective single-center study including 17 consecutive postmenopausal patients with early breast cancer receiving either tamoxifen (n = 5) or an AI (n = 12). At baseline and after 6 months, patients filled in a rheumatologic history questionnaire and a rheumatologic examination including a grip strength test was done. At the same time points, MRI of both hands and wrists was performed. The primary end point was tenosynovial changes from baseline on MRI. Secondary end points were changes from baseline for morning stiffness, grip strength, and intra-articular fluid on MRI. Wilcoxon signed ranks was used to test changes from baseline and the Spearman correlation coefficient to assess the association between rheumatologic and MRI changes from baseline.

Results At 6 months, patients on AI had a decrease in grip strength (P = .0049) and an increase in tenosynovial changes (P = .0010). The decrease in grip strength correlated well with the tenosynovial changes on MRI (P = .0074). Only minor changes were seen in patients on tamoxifen. AI users reported worsening of morning stiffness and showed an increase in intra-articular fluid on MRI.

Conclusion The functional impairment of hands in the AI-associated arthralgia syndrome is characterized by tenosynovial changes on MRI correlating with a significant decrease in hand grip strength.

L.M., S.P., and K.V. contributed equally to this work

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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• Getting a Grip on Aromatase Inhibitor–Associated Arthralgias
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  JCO 2008 26: 3120-3121 [Full Text]

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