Originally published as JCO Early Release 10.1200/JCO.2008.20.5435 on September 14 2009

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Sonographic and Electrodiagnostic Evaluations in Patients With Aromatase Inhibitor–Related Arthralgia

From the Department of Medical Oncology, Hacettepe University Institute of Oncology; and the Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey.

Corresponding author: Omer Dizdar, MD, Hacettepe University Institute of Oncology, Department of Medical Oncology, Sihhiye, Ankara 06100, Turkey; e-mail: omerdiz{at}yahoo.com.

Purpose To investigate the prevalence of arthralgia in breast cancer patients taking aromatase inhibitors (AIs) and perform a detailed rheumatologic assessment including autoimmune serology, musculoskeletal sonography, and electromyography (EMG) in these patients.

Patients and Methods Postmenopausal patients with stage I to III breast cancer who were taking adjuvant AIs were enrolled (n = 92). Patients who were not receiving hormone treatment were included as a control group (n = 28). Musculoskeletal sonography and EMG were applied to the patients and the controls along with markers of autoimmunity.

Results Thirty patients (32.6%) reported to have AI-related new-onset or worsening arthralgia. The most commonly affected joints were knee (70%), wrist (70%), and small joints of the hand (63%). Patients taking AIs had increased tendon thicknesses compared with those who never received AIs (P < .001). Patients with AI-related arthralgia had higher rates of effusion in hand joints/tendons than those without arthralgia (P = .033). More patients with AI-related arthralgia had EMG findings consistent with carpal tunnel syndrome (CTS) than those without arthralgia (P = .024). No significant difference was observed in erythrocyte sedimentation rates, C-reactive protein, antinuclear antibody, antidouble stranded DNA antibody, rheumatoid factor, or anticyclic citrullinated peptide levels between patients and controls or between those with and without arthralgia.

Conclusion Patients with AI-related arthralgia often show tenosynovial changes suggesting tenosynovitis, exerting local problems but lacking a systemic inflammatory component. Our finding of increased CTS frequency also supports this hypothesis.

Presented in part in abstract format at the 44th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 30-June 3, 2008.

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

See accompanying editorial on page 4932 and article on page 4961

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