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Management of arthralgias associated with aromatase inhibitor therapy.

Thorne C - Curr Oncol (2007)

Bottom Line: Benefits of the ais include less frequent gynecologic, cerebrovascular, and thromboembolic adverse events; greater disease-free survival; and lower tumour recurrence.To determine appropriate intervention, it is therefore essential to perform a comprehensive evaluation of musculoskeletal complaints to distinguish natural menopause-related degenerative disease from AI-related effects.The transient symptoms associated with the ais are manageable with an appropriate combination of lifestyle changes, including exercise and joint protection in conjunction with pharmacologic approaches.

View Article: PubMed Central - PubMed

Affiliation: The Arthritis Program, Southlake Regional Health Centre, Newmarket, Ontario. cartho@rogers.com

ABSTRACT
For the upfront adjuvant therapy of postmenopausal estrogen receptor-positive breast cancer, the third-generation aromatase inhibitors (AIS) have shown a more favourable overall risk-benefit profile than has tamoxifen. Benefits of the ais include less frequent gynecologic, cerebrovascular, and thromboembolic adverse events; greater disease-free survival; and lower tumour recurrence. Although approximately 25% of postmenopausal women with early breast cancer report experiencing symptoms of arthralgia with ai therapy, 68-month data from the Arimidex, Tamoxifen, Alone or in Combination trial showed that, compared with tamoxifen, anastrozole treatment was associated with only a modest increase in the incidence of joint symptoms. The events, which were mostly mild-to-moderate in intensity, led to treatment withdrawal in 2% of patients on anastrozole as compared with 1% in the tamoxifen arm. The symptoms and changes correlate with clinical, biochemical, and radiologic findings in symptomatic women. To determine appropriate intervention, it is therefore essential to perform a comprehensive evaluation of musculoskeletal complaints to distinguish natural menopause-related degenerative disease from AI-related effects. The present review explores the advantages of differential diagnosis with an emphasis on history and physical and musculoskeletal examination; laboratory investigations are used to corroborate or rule out clinical impressions. The transient symptoms associated with the ais are manageable with an appropriate combination of lifestyle changes, including exercise and joint protection in conjunction with pharmacologic approaches.

No MeSH data available.


Related in: MedlinePlus

Algorithm for assessment of musculoskeletal complaints (adapted25,28,29).
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f1-co14_s1p011: Algorithm for assessment of musculoskeletal complaints (adapted25,28,29).

Mentions: In the preliminary assessment of musculoskeletal complaints, the emphasis is on patient history and physical examination 26. Patients may describe stiffness, aching, or pain in the hands, arms, knees, feet, pelvic and hip bones, or back, which may be temporally associated with the start of ai therapy. This discomfort is usually symmetrical, and may be associated with mild soft-tissue thickening 27. The physician should rule out conditions that require immediate attention, including a history of significant trauma, a hot and swollen joint, acute severe pain, fever, weight loss, malaise, focal or diffuse muscle weakness, burning, numbness, paresthesia, and claudication 26,28 (Figure 1).


Management of arthralgias associated with aromatase inhibitor therapy.

Thorne C - Curr Oncol (2007)

Algorithm for assessment of musculoskeletal complaints (adapted25,28,29).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2140182&req=5

f1-co14_s1p011: Algorithm for assessment of musculoskeletal complaints (adapted25,28,29).
Mentions: In the preliminary assessment of musculoskeletal complaints, the emphasis is on patient history and physical examination 26. Patients may describe stiffness, aching, or pain in the hands, arms, knees, feet, pelvic and hip bones, or back, which may be temporally associated with the start of ai therapy. This discomfort is usually symmetrical, and may be associated with mild soft-tissue thickening 27. The physician should rule out conditions that require immediate attention, including a history of significant trauma, a hot and swollen joint, acute severe pain, fever, weight loss, malaise, focal or diffuse muscle weakness, burning, numbness, paresthesia, and claudication 26,28 (Figure 1).

Bottom Line: Benefits of the ais include less frequent gynecologic, cerebrovascular, and thromboembolic adverse events; greater disease-free survival; and lower tumour recurrence.To determine appropriate intervention, it is therefore essential to perform a comprehensive evaluation of musculoskeletal complaints to distinguish natural menopause-related degenerative disease from AI-related effects.The transient symptoms associated with the ais are manageable with an appropriate combination of lifestyle changes, including exercise and joint protection in conjunction with pharmacologic approaches.

View Article: PubMed Central - PubMed

Affiliation: The Arthritis Program, Southlake Regional Health Centre, Newmarket, Ontario. cartho@rogers.com

ABSTRACT
For the upfront adjuvant therapy of postmenopausal estrogen receptor-positive breast cancer, the third-generation aromatase inhibitors (AIS) have shown a more favourable overall risk-benefit profile than has tamoxifen. Benefits of the ais include less frequent gynecologic, cerebrovascular, and thromboembolic adverse events; greater disease-free survival; and lower tumour recurrence. Although approximately 25% of postmenopausal women with early breast cancer report experiencing symptoms of arthralgia with ai therapy, 68-month data from the Arimidex, Tamoxifen, Alone or in Combination trial showed that, compared with tamoxifen, anastrozole treatment was associated with only a modest increase in the incidence of joint symptoms. The events, which were mostly mild-to-moderate in intensity, led to treatment withdrawal in 2% of patients on anastrozole as compared with 1% in the tamoxifen arm. The symptoms and changes correlate with clinical, biochemical, and radiologic findings in symptomatic women. To determine appropriate intervention, it is therefore essential to perform a comprehensive evaluation of musculoskeletal complaints to distinguish natural menopause-related degenerative disease from AI-related effects. The present review explores the advantages of differential diagnosis with an emphasis on history and physical and musculoskeletal examination; laboratory investigations are used to corroborate or rule out clinical impressions. The transient symptoms associated with the ais are manageable with an appropriate combination of lifestyle changes, including exercise and joint protection in conjunction with pharmacologic approaches.

No MeSH data available.


Related in: MedlinePlus