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Management of arthralgias associated with aromatase inhibitor therapy.

Thorne C - Curr Oncol (2007)

Bottom Line: 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.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

Management of musculoskeletal symptoms in patients with early breast cancer taking an aromatase inhibitor. † Misoprostol or proton pump inhibitor. cox-2 = cyclooxygenase 2; ia = intra-articular; nsaid = nonsteroidal anti-inflammatory drug; otc = over-the-counter; tca = tricyclic antidepressant.
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f2-co14_s1p011: Management of musculoskeletal symptoms in patients with early breast cancer taking an aromatase inhibitor. † Misoprostol or proton pump inhibitor. cox-2 = cyclooxygenase 2; ia = intra-articular; nsaid = nonsteroidal anti-inflammatory drug; otc = over-the-counter; tca = tricyclic antidepressant.

Mentions: The most appropriate intervention for pain management in ai-associated arthralgia may be a combination of lifestyle changes, such as introducing weight-bearing exercise, abstaining from smoking, being moderate in alcohol consumption, and taking dietary calcium supplements and vitamin D for bone protection in conjunction with pharmacologic approaches. Figure 2 contains a proposed algorithm for the management of musculoskeletal symptoms in patients taking an ai32.


Management of arthralgias associated with aromatase inhibitor therapy.

Thorne C - Curr Oncol (2007)

Management of musculoskeletal symptoms in patients with early breast cancer taking an aromatase inhibitor. † Misoprostol or proton pump inhibitor. cox-2 = cyclooxygenase 2; ia = intra-articular; nsaid = nonsteroidal anti-inflammatory drug; otc = over-the-counter; tca = tricyclic antidepressant.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2-co14_s1p011: Management of musculoskeletal symptoms in patients with early breast cancer taking an aromatase inhibitor. † Misoprostol or proton pump inhibitor. cox-2 = cyclooxygenase 2; ia = intra-articular; nsaid = nonsteroidal anti-inflammatory drug; otc = over-the-counter; tca = tricyclic antidepressant.
Mentions: The most appropriate intervention for pain management in ai-associated arthralgia may be a combination of lifestyle changes, such as introducing weight-bearing exercise, abstaining from smoking, being moderate in alcohol consumption, and taking dietary calcium supplements and vitamin D for bone protection in conjunction with pharmacologic approaches. Figure 2 contains a proposed algorithm for the management of musculoskeletal symptoms in patients taking an ai32.

Bottom Line: 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.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