Division of Rheumatology, Immunology and Allergy, Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, NW 20007, USA.
Breast Cancer Res Treat. 2012 Jan;131(2):699-708. doi: 10.1007/s10549-011-1849-8. Epub 2011 Nov 11.
Aromatase inhibitors (AIs) are widely prescribed for post-menopausal hormone receptor-positive breast cancer; however, musculoskeletal symptoms limit their tolerability. The purpose of this study was to determine whether joint pain in women receiving AIs is associated with inflammatory arthritis as measured by the disease activity score-28 (DAS-28), and to evaluate association with tenosynovitis on ultrasound. A total of 48 postmenopausal women with stage I-III breast cancer and hand pain were recruited from the Lombardi Comprehensive Cancer Center. Those receiving AIs were cases (n = 25), and those not receiving AIs were controls (n = 23). During a single study visit, subjects underwent blinded rheumatologic evaluation, DAS-28, health assessment questionnaires, autoantibodies, inflammatory markers, hand X-ray, and hand Duplex ultrasound. There were no significant differences between cases and controls in DAS-28, or inflammatory markers. A positive ANA (titer > 1:160) was found in ten patients, four of whom met criteria for autoimmune disease (two with rheumatoid arthritis and two with Sjogren's syndrome, equally distributed among cases and controls). This highlights the importance of considering underlying autoimmune disease in subjects with musculoskeletal complaints. Morning stiffness was more prolonged in women receiving AIs, but this did not reach statistical significance (P = 0.07). Ultrasound evidence of flexor tenosynovitis was common in both groups. Although tenosynovitis was not correlated with AI use (P = 0.26), there was a trend toward an association between tenosynovitis and morning stiffness (P = 0.089). While aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) were more common in subjects receiving AIs, they were not unique to AI users. There was no association between presence of AIMSS features and other chemotherapy or medication exposures. Although the majority of subjects had been using AIs for more than 6 months, this study did not find evidence for inflammatory arthritis in women with hand pain receiving AIs. Further studies are needed to develop a case definition of AIMSS, and to confirm whether these symptoms are attributable to AI use.
芳香酶抑制剂（AIs）广泛用于绝经后激素受体阳性乳腺癌；然而，肌肉骨骼症状限制了其耐受性。本研究的目的是确定接受 AI 治疗的女性关节疼痛是否与疾病活动评分 28（DAS-28）测量的炎性关节炎有关，并评估与超声检查所见腱鞘炎的关系。总共招募了来自 Lombardi 综合癌症中心的 48 名绝经后 I-III 期乳腺癌和手部疼痛的女性。接受 AI 治疗的为病例组（n=25），未接受 AI 治疗的为对照组（n=23）。在单次研究就诊时，受试者接受了盲法风湿病评估、DAS-28、健康评估问卷、自身抗体、炎症标志物、手部 X 线和手部超声检查。病例组和对照组在 DAS-28 或炎症标志物方面没有显著差异。10 名患者的抗核抗体（滴度>1:160）呈阳性，其中 4 名符合自身免疫性疾病标准（2 名患有类风湿关节炎，2 名患有干燥综合征，病例组和对照组各有 2 名）。这突出表明在有肌肉骨骼投诉的患者中，需要考虑潜在的自身免疫性疾病。接受 AI 治疗的女性晨僵时间延长，但无统计学意义（P=0.07）。两组 flexor 腱鞘炎的超声证据都很常见。尽管腱鞘炎与 AI 使用无关（P=0.26），但腱鞘炎与晨僵之间存在关联趋势（P=0.089）。尽管接受 AI 治疗的患者中芳香酶抑制剂诱导的肌肉骨骼症状（AIMSS）更为常见，但它们并非 AI 使用者所特有。AIMSS 特征的存在与其他化疗药物或药物暴露之间没有关联。尽管大多数患者已经使用 AI 超过 6 个月，但本研究未发现接受 AI 治疗的手部疼痛女性存在炎性关节炎的证据。需要进一步研究来制定 AIMSS 的病例定义，并确认这些症状是否归因于 AI 治疗。
