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Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: associated tenosynovial changes on magnetic resonance imaging

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Abstract

Objective

Arthralgia, skeletal and muscle pain have been reported in postmenopausal women under treatment with third generation aromatase inhibitors (AIs). However, the pathogenesis and anatomic correlate of musculoskeletal pains have not been thoroughly evaluated. Moreover, the impact of AI-induced musculoskeletal symptoms on normal daily functioning needs to be further explored.

Patients and methods

We examined 12 consecutive non-metastatic breast cancer patients who reported severe musculoskeletal pain under a third generation AI; 11 were on letrozole and 1 on exemestane. Clinical rheumatological examination and serum biochemistry were performed. Radiological evaluation of the hand/wrist joints were performed using ultrasound (US) and/or magnetic resonance imaging (MRI).

Results

The most common reported symptom was severe early morning stiffness and hand/wrist pain causing impaired ability to completely close/stretch the hand/fingers and to perform daily activities and work-related skills. Six patients had to discontinue treatment due to severe symptoms. Trigger finger and carpal tunnel syndrome were the most frequently reported clinical signs. US showed fluid in the tendon sheath surrounding the digital flexor tendons. On MRI, an enhancement and thickening of the tendon sheath was a constant finding in all 12 patients.

Conclusions

Musculoskeletal pains in breast cancer patients under third generation AIs can be severe, debilitating, and can limit compliance. Characteristic tenosynovial, and in some patients joint changes on US and MRI were observed in this series and have not been reported before.

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Authors and Affiliations

  1. Department of General Medical Oncology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

    Leilani Morales, Robert Paridaens & Hans Wildiers

  2. Department of Radiology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

    Steven Pans

  3. Department of Rheumatology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

    Rene Westhovens

  4. Department of Obstetrics & Gynecology and Division of Gynecological Oncology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

    Dirk Timmerman, Johan Verhaeghe, Karin Leunen, Frederic Amant, Patrick Berteloot, Ignace Vergote & Patrick Neven

  5. Department of Surgery and Division of Oncologic and Orthopedic Surgery, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

    Ann Smeets, Luc De Smet & Marie-Rose Christiaens

  6. Department of Radiotherapy, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

    Erik Van Limbergen, Caroline Weltens & Walter Van den Bogaert

  7. Multidisciplinary Breast Center, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

    Robert Paridaens, Hans Wildiers, Karin Leunen, Frederic Amant, Patrick Berteloot, Ann Smeets, Erik Van Limbergen, Caroline Weltens, Walter Van den Bogaert, Marie-Rose Christiaens & Patrick Neven

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  1. Leilani Morales
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  2. Steven Pans
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  3. Robert Paridaens
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  7. Hans Wildiers
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  8. Karin Leunen
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  11. Ann Smeets
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  12. Erik Van Limbergen
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  13. Caroline Weltens
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  14. Walter Van den Bogaert
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  15. Luc De Smet
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  16. Ignace Vergote
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  17. Marie-Rose Christiaens
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  18. Patrick Neven
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Corresponding author

Correspondence to Patrick Neven.

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Morales, L., Pans, S., Paridaens, R. et al. Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: associated tenosynovial changes on magnetic resonance imaging. Breast Cancer Res Treat 104, 87–91 (2007). https://doi.org/10.1007/s10549-006-9394-6

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  • DOI: https://doi.org/10.1007/s10549-006-9394-6

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