Joint symptoms: a practical problem of anastrozole.
BACKGROUND
Anastrozole and tamoxifen have mild toxicity. However, we noticed that more patients treated with anastrozole complained of joint symptoms than expected. In particular, digital stiffness as is seen with rheumatoid arthritis is a problem. Some clinical trials of anastrozole in Europe and the United States reported musculoskeletal disorders as adverse events, however, joint symptoms were not described in detail.


METHODS
At our clinic from August 2001 to March 2005, 53 postmenopausal women with estrogen receptor-positive breast cancer were treated with anastrozole. We calculated the incidence and classified the grade of joint symptoms by interviewing patients. We also investigated the patients' characteristics and their relevance to joint symptoms.


RESULTS
Of 53 patients, 14 patients (26%) had joint symptoms (13 patients with digital stiffness and 3 patients with arthralgias of wrist and shoulders). Joint symptoms tended to occur in the patients who had previously undergone chemotherapy; however, there has no relationship between prior hormonal therapy and joint symptoms. Seven patients who discontinued anastrozole treatment showed improved symptoms. Five patients with grade 1 digital stiffness continued anastrozole treatment without additional treatment. Two patients with grade 1 digital stiffness, who took a Chinese herbal medicine showed improved symptoms and continued anastrozole treatment.


CONCLUSIONS
Benefits to the patients may possibly be lost by discontinuation of anastrozole or changing to tamoxifen since the clinical superiority of anastrozole to tamoxifen has been reported. We should continue anastrozole in patients with low grade symptoms, while ensuring that patients are aware of the toxicity of anastrozole.
Ohsako
Tomofumi
T
Department of Surgery, Japan Labour Health and Welfare Organization Kumamoto Rosai Hospital, Japan. geka-ohsako@kumamotoh.rofuku.go.jp.
Inoue
Katsuhiko
K
Department of Surgery, Japan Labour Health and Welfare Organization Kumamoto Rosai Hospital, Japan.
Nagamoto
Norihide
N
Department of Surgery, Japan Labour Health and Welfare Organization Kumamoto Rosai Hospital, Japan.
Yoshida
Yasushi
Y
Department of Surgery, Japan Labour Health and Welfare Organization Kumamoto Rosai Hospital, Japan.
Nakahara
Osamu
O
Department of Surgery, Japan Labour Health and Welfare Organization Kumamoto Rosai Hospital, Japan.
Sakamoto
Namiko
N
Department of Surgery, Japan Labour Health and Welfare Organization Kumamoto Rosai Hospital, Japan.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007592:Joint Diseases / Q000139:chemically induced*; D008875:Middle Aged; D009570:Nitriles / Q000009:adverse effects*; D017698:Postmenopause; D014230:Triazoles / Q000009:adverse effects*
D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D014230:Triazoles; D000077384:Anastrozole