title: Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: associated tenosynovial changes on magnetic resonance imaging.
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.
  
  
  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.
authors.affiliation: Department of General Medical Oncology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Leilani
authors.initials: L
authors.lastname: Morales
authors.forename: Steven
authors.initials: S
authors.lastname: Pans
authors.forename: Robert
authors.initials: R
authors.lastname: Paridaens
authors.forename: Rene
authors.initials: R
authors.lastname: Westhovens
authors.forename: Dirk
authors.initials: D
authors.lastname: Timmerman
authors.forename: Johan
authors.initials: J
authors.lastname: Verhaeghe
authors.forename: Hans
authors.initials: H
authors.lastname: Wildiers
authors.forename: Karin
authors.initials: K
authors.lastname: Leunen
authors.forename: Frederic
authors.initials: F
authors.lastname: Amant
authors.forename: Patrick
authors.initials: P
authors.lastname: Berteloot
authors.forename: Ann
authors.initials: A
authors.lastname: Smeets
authors.forename: Erik
authors.initials: E
authors.lastname: Van Limbergen
authors.forename: Caroline
authors.initials: C
authors.lastname: Weltens
authors.forename: Walter
authors.initials: W
authors.lastname: Van den Bogaert
authors.forename: Luc
authors.initials: L
authors.lastname: De Smet
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.forename: Marie-Rose
authors.initials: MR
authors.lastname: Christiaens
authors.forename: Patrick
authors.initials: P
authors.lastname: Neven
mesh_terms: D000368:Aged; D000730:Androstadienes / Q000009:adverse effects*; D047072:Aromatase Inhibitors / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002349:Carpal Tunnel Syndrome / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D000077289:Letrozole; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D009570:Nitriles / Q000009:adverse effects*; D010146:Pain / Q000139:chemically induced / Q000473:pathology; D012720:Severity of Illness Index; D014230:Triazoles / Q000009:adverse effects*; D014463:Ultrasonography; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D000730:Androstadienes; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D000077289:Letrozole; C056516:exemestane