title: Patterns and risk factors associated with aromatase inhibitor-related arthralgia among breast cancer survivors.
abstract: BACKGROUND
  Arthralgia is common in postmenopausal breast cancer survivors (BCS) who are receiving aromatase inhibitors (AIs). The objective of this study was to evaluate the perceived onset, characteristics, and risk factors for AI-related arthralgia (AIA).
  
  
  METHODS
  In a cross-sectional survey of postmenopausal BCS who were receiving adjuvant AI therapy at a university-based oncology clinic, patient-reported attribution of AIs as a cause of joint pain was used as the primary outcome. Multivariate logistic regression analyses were performed to evaluate risk factors.
  
  
  RESULTS
  Among 300 survey respondents, 139 (47%) attributed AI as a cause of their current arthralgia. Of those patients, 74% recognized the onset of AIA within 3 months of starting medication, and 67% rated joint pain as moderate or severe in the previous 7 days. In multivariate logistic regression analyses, the time since last menstrual period (LMP) was the only significant predictor of AIA. Controlling for covariates, the women who had their LMP within 5 years had the highest probability of reporting AIA (73%), whereas those who had their LMP > or =10 years previously had the lowest probability of reporting AIA (35%; adjusted odds radio, 3.39; 95% confidence interval, 1.21-9.44; P = .02). Wrists/hands, ankles/feet, elbows, and knees appeared to be associated more strongly with AI-related symptoms than non-AI-related joint symptoms (all P < .01).
  
  
  CONCLUSIONS
  AIA was common, began within the first 3 months of therapy in most patients, and appeared to be related inversely to the length of time since cessation of menstrual function. These findings suggest that estrogen withdrawal may play a role in the mechanism of this disorder.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, PA, USA. jun.mao@uphs.upenn.edu
authors.forename: Jun J
authors.initials: JJ
authors.lastname: Mao
authors.forename: Carrie
authors.initials: C
authors.lastname: Stricker
authors.forename: Deborah
authors.initials: D
authors.lastname: Bruner
authors.forename: Sharon
authors.initials: S
authors.lastname: Xie
authors.forename: Marjorie A
authors.initials: MA
authors.lastname: Bowman
authors.forename: John T
authors.initials: JT
authors.lastname: Farrar
authors.forename: Brandon T
authors.initials: BT
authors.lastname: Greene
authors.forename: Angela
authors.initials: A
authors.lastname: DeMichele
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D047072:Aromatase Inhibitors / Q000009:adverse effects*; D018771:Arthralgia / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D001943:Breast Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors