title: A prospective study of aromatase inhibitor-associated musculoskeletal symptoms and abnormalities on serial high-resolution wrist ultrasonography.
abstract: BACKGROUND
  Nearly half of women treated with aromatase inhibitors (AI) develop AI-associated musculoskeletal symptoms (AIMSS) such as arthralgias, but to the authors' knowledge the etiology is unclear. The upper extremities are frequently affected, especially the wrists, hands, and fingers. AI use may also increase the risk of developing carpal tunnel syndrome. Tendon sheath fluid and tenosynovial changes have been demonstrated by imaging symptomatic patients who were treated with AIs. The authors hypothesized that these abnormalities are correlated with AIMSS.
  
  
  METHODS
  Thirty consecutive patients in whom adjuvant therapy with letrozole or exemestane was initiated on a prospective clinical trial enrolled in a pilot study evaluating tendon and joint abnormalities at baseline and after 3 months of AI therapy. Patients underwent high-resolution ultrasonography of the wrists bilaterally and completed the Health Assessment Questionnaire (HAQ) and pain Visual Analog Scale (VAS). AIMSS were defined as an increase in the HAQ or VAS score during AI therapy that exceeded a predefined cutoff.
  
  
  RESULTS
  Twenty-five patients completed both the baseline and 3-month assessments. During the first 12 months of AI therapy, 15 patients developed AIMSS, and 13 discontinued therapy because of musculoskeletal symptoms. There was a trend toward an association between the presence of tendon sheath abnormalities on wrist ultrasound at baseline and the development of AIMSS (P = .06).
  
  
  CONCLUSIONS
  Clinically relevant musculoskeletal symptoms develop in women treated with AIs, leading to treatment discontinuation in a substantial percentage of these patients. However, in the current study, patient-reported symptoms were not found to be associated with changes visible on wrist ultrasonography.
authors.affiliation: Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109-5419, USA. norahh@med.umich.edu
authors.forename: N Lynn
authors.initials: NL
authors.lastname: Henry
authors.forename: Jon A
authors.initials: JA
authors.lastname: Jacobson
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Jill
authors.initials: J
authors.lastname: Hayden
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Smerage
authors.forename: Catherine
authors.initials: C
authors.lastname: Van Poznak
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Storniolo
authors.forename: Vered
authors.initials: V
authors.lastname: Stearns
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hayes
mesh_terms: D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D047072:Aromatase Inhibitors / Q000009:adverse effects*; D018771:Arthralgia / Q000000981:diagnostic imaging; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods; D028761:Withholding Treatment; D014953:Wrist / Q000000981:diagnostic imaging*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors