title: Prospective study to assess fluid accumulation and tenosynovial changes in the aromatase inhibitor-induced musculoskeletal syndrome: 2-year follow-up data.
abstract: BACKGROUND
  Aromatase inhibitors (AIs) frequently lead to the AI-induced musculoskeletal syndrome (AIMSS). Looking into its pathophysiology, 6 months of AI therapy thickens the tendon sheath with intra-articular fluid (IAF) retention and loss of grip strength. We here report 24-month follow-up data.
  
  
  METHODS
  A prospective cohort study of 33 postmenopausal breast cancer patients received adjuvant endocrine therapy; 27 received an AI and 6 received tamoxifen. At baseline, 6 and 24 months patients had a rheumatologic examination, including a grip strength test, and magnetic resonance imaging of both hands and wrists. The primary end point was tenosynovial changes; secondary end points were changes in morning stiffness, grip strength and IAF.
  
  
  RESULTS
  Twenty-three AI and 5 tamoxifen patients completed all investigations. Between month 6 and 24, IAF further increased in AI users (P = 0.04) but not in tamoxifen users, and grip strength further decreased in both groups. The worsened tenosynovial changes were strongly correlated with a decrease in grip strength. At 24 months, morning stiffness continued to be present in over a third of AI users.
  
  
  CONCLUSIONS
  AIMSS represents a substantial problem in breast cancer patients. It is associated with tenosynovial changes, IAF retention, joint stiffness and loss of grip strength that do not improve with prolonged use.
authors.affiliation: Department of Obstetrics and Gynecology, KU Leuven, Leuven. Electronic address: patrick.neven@uzleuven.be.
authors.forename: A
authors.initials: A
authors.lastname: Lintermans
authors.affiliation: Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven; Leuven Cancer Institute (LKI), KU Leuven, Leuven.
authors.forename: A
authors.initials: A
authors.lastname: Laenen
authors.affiliation: Leuven Cancer Institute (LKI), KU Leuven, Leuven; Department of Development and Regeneration, KU Leuven, Leuven.
authors.forename: B
authors.initials: B
authors.lastname: Van Calster
authors.affiliation: Department of Rheumatology, KU Leuven, Leuven.
authors.forename: M
authors.initials: M
authors.lastname: Van Hoydonck
authors.affiliation: Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Pans
authors.affiliation: Department of Obstetrics and Gynecology, KU Leuven, Leuven.
authors.forename: J
authors.initials: J
authors.lastname: Verhaeghe
authors.affiliation: Department of Rheumatology, KU Leuven, Leuven.
authors.forename: R
authors.initials: R
authors.lastname: Westhovens
authors.affiliation: Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA.
authors.forename: N L
authors.initials: NL
authors.lastname: Henry
authors.affiliation: Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven.
authors.forename: H
authors.initials: H
authors.lastname: Wildiers
authors.affiliation: Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven.
authors.forename: R
authors.initials: R
authors.lastname: Paridaens
authors.affiliation: Department of Obstetrics and Gynecology, KU Leuven, Leuven.
authors.forename: A S
authors.initials: AS
authors.lastname: Dieudonné
authors.affiliation: Department of Obstetrics and Gynecology, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven.
authors.forename: K
authors.initials: K
authors.lastname: Leunen
authors.affiliation: Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven.
authors.forename: L
authors.initials: L
authors.lastname: Morales
authors.affiliation: Department of Rheumatology, KU Leuven, Leuven.
authors.forename: K
authors.initials: K
authors.lastname: Verschueren
authors.affiliation: Department of Obstetrics and Gynecology, KU Leuven, Leuven.
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
authors.affiliation: Orthopedic Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: De Smet
authors.affiliation: Department of Obstetrics and Gynecology, KU Leuven, Leuven; Leuven Cancer Institute (LKI), KU Leuven, Leuven.
authors.forename: I
authors.initials: I
authors.lastname: Vergote
authors.affiliation: Department of Obstetrics and Gynecology, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven.
authors.forename: M R
authors.initials: MR
authors.lastname: Christiaens
authors.affiliation: Department of Obstetrics and Gynecology, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven.
authors.forename: P
authors.initials: P
authors.lastname: Neven
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008875:Middle Aged; D009140:Musculoskeletal Diseases; D017698:Postmenopause; D011446:Prospective Studies; D013583:Synovial Membrane / Q000187:drug effects*; D013629:Tamoxifen / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013710:Tendons / Q000187:drug effects*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D013629:Tamoxifen