Joint Pain, Sicca Syndrome Increased with Aromatase Inhibitors

NEW YORK DEC 18, 2007 (Reuters Health) - Women who take aromatase inhibitors after undergoing breast cancer surgery often have joint pain and sicca syndrome, according to a report in the November issue of The Journal of Rheumatology.

More than a quarter of women in the Arimidex, Tamoxifen, Alone or In Combination (ATAC) study had muscular and skeletal symptoms, the authors explain, but the origin of this pain was unclear.

Dr. Michel Laroche from CHU Rangueil, Toulouse, France and colleagues investigated the origin of joint pain that developed in 24 women an average of 2.5 months after the start of aromatase inhibitor treatment.

Five of the patients were found to have osteoarthritis, shoulder tendinitis, or paraneoplastic aponeurositis.

Most of the other patients had pain of the inflammatory type, with morning stiffness lasting 15 to 30 minutes, improvement with exercise, and symmetrical pain involving the proximal interphalangeal and metacarpophalangeal joints, wrists, shoulders, forefeet, ankles, or knees, the authors report.

Only 2 women had an inflammatory syndrome, but 9 patients had antinuclear antibody titers above 1/160. Overall, 10 of 19 patients complained of sicca syndrome affecting the mouth, the eyes, or both, the report indicates.

"In women with breast cancer," the authors conclude, "aromatase inhibitors, perhaps through the major estrogen deficiency they induce, could be conducive to development of such a syndrome associating joint pain, sicca syndrome, presence of ANA with no biological inflammatory syndrome, with moderate histopathological lesions of the accessory salivary glands."

"Studies of a larger patient series and investigation for sicca syndrome and autoantibodies in women who have had breast cancer but who have not been treated with aromatase inhibitors is needed to confirm this hypothesis," the researchers note.

"Similarly," they add, "it is essential to follow these patients after aromatase inhibitors have been discontinued to assess the reversibility of the sicca syndrome."

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