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Prevalence of Joint Symptoms in Postmenopausal Women Taking Aromatase Inhibitors for Early-Stage Breast Cancer

Katherine D. Crew, Heather Greenlee, Jillian Capodice, George Raptis, Lois Brafman, Deborah Fuentes, Alex Sierra, Dawn L. Hershman

From the Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons; and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY

Address reprint requests to Dawn L. Hershman, MD, MS, Columbia University, 161 Fort Washington Ave, 10-1068, New York, NY 10032; e-mail: dlh23{at}columbia.edu

Purpose: Aromatase inhibitors (AIs) improve survival in postmenopausal women with hormone-sensitive breast cancer, but can cause joint pain and stiffness. The purpose of the current study was to evaluate the prevalence of and identify risk factors for AI-related joint symptoms.

Patients and Methods: We performed a cross-sectional survey of consecutive postmenopausal women receiving adjuvant AI therapy for early-stage hormone-sensitive breast cancer at an urban academic breast oncology clinic. Patients completed a 25-item self-administered questionnaire assessing the presence of joint symptoms that started or worsened after initiating AIs. Multivariate regression was used to compare those with AI-related arthralgia with those who did not report symptoms, adjusting for demographic and clinical factors.

Results: Of 200 patients who completed the survey, 94 (47%) reported having AI-related joint pain and 88 (44%) reported AI-related joint stiffness. In multiple logistic regression analysis, being overweight (body mass index of 25 to 30 kg/m²) and prior tamoxifen therapy were inversely associated with AI-related joint symptoms. Patients who received taxane chemotherapy were more than four times more likely than other patients to have AI-related joint pain and stiffness (odds ratio [OR] = 4.08, 95% CI, 1.58 to 10.57 and OR = 4.76; 95% CI, 1.84 to 12.28, respectively).

Conclusion: Our study suggests that AI-related joint symptoms are more prevalent than what has been described previously in clinical trials. The success of AI therapy depends on patients' ability to adhere to treatment recommendations; therefore, additional studies of interventions that may alleviate these symptoms are needed.

K.D.C. is the recipient of a Lance Armstrong Young Investigator Award. H.G. is the recipient of an R25 Award from the National Cancer Institute (CA94061). D.L.H. is the recipient of a K07 Award from the National Cancer Institute (CA95597), an Irving Scholar Award, and a research award from Women at Risk.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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