SAT0542 Musculoskeletal Syndromes Related to Aromatase Inhibitor Therapy: A Clinical and Laboratory Evaluation. (9th June 2015)

• Record Type: Journal Article
• Authors: Vadacca, M.; Lo Vullo, M.; Margiotta, D.P.E.; Navarini, L.; Sambataro, G.; D'Onofrio, L.; Santini, D.; Afeltra, A.
• Is Part Of: Annals of the rheumatic diseases. Volume 74(2015)Supplement 2
• Page Start: 856
• Page End: 856
• Publication Date: 2015-06-09
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2015-eular.6142
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Aromatase inhibitors (AI) are widely used in the treatment of estrogen receptor-positive breast cancer in postmenopausal women. The onset of musculoskeletal symptoms related to AI therapy limits the treatment compliance. Objectives: To evaluate the incidence and the clinical presentation of musculoskeletal syndromes and the prevalence of autoantibodies during AI therapy. Methods: We enrolled 49 consecutive postmenopausal patients with non-metastatic breast cancer treated with third generation AI for at least three months (AI+ group) and 10 postmenopausal controls with breast cancer in adjuvant therapy but not treated with AI (AI- group). The two groups were evaluated with a rheumatological examination (tender and swollen joint count, tender points, CDAI), with PRO-CLARA, FACIT-fatigue and HAQ questionnaires and ANA, ENA screen and ACPA dosage. ANA were assayed in indirect immunofluorescence on Hep-2 cells using as a cut-off a dilution of 1:80; ENA screen and ACPA were assayed with ELISA commercial kits. Results: The mean ages were 62.6±9 years for AI+ group and 58±11.8 years for AI- group (p=0.2, U=140.5). In AI+ group, 27 (55%) patients exhibited at least one tender joint and 15 (30%) patients exhibited at least one swollen joint. In AI- group, two patients exhibited at least one tender joint and one patient exhibited at least one swollen joint. 22% of AI+ group patients and 20% of AI- group patients showed more than 11 tender points (TP). When patients with more than 11 TP positivity were excluded from the analysis, tender joint count was more higher in AI+ group (p=0.037). Differences between AI+ and AI- groups regarding PRO-CLARA, FACIT-fatigue, HAQ and CDAI were summarized in Tab. 1. In AI+ group, PRO-CLARA values correlates with FACIT-fatigue values (R=-0.59, p<0.0001), swollen joint count (R=0.48, p=0.001), tender joint count (R=0.72, p<0.0001), tender points count (R=0.76, p<0.0001), HAQ values (R=0.85, p<0.0001), CDAI values (R=0.89, p<0.0001) and does not correlate with the age of the patients. 67% of the AI+ group patients showed ANA positivity vs 20% AI- group patients (p 0.01, RR 3.3). Conclusions: In this preliminary study, we demonstrated a higher prevalence of arthralgia/arthritis in AI+ group than in AI- group. No significant difference in tender points count was detected between the two groups. In AI+ group, higher values of PRO-CLARA, HAQ and CDAI than those of AI- group were showed. A higher rate of ANA positivity was demonstrated in AI+ group. These results support the hypothesis of a possible role of an immune system dysregulation in the development of musculoskeletal syndromes during AI therapy. The expertise of a rheumatologist could help patients with estrogen receptor-positive breast cancer treated with AI to improve their quality of life and to ensure a greater compliance to AI therapy. References: Lønning PE, et al. Endocr Relat Cancer. 2013 Jun 24;20(4):R183-201. Niravath P. Ann Oncol. 2013 Jun;24(6):1443-9. Shanmugam VK, et al. Breast Cancer Res Treat. 2012 Jan;131(2):699-708. Disclosure of Interest: None declared