Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Joint pain linked to breast cancer drug not inflammatory arthritis or autoimmune disease

08.11.2010
A new study suggests joint complaints attributed to aromatase inhibitors (AI), popular breast cancer drugs, are not associated with inflammatory arthritis or autoimmune disease.

Because of that, researchers say women who were primarily concerned about the threat of arthritis should be encouraged to continue taking the medication. The findings of the study will be presented Tuesday, Nov. 9 at the 74th Annual Scientific Meeting of the American College of Rheumatology in Atlanta, Georgia

For many post-menopausal women with breast cancer promoted by the hormone estrogen, AIs can dramatically reduce the risk of their cancer coming back. Doctors say the AIs must be taken for five years to gain the full benefit, however the development of joint complaints in up to 35 percent of women forces many of them to stop early.

"It's not clear why these joint symptoms occur, but we wondered if they could be related to inflammation or an autoimmune disease," says Victoria K Shanmugam, MBBS, MRCP, assistant professor in the Division of Rheumatology, Immunology and Allergy at Georgetown University Medical Center, who led the study. "Our research ruled out both."

The case-controlled study included 25 postmenopausal breast cancer patients with hand pain and no known autoimmune disease who were treated for their cancer at Georgetown Lombardi Comprehensive Cancer Center. Another 23 participants who were not receiving the drugs enrolled as a control group.

Subjects were evaluated after abstaining from non-steroidal anti-inflammatory drugs for 48 hours. Signs of inflammation from arthritis would reappear in that time frame, the researchers reasoned. They completed a health assessment questionnaire. The rheumatologist completed a history and physical, and disease activity score. Various blood tests were conducted and x-rays and ultrasounds of all participants' hands were performed.

The rheumatologist and radiologist did not know which participants were taking AIs and which were not.

"We did find 4 of 48 women with autoimmune disease – 2 in each group -- that had previously been undiagnosed, but the frequency was similar both in women receiving AIs and those who were not receiving AIs," Shanmugam says. "We found that several patients in the control arm had a similar constellation of symptoms to those receiving AIs."

But Shanmugam and her team did not find any conclusive evidence from their tests of inflammatory arthritis in the women with breast cancer.

"Although our study helps to rule out inflammatory arthritis or autoimmune disease, we do not know why women using AIs have these musculoskeletal symptoms. Still, knowing that the drugs are not promoting inflammatory arthritis may be beneficial to a number of women," she concludes.

"It would be prudent to refer those experiencing joint pain to a rheumatologist to rule out a previously undiagnosed autoimmune disease, and so that we can help address the symptoms," Shanmugam says. "Since the syndrome doesn't appear to be related to inflammatory arthritis, women should be encouraged to stay on their medication so they can gain the full benefit from it."

The study was supported by funds from the Georgetown University Department of Medicine, Grant and the National Institutes of Health. Shanmugam's research is funded by the American College of Rheumatology, Research and Education Foundation, Physician Scientist Development Award and the National Center for Research Resources.

Claudine Isaacs, a co-author, is part of a speakers bureau for AstraZeneca, which makes an aromatase inhibitor. No other authors report related financial interests.

About Georgetown University Medical Center

Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Georgetown Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO). In fiscal year 2009-2010, GUMC accounted for 79 percent of Georgetown University's extramural research funding.

Research to be presented Tuesday, November 9, 2010, 9:00 am / Halls B1 & B2 Abstract: [912] - The CIRAS Study: A Case Control Study To Define the Clinical, Immunologic and Radiographic Features of the Aromatase Inhibitor Arthralgia Syndrome.

Victoria K Shanmugam, MBBS, MRCP1,James McCloskey, MD2,Elizabeth Elston, MSc (PT)3,Sandra J. Allison, MD4,Claudine Isaacs, MD5,Jennifer Eng-Wong, MD, MPH5. 1Division of Rheumatology, Immunology and Allergy, Georgetown University Medical Center, Washington, DC,2Department of Internal Medicine, Georgetown University Medical Center, Washington, DC,3Georgetown University,4Department of Radiology, Georgetown University Medical Center, Washington, DC,5Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC

Background: Aromatase inhibitors (AIs) reduce recurrence in post-menopausal hormone-receptor positive breast cancer. However, development of joint pains (Arthralgia Syndrome) limits compliance. The pathophysiology of this syndrome is unknown, but morning stiffness suggests an inflammatory etiology. Associations have been reported with tenosynovitis and autoimmune diseases. The CIRAS study was designed to determine the evidence for an inflammatory etiology.

Methods: Postmenopausal breast cancer patients followed at Lombardi Cancer Center with hand pain but without known autoimmune disease were recruited. Subjects receiving AIs were cases (n=25) while those not receiving AIs were controls (n=23).

Subjects were evaluated after abstaining from non-steroidal anti-inflammatory drugs for 48 hours. They completed a health assessment questionnaire (PROMIS-HAQ). The rheumatologist completed a history and physical, and disease activity score (DAS-28). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antinuclear antibody (ANA), rheumatoid factor (RF), anti-cyclic citrullinated peptide (CCP), vitamin D and cytokine levels were tested. Bilateral hand radiographs and ultrasound were performed. The hand ultrasound was scored for presence of flexor tenosynovitis, fluid in the metacarpophalangeal joints, tissue edema, and tendon sheath enhancement for each digit on both hands, and a total ultrasound score was computed. The rheumatologist and radiologist were blinded as to study group. Data was analyzed using t-test and Fisher's exact test.

Results: Patients in both groups were predominantly Caucasian and of similar age. Neither the DAS-28 nor the ESR was significantly different between cases and controls.

Hypovitaminosis D was found in 1 case and 5 controls (p 0.06).There was no significant difference in mean vitamin D. In each group two subjects had previously undiagnosed autoimmune disease (8.3%). A positive ANA was identified in 6 controls and 4 cases (20.8%). While cases experienced more prolonged morning stiffness, this did not reach statistical significance (p= 0.07). PROMIS-HAQ, global-HAQ and mean pain scores were not significantly different. There was no difference in ultrasound score or tendon nodules, Dequervain's tenosynovitis, ganglion cysts or flexor tenosynovitis. Several patients in the control arm had a similar constellation of symptoms to those receiving AIs.

Conclusions: The arthralgia syndrome may not be unique to patients receiving AIs. This syndrome warrants further investigation since development affects compliance with AI therapy.

Karen Mallet | EurekAlert!
Further information:
http://www.georgetown.edu

More articles from Studies and Analyses:

nachricht New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)

nachricht Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

DGIST develops 20 times faster biosensor

24.04.2017 | Physics and Astronomy

Nanoimprinted hyperlens array: Paving the way for practical super-resolution imaging

24.04.2017 | Materials Sciences

Atomic-level motion may drive bacteria's ability to evade immune system defenses

24.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>