Efficacy of management strategies for aromatase inhibitor‐induced arthralgia in breast cancer patients: a systematic review

Abstract

Aromatase inhibitors are the gold standard in the treatment of hormone receptor-positive breast cancer, but lead to an arthralgia syndrome which is implicated in 13-22% of noncompliance. This is the first systematic review of the efficacy of existing management strategies for this side effect.Eligible studies were retrieved from computer searches of Medline, Cochrane and Embase and the significant intervention groups were identified. The risk of bias of selected studies was evaluated and the relevant data items were extracted, summarized and analyzed. A total of 21 studies were discussed in this review representing 12 different interventions. While several trials had positive findings, the major methodological limitations of the studies meant that no definitive evidence could be found supporting any of the interventions. Future trials are needed which address the methodological problems identified in this review. Exercise holds promise for future research based on its proven benefit in breast cancer.

Endocrine Therapy–Related Symptoms and Quality of Life in Female Cancer Survivors in the Yale Fitness Intervention Trial

“…Therefore, there is a need to explore the underlying symptom mechanisms, identify predictors of women at greatest risk (Henry & Stearns, 2011 ;Olufade, Gallicchio, MacDonald, & Helzlsouer, 2015 ), and develop both pharmacologic and nonpharmacologic interventions to relieve these symptoms. Studies have examined various approaches for such relief, including vitamin D, yoga, acupuncture, physical activity, pharmacology, and complementary interventions (Nahm, Mee, & Marx, 2018 ;Roberts, Rickett, Greer, & Woodward, 2017 ). Many studies, however, have limitations in terms of small sample size, short intervention period, and lack of follow-up measurement (Nahm et al, 2018 ;Roberts et al, 2017 ).…”

“…Studies have examined various approaches for such relief, including vitamin D, yoga, acupuncture, physical activity, pharmacology, and complementary interventions (Nahm, Mee, & Marx, 2018 ;Roberts, Rickett, Greer, & Woodward, 2017 ). Many studies, however, have limitations in terms of small sample size, short intervention period, and lack of follow-up measurement (Nahm et al, 2018 ;Roberts et al, 2017 ). Using selfreported outcome measures also raises questions on how accurately the women can identify AI-related musculoskeletal symptoms versus non-AI-related musculoskeletal symptoms or other symptoms that can be mistaken for musculoskeletal symptoms (Nahm et al, 2018 ).…”

“…Many studies, however, have limitations in terms of small sample size, short intervention period, and lack of follow‐up measurement (Nahm et al., ; Roberts et al., ). Using self‐reported outcome measures also raises questions on how accurately the women can identify AI‐related musculoskeletal symptoms versus non‐AI‐related musculoskeletal symptoms or other symptoms that can be mistaken for musculoskeletal symptoms (Nahm et al., ). Further research is needed to establish effective exercise interventions specifically designed for AI‐related musculoskeletal symptoms.…”

Aromatase Inhibitors—Induced Musculoskeletal Disorders: Current Knowledge on Clinical and Molecular Aspects

“…Low levels of evidence have been achieved in most cases. Presently, there are not standard, uniformly accepted treatments for AIA, and the majority of the proposed algorithms are based on anecdotal reports, or derived from experiences in other pathologies (e.g., arthritis), rather than from specific trials [83].…”

“…Only a single-arm study on a small patient series addressed the efficacy of corticosteroids in 27 women with AIA, showing a beneficial effect of low-dose prednisolone (25 mg daily) administered for a short period (one week) [96]. However, these results are questionable, due to the short follow-up (two months) and the use of an unvalidated questionnaire [83].…”