One of the most effective new treatments for breast cancer is a hormonetherapy. Aromatase inhibitors work by powerfully blocking theconversion of androgen precursors into estrogens, which lowersestradiol levels in the bloodstream and estrogen levels in peripheraltissues. Because aromatase inhibitors reduce the rates of recurrence inwomen with early-stage postmenopausal breast cancer, these agents arenot only becoming widely used in breast cancer treatment, but alsobeing explored for their potential to prevent the disease in women athigh risk. While focusing on this therapy's promise, advocates havetended to downplay one of its drawbacks. Women treated with aromataseinhibitors often experience joint pain and musculoskeletalaching--severe enough, in some cases, to make them stop the treatment.
Two noted researchers, David T. Felson, M.D., of Boston UniversityClinical Epidemiology Unit, and Steven R. Cummings, M.D., of CaliforniaPacific Medical Center Research Institute and University of California,San Francisco, have thoroughly examined the evidence linking aromataseinhibitors and, more broadly, estrogen deprivation joint pain. In theSeptember 2005 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis),they share their insights to alert oncologists, primary carephysicians, and other health care professionals to this widelyoverlooked, potential problem for women.
"Estrogen's effects on inflammation within the joint are not wellknown," Dr. Felson and Dr. Cummings observe. Yet, as they note,estrogen has well-established tissue-specific effects on inflammatorycytokines. Estrogen's role in joint inflammation could account for theincreased sensitivity to pain that some women suffer with estrogendepletion. Citing studies of pharmacological suppression of estrogenand studies of natural menopause, the authors offer a look atcompelling evidence associating estrogen deprivation with joint pain,including:
Dr. Felson and Dr. Cummings also highlight recent data showing thatAsian women undergoing menopause have lower estradiol levels thanCaucasian women and seem to be more vulnerable to a syndrome commonlyknown as "menopausal arthritis." They also note the high rate of bothosteoarthritis and rheumatoid arthritis in postmenopausal women. Theyconclude by stressing the need for further research into thecontribution of estrogen deficiency to arthritis, as well as forrecognizing the risks of musculoskeletal syndrome when prescribingaromatase inhibitors and other estrogen-depleting treatments.
Article: "AromataseInhibitors and the Syndrome of Arthralgias With Estrogen Deprivation,"David T. Felson and Steven R. Cummings, Arthritis & Rheumatism,September 2005; 52:9; pp. 2594-2598.
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