Aromatase inhibitor-associated arthralgia in breast cancer: etiopathogenesis and treatment
Background: Aromatase inhibitors (AIs) are currently used for the chemoprevention and treatment of hormone-dependent (HR+) breast cancer (BC). In premenopausal women with HR+ BC at high risk of recurrence, as determined by clinicopathological characteristics, the use of these drugs reduces the risk by 10–15%.Shaikhelislamova L.F., Lazakovich A.A., Vats A.B., Akhmedov R.M., Zhurov A.S., Zueva D.S., Belousov A.M., Dashyan G.A.
Objective: Review of literature on the incidence and mechanisms of AI-associated arthralgia, as well as methods for preventing musculoskeletal disorders (MSDs) during treatment with these medications.
Results: The studies reviewed in this study demonstrate that over 50% of women experience pain, necessitating further investigation of the underlying mechanisms of these complications and the development of strategies to minimize them. CDK4/6 inhibitors may be an alternative, as they have less pronounced side effects on the musculoskeletal system. Observations also confirm a link between side effects and recurrence rates. Duloxetine has been shown to be effective in reducing the incidence of arthralgia, although its effect in patients with a high body mass index requires further analysis. The risk of osteoporosis associated with AI treatment can be reduced with bisphosphonates, which is also supported by a reduction in fracture rates in high-risk patients. True acupuncture is an effective method for reducing arthralgia associated with AI use in women with HR+ BC. Moderate physical activity is an effective non-pharmacological strategy for relieving arthralgia during AI therapy in BC, associated with a reduction in systemic inflammation and an improvement in quality of life.
Keywords
aromatase inhibitors
arthralgia
osteoporosis
aromatase inhibitor side effects
breast cancer therapy complications
About the Authors
L.F. Shaykhelislamova, Oncologist, Plastic Surgeon, Oncology Department No. 1, N.I. Pirogov Clinic of High Medical Technologies, St. Petersburg State University, St. Petersburg, Russia; shaykhelislamovalf@mail.ru; ORCID: https://orcid.org/0000-0001-9623-387, SPIN code: 2166-8716.A.A. Lazakovich, Oncologist, Oncology Department No. 1, N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University, St. Petersburg, Russia; ORCID: https://orcid.org/0009-0007-3112-8081, SPIN: 6144-1590
A.B. Vats, Oncologist, Plastic Surgeon, Oncology Department No. 1, N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University, St. Petersburg, Russia; ORCID: https://orcid.org/0009-0000-0450-0166
R.M. Akhmedov, Oncologist, Plastic Surgeon, Oncology Department No. 1, N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0003-3348-4251, SPIN-code: 5361-5059
A.S. Zhurov, Oncologist, Oncology Department No. 1, N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University, St. Petersburg, Russia; ORCID: https://orcid.org/0009-0004-7511-2952
D.S. Zueva, Therapist, Oncology Department No. 1, N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0002-3515-6676
A.M. Belousov, Dr. Sci. (Med.), Surgeon, Oncologist, Deputy Director for Medicine (Surgery and Oncology), N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0002-2274-8170, SPIN: 2842-7325
G.A. Dashyan, Dr. Sci. (Med.), Oncologist, Head of Oncology Department No. 1, N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University, St. Petersburg, Russia; ORCID: https://orcid.org/0000-0001-6183-9764, SPIN: 6989-7148 (corresponding author)
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