Joint Pain and Aromatase Inhibitors

Aromatase inhibitors (AIs) have now been established as successful adjuvant therapy for breast cancer survivors who are post-menopausal and whose cancer is estrogen-receptor-positive. These include anastrozole (Arimidex), letrozole (Femara) and exemastane (Aromasin). Unfortunately, nearly half of women taking AIs report joint pain, or arthralgia. It is estimated that 20-30% of patients discontinue AI treatment due to joint pain. The pain and/or stiffness is usually symmetrical (i.e., on both sides) and often affects hands, feet, knees, hip and back.

In a recent publication, researchers searched for and evaluated studies that examined the effect of several different ways of managing arthralgia related to AIs. Five types of interventions were identified that have been studied: pharmacological (drug) approaches, acupuncture, nutritional supplementation, relaxation techniques and physical exercise. Pharmacological approaches, including duloxetine (Cymbalta), immunotherapy and changing between AI options showed promise in relieving arthralgia symptoms. Acupuncture was promising in reducing pain in four studies. Two studies showed a possible positive impact of Yoga and Tai Chi on AI joint pain, function and quality of life. Several studies looked at exercise, primarily walking, and found a trend to decreasing pain with exercise, but this decrease was not statistically significant.

Bottom Line: There may be several approaches to managing AI-related joint pain. Your medical oncologist will be helpful in choosing what is right for you. Acupuncture, yoga and tai chi appear to be helpful. Exercise, such as walking, shows promise in helping manage AI pain, but further study is needed. Keep in mind, that there are many other benefits of regular exercise for breast cancer patients (see this month’s nutrition section!). Consider joining us for this month’s education event ‘Bones, Joints and Breast Cancer’ and don’t forget that TurningPoint has a weekly Yoga class!

Yang GS, et al. Interventions for the Treatment of Aromatase Inhibitor-Associated Arthralgia in Breast Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Nurs. June 21, 2016. [Epub ahead of print]