Letrozole Joint Pain & Exercise
I've been on Letrozole since August 2018 and have had a lot of joint pain and for the last few weeks, soft tissue issues with my knee as well (area of an old ligament injury). I'm cautious about sayi...
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haha @Artferret - that gives your hubby something to do - I just don't wear bras! ;) Yes, I've changed how I hold cups, pick up many items, how I use a pepper grinder, pull up my trousers. It is as if something else 'happens' every other week - something I can't do, that I could, quite easily, just months ago.
I've just noticed in the last 2 days that I can't even squeeze the toothpaste tube any more, with either hand! I lay it on the bench & squash it! grr And I was hoping for LESS pain/restriction whilst 'off the meds' for 4 weeks! (Half way thru now!)
In the 'Trigger Thumb' document on the previous page - they mention that some women had had X-rays/scans, blood tests etc & there is nothing to show for the reason of active pain or restriction of movements in the hands/thumb - and could only be caused by the meds. Not sure I am up to having surgery on both thumbs tho!
Mine are locked 'straight' (not bent - hers were locked bent) but if I can bend mine (painfully), they then remain lock bent & I can only straighten them manually, using my other hand!
Quote: A 49-year-old woman visited our department due to painful bilateral trigger thumbs, which were characteristically locked in flexion. Both thumbs showed passively correctable locking and the patient did not perform an extension of both thumbs because it was very painful. There were no palpable nodules in either thumb. The patient had no history of previous trauma or familial history. Laboratory tests were normal, including blood sugar, erythrocyte sedimentation rate, C-reactive protein, renal function, thyroid function, and rheumatoid factor. Radiographs of the hands were also normal. Three years ago, the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy due to endometrial adenocarcinoma. One year later, treatment with pelvic radiotherapy and anastrozole (Arimidex®, AstraZeneca, Seoul, Korea) was started due to iliac lymph nodes metastases. Since then, the patient experienced tolerable arthralgias, myalgia, and mild triggering during the treatment with anastrozole. After 2 years of treatment with anastrozole, the patient developed severe triggering and locking in both thumbs. Conservative management with local steroid injections was not effective and further aggravated the triggering.
Hence, AIs are useful in the management of endometrial cancer. However, musculoskeletal complaints, particularly arthralgia and myalgia, in patients treated with AIs have been reported. It has been suggested that AIs reduce the antinociceptive effects of estrogen by complete estrogen depletion, and therefore, decrease the pain-threshold, resulting in arthralgia. Also, it has been reported that AIs are associated with carpal tunnel syndrome (CTS) and trigger finger. CTS has been reported to be associated with all AIs, anastrozole, exemestane, and letrozole. Arthralgia, trigger finger, and CTS were frequently reported for patients treated with letrozole or exemestane, and most patients showed a severely reduced mobility of the hand or wrist. Patients receiving anastrozole showed a higher incidence of joint symptoms, arthralgia, arthritis, and CTS, as well as of tendinopathy. However, severe trigger finger has not been reported yet for cases treated with anastrozole. The exact mechanism for AI-induced trigger digit is unclear. Morales, et al. showed a thickening of the flexor tendon sheath in all patients treated with letrozole and exemestane. Martens, et al. reported thickening of the abductor pollicis longus tendon in patients receiving anastrozole. These reports provide a feasible reason for the trigger thumbs in patients treated with AI, as thickening of the tendon sheaths of the A1 pulley may lead to severe triggering of the flexor tendon, as was observed in our case.
I've just noticed in the last 2 days that I can't even squeeze the toothpaste tube any more, with either hand! I lay it on the bench & squash it! grr And I was hoping for LESS pain/restriction whilst 'off the meds' for 4 weeks! (Half way thru now!)
In the 'Trigger Thumb' document on the previous page - they mention that some women had had X-rays/scans, blood tests etc & there is nothing to show for the reason of active pain or restriction of movements in the hands/thumb - and could only be caused by the meds. Not sure I am up to having surgery on both thumbs tho!
Mine are locked 'straight' (not bent - hers were locked bent) but if I can bend mine (painfully), they then remain lock bent & I can only straighten them manually, using my other hand!
Quote: A 49-year-old woman visited our department due to painful bilateral trigger thumbs, which were characteristically locked in flexion. Both thumbs showed passively correctable locking and the patient did not perform an extension of both thumbs because it was very painful. There were no palpable nodules in either thumb. The patient had no history of previous trauma or familial history. Laboratory tests were normal, including blood sugar, erythrocyte sedimentation rate, C-reactive protein, renal function, thyroid function, and rheumatoid factor. Radiographs of the hands were also normal. Three years ago, the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy due to endometrial adenocarcinoma. One year later, treatment with pelvic radiotherapy and anastrozole (Arimidex®, AstraZeneca, Seoul, Korea) was started due to iliac lymph nodes metastases. Since then, the patient experienced tolerable arthralgias, myalgia, and mild triggering during the treatment with anastrozole. After 2 years of treatment with anastrozole, the patient developed severe triggering and locking in both thumbs. Conservative management with local steroid injections was not effective and further aggravated the triggering.
Hence, AIs are useful in the management of endometrial cancer. However, musculoskeletal complaints, particularly arthralgia and myalgia, in patients treated with AIs have been reported. It has been suggested that AIs reduce the antinociceptive effects of estrogen by complete estrogen depletion, and therefore, decrease the pain-threshold, resulting in arthralgia. Also, it has been reported that AIs are associated with carpal tunnel syndrome (CTS) and trigger finger. CTS has been reported to be associated with all AIs, anastrozole, exemestane, and letrozole. Arthralgia, trigger finger, and CTS were frequently reported for patients treated with letrozole or exemestane, and most patients showed a severely reduced mobility of the hand or wrist. Patients receiving anastrozole showed a higher incidence of joint symptoms, arthralgia, arthritis, and CTS, as well as of tendinopathy. However, severe trigger finger has not been reported yet for cases treated with anastrozole. The exact mechanism for AI-induced trigger digit is unclear. Morales, et al. showed a thickening of the flexor tendon sheath in all patients treated with letrozole and exemestane. Martens, et al. reported thickening of the abductor pollicis longus tendon in patients receiving anastrozole. These reports provide a feasible reason for the trigger thumbs in patients treated with AI, as thickening of the tendon sheaths of the A1 pulley may lead to severe triggering of the flexor tendon, as was observed in our case.
Conservative treatments, such as splinting, NSAIDs and steroid injection, may be less effective to treat AI-induced CTS or trigger finger, compared with idiopathic CTS or trigger finger. Among AIs, anastrozole and letrozole reversibly bind to aromatase enzyme, while exemestane irreversibly binds thereto. However, the triggering of our patient was not improved after treatment with anastrozole. At first, our patient received local corticosteroid injections in both thumbs; however, the symptoms aggravated in both thumbs and resulted in locking. Thus, surgery was performed. While corticosteroid injections may be effective in treating conventional trigger digits, our findings suggest that AI-associated trigger digit requires surgical treatment.
Unilateral trigger digit is an entity commonly seen by hand surgeons. Even if only one finger is involved in the triggering phenomenon, hand function can be seriously compromised when the digit is locked in flexion. In our patient, there were no predisposing factors present, such as thyroid disease, diabetes, renal disease, or rheumatoid arthritis. Our patient showed locking trigger thumbs in both hands in association with the AI anastrozole (Arimidex®). To the best of our knowledge, no previous reports have suggested an association between anastrozole and bilateral trigger thumbs in the treatment of endometrial cancer. Nevertheless, clinicians should be aware of possible medication side effects as a potential etiology of trigger thumbs. Unquote