Abstract P1-13-05: A prospective study to evaluate joint changes by ultrasound and magnetic resonance imaging induced by adjuvant chemotherapy followed by aromatase inhibitors in postmenopausal early breast cancer patients developing G3 arthralgia
Authors: Fontaine C , Shahabpour M , Decoster L , Hanssens S , Schallier D , Boulet C , Vanhoeij M , Verfaillie G , Lamote J , De Grève J 
Published: August 2014

Introduction: Aromatase inhibitors (AI) are a well-established component of the adjuvant hormonal therapy in postmenopausal (PM) EBC patients (pts). AI have been associated with joint symptoms in 20 to 40% of pts adversely affecting quality of life and compliance. The subjective nature of these toxicities warrants objective correlates. In this study we have compared synovial changes on MRI with ultrasound (US).

Aim of the study: The primary aim was to assess joint changes in PM EBC pts by MRI and US at baseline and at occurrence of arthralgia G3 during AI therapy. The secondary aim was to investigate the relationship between clinical severity of articular symptoms and markers of bone metabolism.

Methods: PM EBC pts, stages I-III, with a grade 0, 1 arthralgia (CTCAE version 4.0) at baseline were recruited for the study. At baseline and at 3, 6, 9, 12 and 18 months (mths) a rheumatologic questionnaire was performed. At the same time points serum samples for bone markers (Ca, ostase, intact PTH, alkaline phosphatase and vit. D), rheumatoid factor (RF) and urine samples for urinary N-telopeptide (uNTX) were taken. Pain was assessed by the Visual Analog Scale (VAS). Before start of AI, osteoarthritis was quantified by plain radiography (hands, wrists and knees), joint changes were assessed baseline and at occurrence of arthralgia G3 by MRI and US (hands and wrists), and bone density by DEXA.

Results: 29 evaluable PM EBC pts were included in the study. At baseline, 60% of the pts had a mean VAS score of 2 (0/10-5/10), which increased to 2.5 after the adjuvant chemotherapy and to 4.5 (0-8) at mth 12 (p = 0.013) of AI therapy, and subsequently dropped to 2.5 at mth 18 (p = 0.2). The most commonly affected joints at baseline were knees (47%), shoulders (41%), and ankles/feet (29%); whereas during AI therapy it involved mainly knees (53%), shoulders (46%) and hands/wrists (32%). Fifty percent of the pts had signs of osteoarthritis of the hands (25%), knees (16%) and both (8%) on plain radiographs obtained at baseline. Grade 0-1 arthralgia was not significantly correlated with the imaging of osteoarthritis or grade of osteoporosis. At baseline intra-articular fluid was detected on MRI of the hands/wrists in 6 pts, 14 pts had synovial changes and 4 had both. Six out of 29 pts had also signs of synovitis with hyperaemia on US before the start of an AI. G3 arthralgia occurred in five pts of which only three agreed to the repeat radiological imaging. In two of these pts a worsening of imaging both by MRI and US was observed, whereas in the third pt imaging was unchanged.

Markers of bone metabolism and uNTX did not differ significantly between groups with arthralgia and without (p&gt;0.05). RF was positive in only two pts, one with arthralgia G1 at baseline and one pt at the moment of G3 arthralgia.

Conclusions: This study is the first to prospectively report on synovial changes by combined MRI and US before initiation of adjuvant AI in PM women and at occurrence of arthralgia G3. Only 17% of pts developed G3 arthralgia which corresponded to worsening imaging signs. From the small sample size it seems that baseline MRI changes predicts the development of G3 arthralgia with higher sensitivity than baseline US. Sensitivity of US improved during AI therapy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-13-05.