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September 23, 2014

Managing Arthralgia

Painful joint pain doesn't have to disrupt treatment.
BY Lacey Marlow
PUBLISHED September 25, 2014

Many cancer treatments can cause severe joint pain—a condition called arthralgia—which can diminish quality of life and daily functioning. Persistent symptoms can lead some patients to discontinue treatment.

Causes
Aromatase inhibitors (AIs), commonly used as adjuvant therapy for postmenopausal women with early stage, hormone receptor-positive breast cancer, can cause arthralgia, as can taxane chemotherapy drugs, such as paclitaxel and docetaxel, and drugs that stimulate white blood cell production, such as filgrastim.

About half of women taking AIs experience arthralgia. The incidence of taxane-related arthralgia varies, with studies reporting that docetaxel causes more pain than paciltaxel.

AI-related arthralgia often appears about two months after starting therapy, but can also begin up to two years later. Symptoms can diminish or resolve within several months or persist until AI therapy is stopped.

Taxane-induced arthralgia usually begins 24 to 48 hours after infusion and can last for three to five days, occasionally lingering for a week or longer.

Symptoms and Consequences
The term arthralgia means “joint pain,” whereas arthritis is a disease that causes joint inflammation, which can in turn cause joint pain and stiffness. Arthralgia can be accompanied by symptoms such as joint stiffness, aches, muscle pain (myalgia) and inflammation, such as swelling, tenderness and redness around the joint.

This pain can affect only one joint or area, or it may affect multiple joints. The pain can be mild or severe, and it can last for a few minutes, come and go, or be constant. Joint pain or stiffness is often worse upon waking or after long periods of inactivity and can improve with movement. Treatment-related arthralgia can cause new pain or exacerbate preexisting joint pain. The exact physiology of arthralgia is unclear and may involve several different mechanisms depending on the drug and the individual. Therefore, the symptoms and time course can be highly variable.

Common areas of joint pain or discomfort include the hands (fingers and wrists), arms, knees, feet, pelvic and hip bones, shoulders and back. Arthralgia can make it difficult to perform normal activities, interfere with sleep, and diminish quality of life and day-to-day well-being. Importantly, studies show that joint pain is the main reason women stop AI therapy early.

Management Strategies
Mild pain relievers, such as acetaminophen, and nonsteroidal antiinflammatory drugs, such as ibuprofen, can provide partial or complete relief of moderate joint and muscle pain. More severe or persistent pain may require the addition of stronger pain relievers, such as acetaminophen combined with either codeine or oxycodone for short-term relief, corticosteroids, such as prednisone and dexamethasone, or antidepressants, such as Effexor (venlafaxine) or Cymbalta (duloxetine).

For women with AI-associated arthralgia, switching to a different AI has been shown to be effective sometimes if symptom management is inadequate. Changing to tamoxifen may also be an option.

In addition to medications, complementary therapies, such as exercise, acupuncture and dietary supplements, can also provide symptom relief. A 2013 study of women with AI-related arthralgia found that a yearlong exercise program reduced the severity of joint pain by at least 20 percent. In a small study of postmenopausal women with breast cancer with AI-related arthralgia, a six-week course of acupuncture resulted in improvements in pain severity, pain-related interference and physical wellbeing. Glucosamine, a supplement commonly used for arthritis, has also shown potential in managing joint pain.

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