Aromatasehemmer-assoziierte Arthralgien: klinische Erfahrungen und Therapieempfehlungen

Zusammenfassung

Fragestellung: Die Überlegenheit von Aromatasehemmern (AH) gegenüber dem Antiöstrogen Tamoxifen in der adjuvanten endokrinen Therapie bei postmenopausalen Frauen mit einem Hormonrezeptor-positiven Mammakarzinom ist mittlerweile hinreichend belegt. Allerdings wird unter der Therapie mit AH, im Gegensatz zu Tamoxifen, eine erhöhte Inzidenz von Arthralgien beschrieben. Es wird vermehrt befürchtet, dass Patientinnen wegen der AH-assoziierten Arthralgien ihre Aromatasehemmer-Behandlung vorzeitig abbrechen. Daher nehmen sowohl die Patientenaufklärung über das mögliche Auftreten von Arthralgien als auch das wirksame Management der Symptome eine bedeutende Rolle ein, um Patientinnen zur Fortsetzung ihrer AH-Behandlung zu bewegen und somit die Heilungschancen ihrer Primärerkrankung zu verbessern. Methoden: In diesem Artikel betrachten und diskutieren wir potenzielle Mechanismen, die zum Entstehen der AH-assoziierten Arthralgien führen, bewerten die Häufigkeit des Vorkommens solcher Arthralgien und schlagen einen spezifischen Algorithmus für die Therapie Aromatasehemmer-assoziierter Arthralgien vor. So wird – wie auch bei Gelenkbeschwerden anderer Patienten ohne Mammakarzinom – ein sequenzieller Therapieansatz zum Management der Beschwerden empfohlen. Dieser beinhaltet neben einem veränderten individuellen Lebensstil einen Stufenplan zur medikamentösen Intervention mit Analgetika und antientzündlichen Substanzen. Schlussfolgerung: Die Erkenntnis, dass Gelenkbeschwerden bei den meisten Patientinnen gut handhabbar sind, kann sowohl das Arzt-Patienten-Verhältnis als auch die Patienten-Compliance verbessern. Ein spezifischer Algorithmus für die Therapie kann Arzt und Patientin im Umgang mit Aromatasehemmer-assoziierten Arthralgien unterstützen.

Abstract

Objective: It is well documented that aromatase inhibitors (AI) are superior to tamoxifen as an adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive breast cancer. However, compared with tamoxifen, an elevated incidence of arthralgia has been observed during AI treatment. Concerns have been raised that AI-induced arthralgia may dissuade patients from completing their full AI treatment course. Patient education on the possibility of experiencing arthralgia and the effective management of symptoms, if they appear, is important in helping patients adhere to AI treatment schedules and, consequently, in improving breast cancer outcomes. Methods: In this paper, we discuss the potential mechanisms behind AI-induced arthralgia, review the frequency with which arthralgia occurs, and propose an algorithm specifically for the treatment of AI-induced arthralgia. As with joint pain in non-breast cancer patients, a sequential approach to disease management is recommended, involving modifications of the patient's lifestyle in addition to taking a stratified approach to pharmacological intervention with analgesia and anti-inflammatory medication. Conclusion: Knowing that joint symptoms can be managed in most patients may encourage patient-physician communication and treatment compliance. A specific treatment algorithm is proposed that may support doctors and patients when dealing with AI-induced arthralgia.

Schlüsselwörter

Aromatasehemmer - Arthralgie - COX‐2‐selektives NSAR (Coxib) - Gelenkschmerzen - traditionelle nicht steroidale Antirheumatika (tNSAR)

Key words

aromatase inhibitors - arthralgia - coxib - joint pain - tNSAID

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