Arthralgias
Musculoskeletal and joint pain are common in women, especially in perimenopausal and aging women. In women diagnosed with breast cancer, cancer treatment can be associated with musculoskeletal symptoms, particularly arthralgia, or non-inflammatory joint pain. Evaluation of new-onset arthralgia should include the history, physical examination, and laboratory evaluation for common non-inflammatory and inflammatory causes of joint pain. After chemotherapy, the self-limited syndrome of post-chemotherapy rheumatism may develop within 3–4 months of treatment and can last several months before it subsides. This syndrome may overlap with the start of adjuvant endocrine therapy, which may also be associated with arthralgia, particularly endocrine therapy with aromatase inhibitors. Aromatase inhibitor-associated arthralgia (AIAA) is common and difficult to treat. Regular exercise and adequate vitamin D levels can alleviate arthralgia and are also associated with improved well-being and better breast cancer and overall outcomes. Other approaches to relieve AIAA include switching to another endocrine therapy, use of a complementary intervention (like acupuncture or a supplement), and duloxetine. In cases where inflammatory arthritis is suspected or arthralgia is more persistent or severe than is typical for AIAA, referral to a rheumatologist is warranted.
