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Shear wave elastography detects novel imaging biomarkers of aromatase inhibitor–induced joint pain: a pilot study

  • Martinez, Jessica A.1, 2
  • Taljanovic, Mihra S.3, 4
  • Witte, Russell S.1, 5
  • Nuncio Zuniga, Andres A.5
  • Wertheim, Betsy C.1
  • Kwoh, C. Kent3, 6, 7
  • Goldstein, Brian A.5
  • Roe, Denise J.1, 8
  • Chalasani, Pavani1, 7
  • 1 The University of Arizona Cancer Center, Tucson, AZ
  • 2 Department of Nutritional Sciences, University of Arizona, Tucson, AZ
  • 3 Department of Medical Imaging, University of Arizona, Tucson, AZ
  • 4 Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ
  • 5 Department of Biomedical Engineering, University of Arizona, Tucson, AZ
  • 6 The University of Arizona Arthritis Center, Tucson, AZ
  • 7 Department of Medicine, University of Arizona, Tucson, AZ
  • 8 Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ
Published Article
Journal of Ultrasonography
Exeley Inc.
Publication Date
Mar 08, 2021
DOI: 10.15557/JoU.2021.0001


Aim: To determine whether differences in joint and tendon stiffness as measured by ultrasound shear wave elastography are present in breast cancer patients with aromatase inhibitor-associated arthralgias compared to age-comparable healthy control women. Methods: Postmenopausal women with stage I–III breast cancer who were taking adjuvant aromatase inhibitors and complained of joint pain were enrolled (n = 6). Postmenopausal women with no history of breast cancer, hormone treatment, or joint pain served as controls (n = 7). All subjects had bilateral hands and wrists evaluated by gray-scale and power Doppler ultrasound, and shear wave elastography ultrasound. Results: Patients with AI-associated arthralgias had significantly stiffer tendons than controls in the 1st extensor compartment (long axis; p = 0.001), 4th extensor compartment (long axis; p = 0.014), 3rd metacarpophalangeal joint (p = 0.002), the pooled values of the extensor compartments, both long (p = 0.044) and short axes (p = 0.035), and the pooled values for the metacarpophalangeal joints (p = 0.002). On ultrasound, the patients (but not controls) presented with hyperemia and increased tenosynovial fluid in the flexor and extensor tendon sheaths, and the median nerves were symptomatic and bifid; however, these differences were not statistically significant. Conclusions: This is the first study to identify increased tendon stiffness as a putative physiological characteristic of aromatase inhibitor–associated arthralgias. Future studies should determine whether increased tendon stiffness is a risk factor for the development of aromatase inhibitor–associated arthralgias, or a result of aromatase inhibitor treatment.

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