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

Authors
  • 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
Type
Published Article
Journal
Journal of Ultrasonography
Publisher
Exeley Inc.
Publication Date
Mar 08, 2021
Volume
21
Pages
1–6
Identifiers
DOI: 10.15557/JoU.2021.0001
Source
Exeley
Keywords
License
Green

Abstract

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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