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Baba O, Kisaoglu H, Kalyoncu M. Letrozole-induced inflammatory arthritis and tendinopathy in pediatric rheumatology setting. Int J Rheum Dis 2023; 26:2314-2316. [PMID: 37218595 DOI: 10.1111/1756-185x.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
Musculoskeletal symptoms associated with the use of aromatase inhibitors are a well-known side effect of these drugs and are more prevalent in postmenopausal women. Aromatase inhibitor-associated symptoms are not overt inflammatory processes so are described as arthralgia syndrome. In contrast, aromatase inhibitor-associated inflammatory conditions such as myopathies, vasculitis, and rheumatoid arthritis were also reported. To our knowledge, inflammatory arthritis or tendinopathy associated with aromatase inhibitors were not reported in children despite their increased off-label use in the pediatric setting. Herein, we report a girl with inflammatory arthritis and tendinopathy associated with letrozole treatment.
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Affiliation(s)
- Ozge Baba
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Karadeniz Technical University, Trabzon, Turkey
| | - Hakan Kisaoglu
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Karadeniz Technical University, Trabzon, Turkey
| | - Mukaddes Kalyoncu
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Karadeniz Technical University, Trabzon, Turkey
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2
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Christensen Holz S. Aromatase Inhibitor Musculoskeletal Syndrome and Bone Loss: a Review of the Current Literature. Curr Oncol Rep 2023; 25:825-831. [PMID: 37052869 DOI: 10.1007/s11912-023-01413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE OF REVIEW The study aims to review the literature regarding musculoskeletal complications of aromatase inhibitors and treatment options for these complications. RECENT FINDINGS Aromatase inhibitors are common medications to treat hormone receptor-positive breast cancer in postmenopausal women and have been shown to improve survival and prevent disease recurrence. However, 20-60% patients stop treatment prematurely due to side effects. Side effects include joint stiffness and pain, tendonitis, tendon tears, muscle pain, and carpal tunnel syndrome known as aromatase inhibitor musculoskeletal syndrome (AIMSS) as well as bone loss. Proposed mechanisms of AIMSS include decreased estrogen levels, inflammation, and genetic factors. Switching aromatase inhibitors, exercise, non-steroidal anti-inflammatory medications, duloxetine, acupuncture, prednisone, and bisphosphonates are some treatment options for this syndrome and will be discussed in more detail in this review. Aromatase inhibitors are important in the treatment of hormone receptor-positive breast cancer in postmenopausal women. As we study the incidence of side effects of these medications including bone loss and AIMSS and determine the mechanisms of these symptoms and possible treatment options, we will decrease the incidence of patients discontinuing treatment prematurely and improve symptoms, quality of life, and survival in this patient population.
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Tenti S, Correale P, Cheleschi S, Fioravanti A, Pirtoli L. Aromatase Inhibitors-Induced Musculoskeletal Disorders: Current Knowledge on Clinical and Molecular Aspects. Int J Mol Sci 2020; 21:E5625. [PMID: 32781535 PMCID: PMC7460580 DOI: 10.3390/ijms21165625] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023] Open
Abstract
Aromatase inhibitors (AIs) have radically changed the prognosis of hormone receptor positive breast cancer (BC) in post-menopausal women, and are a mainstay of the adjuvant therapy for BC after surgery in place of, or following, Tamoxifen. However, AIs aren't side effect-free; frequent adverse events involve the musculoskeletal system, in the form of bone loss, AI-associated arthralgia (AIA) syndrome and autoimmune rheumatic diseases. In this narrative review, we reported the main clinical features of these three detrimental conditions, their influence on therapy adherence, the possible underlying molecular mechanisms and the available pharmacological and non-pharmacological treatments. The best-known form is the AIs-induced osteoporosis, whose molecular pathway and therapeutic possibilities were extensively investigated in the last decade. AIA syndrome is a high prevalent joint pain disorder which often determines a premature discontinuation of the therapy. Several points still need to be clarified, as a universally accepted diagnostic definition, the pathogenetic mechanisms and satisfactory management strategies. The association of AIs therapy with autoimmune diseases is of the utmost interest. The related literature has been recently expanded, but many issues remain to be explored, the first being the molecular mechanisms.
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Affiliation(s)
- Sara Tenti
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy; (S.T.); (A.F.)
| | - Pierpaolo Correale
- Medical Oncology Unit, Grand Metropolitan Hospital “Bianchi-Melacrino-Morelli”, 89121 Reggio Calabria, Italy;
| | - Sara Cheleschi
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy; (S.T.); (A.F.)
| | - Antonella Fioravanti
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy; (S.T.); (A.F.)
| | - Luigi Pirtoli
- Sbarro Institute for Cancer Research and Molecular Medicine-Center for Biotechnology, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
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Tenti S, Giordano N, Cutolo M, Giannini F, Fioravanti A. Primary antiphospholipid syndrome during aromatase inhibitors therapy: A case report and review of the literature. Medicine (Baltimore) 2019; 98:e15052. [PMID: 30921233 PMCID: PMC6455664 DOI: 10.1097/md.0000000000015052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Aromatase inhibitors (AIs) are a class of drugs widely used in the treatment of estrogen sensitive breast and ovarian cancer which convert testosterone to estradiol and androstenedione to estrogen. The AIs of third generation, including anastrazole, letrozole and exemestane, have actually become the standard of care of estrogen-receptor-positive breast cancer in menopausal women and are recommended as adjuvant treatment after surgery in place of/or following tamoxifen. Their main side-effects include reduction in bone mineral density, occurrence of menopausal manifestations and development of musculoskeletal symptoms which are, usually, transient, but sometimes evolve into a typical form of arthritis, such as rheumatoid arthritis (RA). Recently, a pathogenic linkage with other autoimmunity diseases, such as Sjogren syndrome (SjS), anti-synthetase antibody syndrome (ASAS), systemic sclerosis (SS) and subacute cutaneous lupus erythematosus (SCLE), was also described. PATIENT CONCERNS Here, we report the first case of a patient with primary antiphospholipid syndrome (APS) developed during treatment with anastrazole. DIAGNOSIS The patient developed a sudden onset of speech disturbance and disorientation, due to ischemic lesions, after 6 months of AIs therapy and the laboratory examination showed the positivity of anti-Cardiolipin antibodies, anti-β2 Glycoprotein 1 antibodies and Lupus Anticoagulant, so a certain diagnosis of APS was achieved. INTERVENTIONS The patient was treated with warfarin associated to hydroxychloroquine and monthly cycles of low doses intravenous immunoglobulins. OUTCOMES A good control of the disease was obtained despite the continuation of anastrazole; the patient's clinical and laboratory situation remained not modified after AIs withdrawal. LESSONS We discussed the possible role of anastrazole treatment in inducing APS in our patient, reporting the available literature data about the association between AIs treatment and autoimmune diseases. Furthermore, we analyzed the mechanism of action of estrogens in the pathophysiology of autoimmune rheumatic disorders.
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Affiliation(s)
- Sara Tenti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliera Universitaria Senese
| | - Nicola Giordano
- Scleroderma Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic San Martino Hospital, Genoa
| | - Fabio Giannini
- Neurology and Neurophysiology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, Siena, Italy
| | - Antonella Fioravanti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliera Universitaria Senese
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Pires de Carvalho K, Miranda Lima MT, Mazzutti FS, Dias Custódio ID, Lajolo Canto PP, Paiva CE, Paiva Maia YCD. Longer Times of Receipt of Adjuvant Endocrine Therapy Correspond to Improved Functional Capacity and Lower Adiposity in Women Receiving Adjuvant Therapy. Clin Breast Cancer 2018; 19:e208-e219. [PMID: 30316543 DOI: 10.1016/j.clbc.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/07/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To study the use of functional capacity (FC) level and duration of aromatase inhibitor (AI) therapy with adiposity parameters in women with breast cancer. PATIENTS AND METHODS FC was evaluated through the Health Assessment Questionnaire, which was assessed by classification and divided into 3 groups: G1 = mild to moderate difficulty, G2 = moderate to severe disability, and G3 = severe or very severe disability. Body mass, height, and waist circumference (WC) were measured, and body mass index (BMI) was calculated. Bioelectrical impedance analysis was used to calculate body fat (BF) and fat-free mass. The women were divided into 2 time groups (T1 and T2), which were determined by the median months of AI use (T1 ≤ 29.5 and T2 > 29.5 months). RESULTS Impaired FC and adiposity parameters were significantly positively correlated. In addition, physical exercise was significantly lower in women assessed as G2 and G3 compared to those assessed as G1. The effect of FC on BMI, BF, and WC was also verified, as was the effect of the duration of AI receipt on BMI and BF. Women at T1 had significantly greater functional disability, BMI, and BF values. In addition, although not statistically significant, women in T1 who were assessed as G3 presented higher BMI, WC, and BF values than those in T2. CONCLUSION Adiposity above the recommended parameters and impaired FC were associated with the shortest time of receipt of adjuvant endocrine therapy with AI.
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Affiliation(s)
- Kamila Pires de Carvalho
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Fernanda Silva Mazzutti
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil; Nutrition Course, Medical Faculty, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Paula Philbert Lajolo Canto
- Department of Clinical Oncology, Clinic's Hospital, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Carlos Eduardo Paiva
- Department of Clinical Oncology, Breast and Gynecology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Yara Cristina de Paiva Maia
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil; Nutrition Course, Medical Faculty, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil.
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Caprioli M, Carrara G, Sakellariou G, Silvagni E, Scirè CA. Influence of aromatase inhibitors therapy on the occurrence of rheumatoid arthritis in women with breast cancer: results from a large population-based study of the Italian Society for Rheumatology. RMD Open 2017; 3:e000523. [PMID: 29071118 PMCID: PMC5640089 DOI: 10.1136/rmdopen-2017-000523] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/31/2017] [Accepted: 09/04/2017] [Indexed: 11/20/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the risk of developing rheumatoid arthritis (RA) in a population of patients with breast cancer treated with aromatase inhibitors (AIs) compared with tamoxifen. Methods Data were collected from the administrative healthcare database of Lombardy Region, Italy, from 2004 to 2013. This study follows a nested cohort design, including women with a diagnosis of breast cancer starting treatment with tamoxifen, anastrozole, exemestane or letrozole. The risk of RA related to the prescription of the different drugs was estimated by survival models for competing risks and the results are presented as hazard ratios (HRs) and 95% confidence intervals (95% CI), adjusted for age and cancer severity. Results Out of total 10 493 women with breast cancer with a median (IQR) age of 66 (57–74), 7533 (71.8%) started an active treatment with AIs or tamoxifen. In this subgroup a total of 113 new cases of RA developed during the 26 105.9 person-year of 10 186 exposure periods, including time varying exposures in the same patient. Using tamoxifen as reference category, AIs therapy was associated with an increased risk of RA (adjusted HR 1.62 (95%1.03–2.56)), in particular in patients receiving anastrozole, even after adjusting for age and level of neoplasia: (adjusted HR 1.75 (95%1.07–2.86)). Conclusions In a large population-based sample of women with breast cancer, exposure to AIs compared with tamoxifen is associated with a significantly increased risk of RA, which is not influenced by the cancer severity and the relationship of age with indication to specific drugs.
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Affiliation(s)
- Marta Caprioli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Garifallia Sakellariou
- Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Ettore Silvagni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy.,Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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7
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Mascella F, Gianni L, Affatato A, Fantini M. Aromatase inhibitors and anti-synthetase syndrome. Int J Immunopathol Pharmacol 2016; 29:494-7. [PMID: 27225465 DOI: 10.1177/0394632016651086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/26/2016] [Indexed: 11/16/2022] Open
Abstract
Adjuvant therapy in postmenopausal women with endocrine-responsive breast cancer (BC) is actually centered on the use of anti-aromatase inhibitors (AI). Several reports, however, are emerging in literature associating the use of this drugs to rheumatic disorders. This case report describes the first case of anti-synthetase syndrome diagnosis after treatment with anti-estrogen agents in a patient with pre-existing rheumatoid arthritis.
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Affiliation(s)
- Fabio Mascella
- Internal Medicine and Rheumatology, Ospedale degli Infermi, Rimini, Azienda Sanitaria della Romagna, Italy
| | - Lorenzo Gianni
- Oncology Department, Ospedale degli Infermi, Azienda Sanitaria della Romagna, Italy
| | - Alessandra Affatato
- Oncology Department, Ospedale degli Infermi, Azienda Sanitaria della Romagna, Italy
| | - Manuela Fantini
- Oncology Department, Ospedale degli Infermi, Azienda Sanitaria della Romagna, Italy
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Zarkavelis G, Kollas A, Kampletsas E, Vasiliou V, Kaltsonoudis E, Drosos A, Khaled H, Pavlidis N. Aromatase inhibitors induced autoimmune disorders in patients with breast cancer: A review. J Adv Res 2016; 7:719-726. [PMID: 28275510 PMCID: PMC5328027 DOI: 10.1016/j.jare.2016.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022] Open
Abstract
Subacute cutaneous lupus erythematosus (SCLE) is characterized by particular cutaneous manifestations such as non-scaring plaques mainly in sunlight exposed parts of the body along with specific serum autoantibodies (i.e. antinuclear antibodies (ANA), Ro/SSa, La/SSb). It is considered either idiopathic or drug induced. The role of chemotherapeutic agents in causing SCLE has been investigated with the taxanes being the most common anticancer agents. However, recent data emerging point toward antiestrogen therapies as a causative factor not only for SCLE but also for a variety of autoimmune disorders. This is a report of a case of a 42 year old woman who developed clinical manifestations of SCLE after letrozole treatment in whom remission of the cutaneous manifestations was noticed upon discontinuation of the drug. In addition, an extensive review of the English literature has been performed regarding the association of antiestrogen therapy with autoimmune disorders. In conclusion, Oncologists should be aware of the potential development of autoimmune reactions in breast cancer patients treated with aromatase inhibitors.
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Affiliation(s)
- George Zarkavelis
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Aristomenes Kollas
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Eleftherios Kampletsas
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Vasilis Vasiliou
- Department of Dermatology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Evripides Kaltsonoudis
- Rheumatology Clinic, Department of Internal Medicine, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Alexandros Drosos
- Rheumatology Clinic, Department of Internal Medicine, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
| | - Hussein Khaled
- Medical Oncology, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Nicholas Pavlidis
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, 45500 Ioannina, Greece
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9
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Craddock TJA, Harvey JM, Nathanson L, Barnes ZM, Klimas NG, Fletcher MA, Broderick G. Using gene expression signatures to identify novel treatment strategies in gulf war illness. BMC Med Genomics 2015; 8:36. [PMID: 26156520 PMCID: PMC4495687 DOI: 10.1186/s12920-015-0111-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/26/2015] [Indexed: 12/12/2022] Open
Abstract
Background Gulf War Illness (GWI) is a complex multi-symptom disorder that affects up to one in three veterans of this 1991 conflict and for which no effective treatment has been found. Discovering novel treatment strategies for such a complex chronic illness is extremely expensive, carries a high probability of failure and a lengthy cycle time. Repurposing Food and Drug Administration approved drugs offers a cost-effective solution with a significantly abbreviated timeline. Methods Here, we explore drug re-purposing opportunities in GWI by combining systems biology and bioinformatics techniques with pharmacogenomic information to find overlapping elements in gene expression linking GWI to successfully treated diseases. Gene modules were defined based on cellular function and their activation estimated from the differential expression of each module’s constituent genes. These gene modules were then cross-referenced with drug atlas and pharmacogenomic databases to identify agents currently used successfully for treatment in other diseases. To explore the clinical use of these drugs in illnesses similar to GWI we compared gene expression patterns in modules that were significantly expressed in GWI with expression patterns in those same modules in other illnesses. Results We found 19 functional modules with significantly altered gene expression patterns in GWI. Within these modules, 45 genes were documented drug targets. Illnesses with highly correlated gene expression patterns overlapping considerably with GWI were found in 18 of the disease conditions studied. Brain, muscular and autoimmune disorders composed the bulk of these. Conclusion Of the associated drugs, immunosuppressants currently used in treating rheumatoid arthritis, and hormone based therapies were identified as the best available candidates for treating GWI symptoms. Electronic supplementary material The online version of this article (doi:10.1186/s12920-015-0111-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Travis J A Craddock
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA. .,Graduate School of Computer and Information Sciences, Nova Southeastern University, Fort Lauderdale, USA. .,Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA. .,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA. .,Department of Medicine, University of Alberta, Edmonton, Canada.
| | | | - Lubov Nathanson
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Zachary M Barnes
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Miller School of Medicine, University of Miami, Miami, USA.,Miami Veterans Affairs Medical Center, Miami, USA.,Diabetes Research Institute, University of Miami, Miami, USA
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Miller School of Medicine, University of Miami, Miami, USA.,Miami Veterans Affairs Medical Center, Miami, USA
| | - Mary Ann Fletcher
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Miller School of Medicine, University of Miami, Miami, USA
| | - Gordon Broderick
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA.,Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Department of Medicine, University of Alberta, Edmonton, Canada
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10
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Breast cancer therapy planning - a novel support concept for a sequential decision making problem. Health Care Manag Sci 2014; 18:389-405. [PMID: 25315184 DOI: 10.1007/s10729-014-9302-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
Breast cancer is the most common carcinosis with the largest number of mortalities in women. Its therapy comprises a wide spectrum of different treatment modalities a breast oncologist decides about for the individual patient case. These decisions happen according to medical guide lines, current scientific publications and experiences acquired in former cases. Clinical decision making therefore involves the time-consuming search for possible therapy options and their thorough testing for applicability to the current patient case.This research work addresses breast cancer therapy planning as a multi-criteria sequential decision making problem. The approach is based on a data model for patient cases with therapy descriptions and a mathematical notion for therapeutic relevance of medical information. This formulation allows for a novel decision support concept, which targets at eliminating observed weaknesses in clinical routine of breast cancer therapy planning.
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11
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Capellino S, Straub RH, Cutolo M. Aromatase and regulation of the estrogen-to-androgen ratio in synovial tissue inflammation: common pathway in both sexes. Ann N Y Acad Sci 2014; 1317:24-31. [PMID: 24684533 DOI: 10.1111/nyas.12398] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sex hormones play an active role in inflammatory responses, with androgens being anti-inflammatory, whereas estrogens have both pro- and anti-inflammatory effects. In rheumatoid arthritis (RA) patients, low levels of androgens and high levels of estrone are found in the synovial fluid. Aromatase is the key enzyme for the conversion of androgens into estrogens. Proinflammatory cytokines stimulate aromatase activity so that the inflammatory milieu can induce conversion of androgens to estrogens. Moreover, testosterone inhibits aromatase activity. As local androgen levels are low in RA, this can contribute to high aromatase activity in the synovium. Importantly, aromatase-converted estrogens are converted into proproliferative and proinflammatory 16-hydroxylated estrogens. A hormone involved in aromatase activity is vitamin D, which downregulates aromatase in human RA macrophages. Collectively, evidence suggests a key role of aromatase in sex hormone balance during chronic inflammation and points to the importance of vitamin D as a possible new tool for aromatase modulation.
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Affiliation(s)
- Silvia Capellino
- Division of Pediatric Endocrinology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Wendling D, Letho-Gyselinck H, Guillot X, Prati C, Pivot X. Arthralgia and aromatase inhibitors. Joint Bone Spine 2014; 81:187-8. [DOI: 10.1016/j.jbspin.2013.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
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13
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Bruzzese V, Hassan C, Zullo A, Zampa G. Rheumatoid arthritis: a complication of aromatase inhibitor therapy? Int J Immunopathol Pharmacol 2012; 24:1099-101. [PMID: 22230418 DOI: 10.1177/039463201102400430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report the case of a 56-year-old woman treated with aromatase inhibitors for a breast cancer. Following one year of such therapy, the patient presented with widespread osteoarthrealgia. The clinical picture worsened 3 years later when the pain became more severe with swelling and stiffness involving several joints in a symmetric fashion. Biochemical analysis showed an increase of ESR, CRP and rheumatoid factor, as well as of anti-CCP antibodies. The x-ray was compatible with a diagnosis of rheumatoid arthritis (RA). Therapy with methotrexate, prednisol one, bisphosphonates and vitamin D was started, achieving a quick clinical remission. Aromatase inhibitors have been shown to alter the distribution of Th1/Th2 lymphocytes and increase the level of RANKL. A possible role of aromatase inhibitors in RA development has been further addressed.
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