Rheumatic symptoms following adjuvant therapy for breast cancer

Twenty-three women with a diagnosis of breast cancer who

subsequently developed new nonmetastatic rheumatic symptoms,

and/or had a history of rheumatic symptoms prior to their

diagnosis of breast cancer, were identified from the oncology

and rheumatology practices of a 400-bed tertiary-care teaching

hospital. For each patient a structured telephone interview

and detailed chart review were conducted. Of eight women with

no previous rheumatic history (Group I), four developed

polyarthritis (1 seropositive), three fibromyalgia, and one

spondylosis after the diagnosis of breast cancer, which in

four cases occurred during or shortly after

cyclophosphamide-based combination chemotherapy, in two cases

during tamoxifen therapy, and in one case after radiotherapy

only. Of 15 women who had previous rheumatic symptoms (Group

II), 12 developed worse and/or new symptoms, five after

chemotherapy and seven on tamoxifen. In both groups the

symptoms had a significant negative impact on functional

status, and in some cases resolution was only partial even

after many years of followup. Prospective studies are needed

to determine the incidence, risk factors, and optimal

management of nondestructive polyarthropathy or fibromyalgia

in women who receive systemic adjuvant therapy for breast

cancer.

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