Occurrence Of Joint Research Articles

Post Covid-19 Effect on Avascular Necrosis of Hip Joint

Background and objectives: The exact course of Severe acute respiratory syndrome (SARS) -2(COVID-19) and itscomplications on multiorgan system are complex and still under studies. Musculoskeletal system has also beenaffected post covid in various forms. This study was taken up to analyse the effects of covid-19 disease on the hipbone and join tissue.Materials and Methods: Retrospective analysis of ten patients was done who had been hospitalised with covid-19infection and later complained of hip pain . They underwent MR imaging and were found to have degenerativechanges characterizing with avascular necrosis (AVN) of head of femur .One of them had history of previoussurgery of femur with PFN, doing well but developed AVN after COVID .Results: Observation of this group showed a clear correlation among the history of COVID-19 disease in thepatients, moderately severe symptoms, high levels of IgG antibodies, and the time of occurrence of joint changes.No other risk factors for AVN or autoimmune or degenerative diseases were found in the study group. The groupof patients responded well to empirical treatment with anti-inflammatory drugs ans supportive therapy, whichsubsided acute inflammatory symptoms and pain in the joints.Conclusions: It is concluded that there have been obvious musculoskeletal complications in covid patientsincluding AVN which could be attributed to the high use steroids and microembolism leading to bone necrosis.Hence more studies and long follow-up is suggested.

Post Covid-19 Effect on Avascular Necrosis of Hip Joint

Background and objectives: The exact course of Severe acute respiratory syndrome (SARS) -2(COVID-19) and itscomplications on multiorgan system are complex and still under studies. Musculoskeletal system has also beenaffected post covid in various forms. This study was taken up to analyse the effects of covid-19 disease on the hipbone and join tissue.Materials and Methods: Retrospective analysis of ten patients was done who had been hospitalised with covid-19infection and later complained of hip pain . They underwent MR imaging and were found to have degenerativechanges characterizing with avascular necrosis (AVN) of head of femur .One of them had history of previoussurgery of femur with PFN, doing well but developed AVN after COVID .Results: Observation of this group showed a clear correlation among the history of COVID-19 disease in thepatients, moderately severe symptoms, high levels of IgG antibodies, and the time of occurrence of joint changes.No other risk factors for AVN or autoimmune or degenerative diseases were found in the study group. The groupof patients responded well to empirical treatment with anti-inflammatory drugs ans supportive therapy, whichsubsided acute inflammatory symptoms and pain in the joints.Conclusions: It is concluded that there have been obvious musculoskeletal complications in covid patientsincluding AVN which could be attributed to the high use steroids and microembolism leading to bone necrosis.Hence more studies and long follow-up is suggested.

Ocular involvement in rheumatic diseases.

Rheumatic diseases are associated with a significant decline in quality of life, which is not only related to the progression of the underlying disease but also to the development of coexisting conditions. One of the possible complications in this group of diseases is ocular involvement. Impaired vision is strongly associated with a significant decline in quality of life and can also exacerbate problems related to physical functioning. Consequently, it can lead to serious complications in the treatment of the underlying disease. Additionally, from a clinical point of view, it is also important to note that ocular diseases may precede the occurrence of inflammatory joint and spinal diseases, as well as organ involvement in systemic connective tissue disorders. Therefore, paying attention to ocular symptoms can help in early diagnosis and thus improve patient prognosis. For the aforementioned reasons, ocular diseases should be carefully considered in routine rheumatologic practice.

Avascular Necrosis of HIP After Active Covid-19 Infection

AbstractBackground and objectives: The exact course of SARS -2(COVID-19) and its complications on multiorgan systemare complex and still under studies. Musculoskeletal system has also been affected post covid in various forms.This study was taken up to analyse the effects of covid-19 disease on the hip bone and join tissue.Materials and Methods: Retrospective analysis of ten patients was done who had been hospitalised with covid-19infection and later complained of hip pain. They underwent MR imaging and were found to have degenerativechanges characterizing with avascular necrosis (AVN) of head of femur .One of them had history of previoussurgery of femur with PFN, doin well but developed AVN after covid.Results: Observation of this group showed a clear correlation among the history of COVID-19 disease in thepatients, moderately severe symptoms, high levels of IgG antibodies, and the time of occurrence of joint changes.No other risk factors for AVN or auto-immune or degenerative diseases were found in the study group. The groupof patients responded well to empirical treatment with anti-inflammatory drugs ans supportive therapy, whichsubsided acute inflammatory symptoms and pain in the joints.Conclusions: It is concluded that there have been obvious musculoskeletal complications in covid patientsincluding AVN which could be attributed to the high use steroids and microembolism leading to bone necrosis.Hence more studies and long follow-up is suggested.

Progressive Increase in Sacroiliac Joint and Spinal Lesions Detected on Magnetic Resonance Imaging in Healthy Individuals in Relation to Age.

Magnetic resonance imaging (MRI) plays a pivotal role in spondyloarthritis (SpA) diagnosis. However, a detailed description of MRI findings of the sacroiliac (SI) joints and spine in healthy individuals is currently lacking. This study was undertaken to evaluate the occurrence of MRI-detected SI joint and spinal lesions in healthy individuals in relation to age. Ninety-five healthy subjects (ages 20-49 years) underwent MRI of the SI joints and spine. Bone marrow edema (BME) and structural lesions of the SI joints were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Spinal inflammatory and structural lesions were evaluated using the SPARCC MRI spine inflammation index and the Canada-Denmark MRI scoring system, respectively. Fulfillment of the Assessment of SpondyloArthritis international Society definition of a positive MRI for sacroiliitis/spondylitis was reviewed. Findings were compared to MRIs of axial SpA patients from the Belgian Inflammatory Arthritis and Spondylitis cohort. Of the subjects ≥30 years old, 17.2% fulfilled the definition of a positive MRI for sacroiliitis, but this occurred rarely in younger subjects. SI joint erosions (20.0%) and fat metaplasia (13.7%) were detected across all age groups. Erosions were more frequently visualized in subjects ages ≥40 years (39.3%). Spinal BME (35.7%) and fat metaplasia (28.6%) were common in subjects older than 40 years. Nonetheless, only 1 subject had ≥3 corner inflammatory lesions. SI joint and spinal SPARCC scores and total structural lesions scores increased progressively with age. Contrary to what is commonly believed, structural MRI-detected SI joint lesions are frequently seen in healthy individuals. Especially in older subjects, the high occurrence of inflammatory and structural MRI-detected lesions impacts their specificity for SpA, which has important implications for the interpretation of MRIs in patients with a clinical suspicion of SpA.

The occurrence of sacroiliac joint (SIJ) syndrome following lumbar decompression, lumbar fusion and possibilities of its treatment

The occurrence of sacroiliac joint (SIJ) syndrome following lumbar decompression, lumbar fusion and possibilities of its treatment

Association between Condylar Bone Density and Disk Displacement in the Temporomandibular Joint

Measuring bone density (BD) is a common method of determining bone quality; however, the relationship between condylar BD and the occurrence of temporomandibular joint (TMJ) disorders has not been investigated. To address this knowledge gap, we aimed to investigate condylar BD in terms of TMJ disk displacement (TMJ DD) using computed tomography (CT) and magnetic resonance imaging (MRI). We classified TMJ MRI results according to the position of the disk: normal disk position (Normal), anterior disk displacement with reduction (ADDR), and anterior disk displacement without reduction (ADDNR). After retrospectively evaluating 86 female condyles, we determined the total, cortical, and trabecular BD in the upper-joint portion of the condyle and the whole condyle using CT data. To standardize condylar BD, we calculated the BD ratios by dividing the condylar BD by the cervical axis BD. The Kruskal-Wallis test analyzed the differences in BD measurements in the TMJ DD patient groups and showed significant between-group differences in condylar BD. The total and trabecular BD was significantly higher in ADDNR condyles than in Normal or ADDR condyles (Normal = ADDR < ADDNR). However, there was no significant difference in the cortical BD among the three TMJ DD groups. The BD ratios showed a similar tendency with condylar BD. These results suggest that increased condylar BD – specifically total and trabecular BD – may be significantly associated with ADDNR condyles. Our findings will help clinicians determine the course of treatment for patients with disk-related TMJ disorders.

The influence of mandibular condyle morphology on TMJ anterior dislocations

The present study was designed to investigate the correlation between the bony morphology of the mandibular condyle and the occurrence of temporomandibular joint (TMJ) idiopathic anterior dislocation. A comparative retrospective study was conducted among 14 patients presenting idiopathic anterior dislocations (study group) and 15 patients who did not suffer from any TMJ disorders (control group). All patients underwent a multidetector computed tomography scan demonstrating the full extent of their joints. The scans of 58 joints were reconstructed and analyzed by tools available in Dolphine3 software. Mandibular condyle size and volume were measured, and its shape was characterized. Shape, width, length, height, and volume of the mandibular condyles did not differ statistically between the study and control groups. Mandibular condyle morphology does not affect TMJ idiopathic anterior dislocation.

The influence of articular eminence morphology on temporomandibular joint anterior dislocations

The aim of this study was to investigate the correlation between the bony morphology of the articular eminence and the occurrence of idiopathic anterior temporomandibular joint (TMJ) dislocation. A comparative retrospective study was conducted in 14 patients with idiopathic anterior dislocations (study group) and 14 patients who did not suffer from any TMJ disorders (control group). All patients underwent multidetector computed tomography (MDCT), which demonstrated the full extent of their joints. The scans of 56 joints were reconstructed and analyzed by using the tools available in Dolphin 3 software. Gross morphology characteristics and fine morphologic characteristics were defined by measuring the articular eminence inclination and height on the lateral, middle, and medial aspects of the articular eminence. Gross and fine morphologic characteristics of the articular eminence did not differ statistically between the study group and the control group. Articular eminence morphology does not affect TMJ idiopathic anterior dislocation.

Abstract P5-12-07: Influence of aromatase inhibitor-related adverse events on the prognosis in postmenopausal Japanese patients with breast cancer: A prospective multicenter cohort study on patient-reported outcomes

Abstract Background Five-year adjuvant treatment with aromatase inhibitors is a standard treatment for postmenopausal women with estrogen receptor-positive breast cancer. However, aromatase inhibitor-related adverse events, including joint and vasomotor symptoms, have a strong impact on patient quality of life and sometimes cause the discontinuation of treatment. The aim of this prospective cohort study based on patient-reported outcomes (PROs) was to examine the influence of adverse events on prognosis in Japanese postmenopausal patients with breast cancer treated with adjuvant anastrozole. Patients and Methods A total of 391 postmenopausal Japanese women with estrogen receptor-positive breast cancer who were treated with adjuvant anastrozole were enrolled from 28 centers in this prospective cohort study (SAVS-JP, UMIN000002455). PRO assessments of adverse events, which included joint and vasomotor symptoms, were obtained at baseline and 3, 6, 9, and 12 months. Symptoms were assessed and assigned to one of four categories: none (G0), mild (G1), moderate (G2), and severe (G3). The questionnaires covered joint symptoms (arthralgia, decrease in range of joint motion, and joint stiffness), vasomotor symptoms (hot flashes, night sweats, and cold sweats), and adherence to anastrozole. The median follow-up was 82 months, and we analyzed the prognosis in patients, focusing on the occurrence of joint and vasomotor symptoms induced by treatment. Results Of the 391 patients, 204 (52.2%) completed 5-year treatment, 75 (19.2%) discontinued (adverse events (n=35), recurrence (n=19), secondary malignancies (n=4), death from non-breast cancer (n=4), and other reasons (n=13)), 48 (12.3%) are receiving treatment, and 64 (16.4%) were unknown. Patients who experienced G2+3 joint symptoms had significantly better disease-free survival (DFS) compared with patients with G0+1 joint symptoms (5-year DFS, 96.1% vs. 83.3%, p=0.002). Similarly, the DFS in patients with G2+3 vasomotor symptoms was significantly better than that in those with G0+1 vasomotor symptoms (5-year DFS, 93.5% vs. 86.3%, p=0.049). Joint symptoms were marginally associated with overall survival (OS) (p=0.062), but no significant association was found with vasomotor symptoms. The DFS was superior in patients with G2+3 joint and vasomotor symptoms (5-year DFS, 100%), inferior in those with G0+1 joint and vasomotor symptoms (5-year DFS, 82.6%), and intermediate in others (5-year DFS, 93.3%; p=0.0024). By multivariable analysis including tumor size and grade, G2+3 joint symptoms were a significant and independent predictive factor for DFS (hazard ratio, 0.298, 95% confidence interval 0.122-0.621, p=0.0007). Conclusion Although adverse events might make patients uncomfortable and reduce their quality of life, it is suggested that worse or new vasomotor symptoms and severe joint symptoms, especially if they are grade 2 or 3, seem to associate with better prognosis. Citation Format: Chiyomi Egawa, Shintaro Takao, Kazuhiro Yamagami, Masaru Miyashita, Masashi Baba, Shigetoshi Ichii, Muneharu Konishi, Yuichiro Kikawa, Junya Minohata, Toshitaka Okuno, Keisuke Miyauchi, Kazuyuki Wakita, Hirofumi Suwa, Takashi Hashimoto, Masayuki Nishino, Takashi Matsumoto, Toshiharu Hidaka, Yutaka Konishi, Yoko Sakoda, Akihiro Miya, Masahiro Kishimoto, Hidefumi Nishikawa, Seishi Kono, Ikuo Kokufu, Isao Sakita, Koushiro Kitatsuji, Koushi Oh, Yasuo Miyoshi. Influence of aromatase inhibitor-related adverse events on the prognosis in postmenopausal Japanese patients with breast cancer: A prospective multicenter cohort study on patient-reported outcomes [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-12-07.

A comprehensive review of the treatment and management of Charcot spine.

Charcot spine arthropathy (CSA), a result of reduced afferent innervation, is an occurrence of Charcot joint, a progressive, degenerative disorder in vertebral joints, related mostly to spinal cord injury. The repeated microtrauma is a result of a lack of muscle protection and destroys cartilage, ligaments, and disc spaces, leading to vertebrae destruction, joint instability, subluxation, and dislocation. Joint destruction compresses nerve roots, resulting in pain, paresthesia, sensory loss, dysautonomia, and spasticity. CSA presents with back pain, spinal deformity and instability, and audible spine noises during movement. Autonomic dysfunction includes bowel and bladder dysfunction. It is slowly progressive and usually diagnosed at a late stage, usually, on average, 20 years after the first initial insult. Diagnosis is rarely clinical related to the nature of nonspecific symptoms and requires imaging with computed tomography (CT) and magnetic resonance imaging (MRI). Conservative management focuses on the prevention of fractures and the progression of deformities. This includes bed rest, orthoses, and braces. These could be useful in elderly or frail patients who are not candidates for surgical treatment, or in minimally symptomatic patients, such as patients with spontaneous fusion leading to a stable spine. Symptomatic treatment is offered for autonomic dysfunction, such as anticholinergics for bladder control. Most patients require surgical treatment. Spinal fusion is achieved with open, minimally-open (MOA) or minimally-invasive (MIS) approaches. The gold standard is open circumferential fusion; data is lacking to determine the superiority of open or MIS approaches. Patients usually improve after surgery; however, the rarity of the condition makes it difficult to estimate outcomes. This is a review of the latest and seminal literature about the treatment and chronic management of Charcot spine. The review includes the background of the syndrome, clinical presentation, and diagnosis, and compares the different treatment options that are currently available.

Research progress of asymptomatic bacteriuria before arthroplasty: A systematic review.

A high prevalence of asymptomatic bacteriuria exists in patients prior to arthroplasty, and urinary tract infection is considered to be a source of postoperative superficial wound and prosthetic joint infections. There is no consensus whether to screen for and treat asymptomatic bacteriuria before arthroplasty. To summarize the association between asymptomatic bacteriuria and complications after arthroplasty and to evaluate the clinical benefits of treating asymptomatic bacteriuria prior to arthroplasty. We systematically searched PubMed, Embase, and the Cochrane Library to retrieve potentially eligible articles. By screening the titles and abstracts of retrieved records and then reading the full texts of the remaining papers, we finally included 8 English-language articles in this systematic review. Asymptomatic bacteriuria prior to arthroplasty is significantly associated with an increased occurrence of postoperative prosthetic joint and superficial wound infections. However, there is little evidence for direct or hematogenous seeding of urinary infections, and treating asymptomatic bacteriuria before arthroplasty did not decrease the incidence of postoperative infectious complications. Asymptomatic bacteriuria is not a contraindication for arthroplasty, and the practice of routine preoperative screening for and treatment of asymptomatic bacteriuria should not be continued.

Dental and skeletal maturation in female adolescents with temporomandibular joint osteoarthritis

Occurrence of temporomandibular disorders (TMDs) and temporomandibular joint (TMJ) osteoarthritis (OA) during adolescence may have interactions with mandibular and dental development. The aim of the present study was to investigate relationships between occurrence of TMD and TMJ OA and extents of dental and skeletal development in juvenile female patients. In total, 95 female adolescents (age range, 11-15years) were selected. Among them, 15 subjects (control) had no signs of TMD, 39 TMD patients did not have OA (TMDnoOA), 17 TMD patients were at initial stage of TMJ OA (TMJOA), and 27 patients showed progressive stage of TMJ OA (TMJOA). Dental age was estimated by Demirjian's stages used in a previous study with Korean adolescents. Craniofacial parameters and cervical vertebrae maturation (CVM) stages, representing skeletal maturity levels, were measured using lateral cephalograms. The estimated dental age was significantly lower than chronological age in all groups, but CVM differences were not statistically significant. Dental age was the lowest, and differences between the chronological age and estimated dental age were the highest among initial stage of TMJOAs followed by progressive stage of TMJOAs, TMDnoOAs and control and were not associated with CVM stages. Cephalometric parameters revealed significant clockwise rotation of the mandible among the TMJOAs compared with controls and TMDnoOAs and were not associated with CVM stages as well. The juvenile female patients with TMD, particularly TMJ OA, showed retarded dental development, mandibular backward positioning and hyperdivergent facial profiles. The TMJ OA may be associated with retarded dental development but not with skeletal maturations.

Degenerative temporomandibular joint changes associated with recent-onset disc displacement without reduction in adolescents and young adults

This study evaluated the occurrence of degenerative temporomandibular joint (TMJ) changes in adolescents and young adults with recent on-set disc displacement without reduction (DDw/oR) using high-resolution cone beam computed tomography (CBCT). The associations between types of osteoarthrosis (OA) changes and clinical factors including disease duration were also examined. CBCT and clinical data of 300 patients (84.70% females, mean age 20.93 ± 4.77 years) diagnosed with unilateral DDw/oR (≤12 months) based on RDC/TMD were acquired. CBCT images of both symptomatic and contralateral asymptomatic TMJs were independently evaluated and scored by two radiologists. Associations between OA changes and gender, age, mouth opening and duration of DDw/oR were analyzed statistically. Condylar OA changes were present in 59.30% of the joints with DDw/oR. Early-stage OA changes (loss of continuity of articular cortex and/or surface destruction) constituted most (45.67%) of the alterations. Prevalence of early-stage OA increased from 24% to about 60% one month after TMJ closed-lock occurred. Logistic regression analysis showed the risk of developing early-stage OA changes was 5.33 times higher one month after onset of DDw/oR. A high prevalence of degenerative TMJ changes was observed with recent on-set DDw/oR in adolescents and young adults. Early diagnosis and intervention of DDw/oR is therefore prudent.

The Association between Pregnancy-Related Discomforts and Pre-Pregnancy Body Mass Index in Japanese Women

Objective: To determine the association between pregnancy-related discomforts and pre-pregnancy body mass index in a longitudinal study. Methods: The study included 355 pregnant women (age, 31.1 ± 4.1 years). Participants were divided into three groups according to their pre-pregnancy body mass index: the low body mass index group, normal body mass index group, and high body mass index group. The occurrence of pregnancy-related discomforts during the second and third trimesters was investigated. Binomial logistic regression analysis was used to examine the association between pre-pregnancy body mass index and pregnancy-related discomforts experienced during the last two trimesters. Results: The occurrence of most pregnancy-related discomforts increased in the third trimester, while that of constipation and shoulder stiffness or headache decreased. Based on logistic regression analysis, pre-pregnancy body mass index was significantly associated with various discomforts. The occurrence of hip joint or pubis pain (odds ratio/95% confidence interval = 2.38/1.14–4.95) during the second trimester, and sleeping difficulty (2.00/1.09–3.67), hand or finger stiffness (3.00/1.36–6.45), leg cramps (2.29/1.32–3.98), low back pain (2.20/1.29– 3.75), hip joint or pubis pain (2.14/1.23–3.73), and shoulder stiffness or headache (2.01/1.06–3.82) during the third trimester was significantly higher in the high body mass index group than in the normal body mass index group. The low body mass index group exhibited a significantly a higher occurrence of shoulder stiffness or headache (2.84/1.35–5.96) during the second trimester and constipation (2.28/1.08–4.82) during the third trimester than the normal body mass index group. Conclusion: The occurrence of discomforts decreased or increased during pregnancy. Furthermore, both prepregnancy high and low body mass index represent important risk factors for many pregnancy-related discomforts, compared with a pre-pregnancy normal body mass index.

Factors Affecting the Occurrence of Distal Radioulnar Joint Arthritis after Ulnar Shortening Osteotomy

Purpose: Ulnar shortening osteotmy is a common operation for the treatment of ulnar impaction syndrome. The purpose of this study was to evaluate factors that may affect the occurrence of distal radioulnar joint (DRUJ) arthritis after ulnar shortening osteotomy. Methods: From September 2005 to August 2012, we performed 81 ulnar shortening osteotomies for ulnar impaction syndrome, and evaluated occurrence or deterioration of DRUJ arthritis in 58 patients with a minimum follow-up of 1 year. We analyzed potential factors that may affect the occurrence of DRUJ arthritis, such as, age, sex, hand dominance, pre- and postoperative ulnar variance, preexisting DRUJ arthritis, types of radial sigmoid notch, amount of ulnar shortening, and follow up period. Results: DRUJ arthritis occurred or deteriorated in 32 out of the 58 patients. Regression analysis indicated a significant correlation between the type of radial sigmoid notch (type 1) and DRUJ arthritis. Other factors were not found to be correlated with occurrence or deterioration of DRUJ arthritis. Conclusion: This study suggests that patients with type 1 radial sigmoid notch (ulnar inclination of more than 10 degrees) are more likely to develop DRUJ arthritis after ulnar shortening osteotomy.

Changes in concurrent monthly precipitation and temperature extremes

While numerous studies have addressed changes in climate extremes, analyses of concurrence of climate extremes are scarce, and climate change effects on joint extremes are rarely considered. This study assesses the occurrence of joint (concurrent) monthly continental precipitation and temperature extremes in Climate Research Unit (CRU) and University of Delaware (UD) observations, and in 13 Coupled Model Intercomparison Project Phase 5 (CMIP5) global climate simulations. The joint occurrences of precipitation and temperature extremes simulated by CMIP5 climate models are compared with those derived from the CRU and UD observations for warm/wet, warm/dry, cold/wet, and cold/dry combinations of joint extremes. The number of occurrences of these four combinations during the second half of the 20th century (1951–2004) is assessed on a common global grid. CRU and UD observations show substantial increases in the occurrence of joint warm/dry and warm/wet combinations for the period 1978–2004 relative to 1951–1977. The results show that with respect to the sign of change in the concurrent extremes, the CMIP5 climate model simulations are in reasonable overall agreement with observations. However, the results reveal notable discrepancies between regional patterns and the magnitude of change in individual climate model simulations relative to the observations of precipitation and temperature.

AB1086 Pathological fracture revealing severe tabetic arthropathy

BackgroundTabetic arthropathy is a devastating complication of neuro-syphilis, now becoming scarce due to early treatment of syphilis.The articular involvement may concern every joint, but more particularly concerns those of the...

A unusual presentation of syringomyelia as neuropathic arthropathy of elbow joint and review of literature

Neuropathic arthropathy (NA) is one of the less understood and challenging condition to treat in clinical practice. Jean Martin Charcot described neuropathic joint in 1868. He has shown occurrence of NA in cases of syringomyelia and tabes dorsalis. Since then NA has been described in various other conditions. Knee and ankle joints are most commonly affected. Occurrence of neuropathic joint in upper extremity is very rare. Elbow is less commonly affected joint. We describe two cases of NA of elbow joint with unusual presentation. One patient presented with 3 month history of elbow injury with gross destruction of elbow joint. Another patient presented with acute swelling of elbow joint mimicking septic arthritis with ulnar nerve involvement. We reviewed literature to discuss etiopathogenesis, clinical presentation, and treatment available for NA of elbow joint.

Arthralgia, AI induced side events: incidence, feature and consequences

After a decade of endocrine adjuvant treatment with AI (Aromatase inhibitors), it is documented that they are somewhat superior to tamoxifen, in postmenopausal women with hormone receptor-positive breast cancer. However, compared with tamoxifen, an elevated incidence of arthralgia (pain in one or more joints), has been observed during AI treatment, symptoms more important and problematic than anticipated. The potential mechanisms behind AI-induced arthralgia are not well understood, even if estrogen withdrawal may probably play a role. The frequency is not well-established within the population and clinical predictors of these related arthralgia remain unclear, but this adverse event may result in poor adherence to treatment; interventions to ameliorate are often not efficient and at least, patients and physicians can be dissuading from completing the full AI treatment. Patient educations about some management of arthralgia symptoms can helping patients adhere to AI treatment and improve breast cancer outcomes. For some authors, the occurrence of joint or vasomotor symptoms might be a predictor of treatment effectiveness and might be useful when reassuring patients who present with them, but nevertheless in reality, this opinion is insufficient to avoid adherence. The association between emergent musculoskeletal symptoms and improved outcomes have not been described as consistent in most of experiences.