- It should be established that a patient’s joint pain is caused by her aromatase inhibitor (AI) and not related to other causes. The most effective way is to note what happens to the joint pain when the AI is stopped for about 2 to 4 weeks. If joint pain resolves, then rechallenge with the same AI. If joint pain reoccurs, causality is proven.
- One of the simplest and most effective methods of maintaining adherence in a patient who experienced AI-induced joint pain is to switch her to another AI. About 30% of women will stay on the second AI for a median of 14 months. Some women are intolerant of all three AIs and are then switched to tamoxifen.
- There are many trials of interventions to mitigate the pain of AI-induced arthralgia. Many of these are flawed methodologically, and are of low to moderate quality. Higher doses of vitamin D3 and omega-3 fatty acids are ineffective. However, there is recent evidence for duloxetine that shows both statistically significant and clinically meaningful reductions in AI-induced arthralgia.
- Healthcare providers have a role in increasing adherence and decreasing discontinuation rates. Adherence, in part, depends on good physician/patient communication with regard to the risks and benefits of treatments, and available alternatives.