For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
39
views
16
references
 Top references
cited by
9
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      352
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      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

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          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.

          Related collections

          Most cited references16

          • Record: found
          • Abstract: found
          • Article: not found

          Aromatase inhibitor-induced arthralgia: a review.

          P Niravath (2013)
          Though aromatase inhibitors (AIs) are an essential part of estrogen receptor-positive (ER+) breast cancer therapy, many patients discontinue the medicine before their adjuvant therapy is completed because of the arthralgia which often accompanies the medicine. Up to half of women on AI therapy experience joint pain, and up to 20% will become non-compliant with the medicine because of the joint pain. Yet, very little is known about what causes AI-induced arthralgia (AIA), and there is no established, effective treatment for this difficult problem. It compromises survivors' quality of life and leads to non-compliance. This paper will discuss AIA in depth, including potential etiologies, clinical significance, risk factors, and possible management solutions. Of note, this article presents one of the first proposed algorithms which clearly lays out a treatment plan for AIA, incorporating a variety of interventions which have been proven by the available literature.
          Article 0 comments Cited 65 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            The role of female hormonal factors in the development of rheumatoid arthritis.

            Deshiré Alpizar-Rodríguez, Nicola Pluchino, Geraldine O. Canny … (2017)
            RA is the most common chronic systemic autoimmune disease, with a higher prevalence in women, suggesting female hormonal factors play a role in the development of the disease. However, many controversies still exist. The aim of this review was to appraise data from recent research concerning female hormonal factors and their association with RA disease development. The study of female hormonal factors is challenging because serum levels may differ throughout a woman's lifetime and interact with various environmental, immunological, genetic and endocrine factors influencing the development of autoimmunity. As some female hormonal factors may be potentially modifiable, understanding their impact on RA development is clinically relevant and may result in specific preventive interventions in high-risk populations.
            Article 0 comments Cited 35 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Aromatase and regulation of the estrogen-to-androgen ratio in synovial tissue inflammation: common pathway in both sexes.

              Rainer H. Straub, Maurizio Cutolo, Silvia Capellino (2014)
              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. © 2014 New York Academy of Sciences.
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): RMD Open
                Journal ID (iso-abbrev): RMD Open
                Journal ID (hwp): rmdopen
                Journal ID (publisher-id): rmdopen
                Title: RMD Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2056-5933
                Publication date Collection: 2017
                Publication date (Electronic): 28 September 2017
                Volume: 3
                Issue: 2
                Electronic Location Identifier: e000523
                Affiliations
                [1 ]departmentDivision of Rheumatology and Clinical Immunology , Humanitas Clinical and Research Center , Rozzano, Italy
                [2 ]departmentEpidemiology Unit , Italian Society for Rheumatology (SIR) , Milan, Italy
                [3 ]departmentChair and Division of Rheumatology , IRCCS Policlinico San Matteo Foundation, University of Pavia , Pavia, Italy
                [4 ]departmentRheumatology Unit, Department of Medical Sciences , University of Ferrara , Ferrara, Italy
                Author notes
                [Correspondence to ] Prof Carlo Alberto Scirè; c.scire@ 123456reumatologia.it
                Author information
                http://orcid.org/0000-0001-7451-0271
                Article
                Publisher ID: rmdopen-2017-000523
                DOI: 10.1136/rmdopen-2017-000523
                PMC ID: 5640089
                PubMed ID: 29071118
                SO-VID: 0452253b-e249-4dd3-b577-fa929259bc34
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 17 June 2017
                Date revision received : 31 August 2017
                Date accepted : 04 September 2017
                Funding
                Funded by: Italian Society for Rheumatology;
                Categories
                Subject: Treatments
                Subject: 1506
                Series title: Short report
                Custom metadata
                special-feature unlocked

                Keywords: tamoxifene,rheumatoid arthritis,aromatase inhibitors,breast cancer
                Data availability:
                Keywords: tamoxifene, rheumatoid arthritis, aromatase inhibitors, breast cancer

                Comments

                Comment on this article

                scite_

                Similar content352

                See all similar

                Cited by13

                See all cited by

                Most referenced authors150

                See all reference authors