Aromatase Inhibitors and Trigger Finger/Thumh

Hi Pitanga,

I entered the northdrugstore link in my computer.  First, my software said they have a poor rating.  It can be for many reasons as rating is based on customer feedback.  Second, they don't allow  you to see who your generic supplier is.  I don't take Aromasin, so don't know if Canada has generic.  But, I do take Arimidex - so I looked at Arimidex and they are offering a generic.  Canada won't have a generic until 2012.  Third, take a look at their policies "Liability of North Drug Stores" they say your sole remedy is to discontinue using them.  Fourth, and this is small and petty, but they didn't give a postal code on their address - so suspicious me, doesn't think they actually reside in Canada.  There is a Shoppers Drug Mart in the plaza but no other drug store - however, there is a UPS store - so I expect they have a mail box in the UPS store.

I am very distrustful of the supposedly "Canadian" mail order pharmacies.  The address is not far from me, so  I'll try and scout them out a little more.

Meantime, I'll ask my pharmasist how much Aromasin is and if they have a generic, and if they can ship to Brazil.  Just to see what they say.

Molly, thank you so much for your input. I am a real greenhorn when it comes to ordering medication online. Your points are very well taken. I also wonder about Canada already having a generic Aromasin. Brazil already has generic Arimidex but not Aromasin, and the gov´t here is far less picky than the FDA in the US about approving new drugs.

Gwen, if I weren´t Stage 4 I might consider stopping AI´s because of the quality of life concerns. After my initial dx I did 4 years of tamoxifen but eventually quit because of SEs. My recurrence/mets dx came 5 years later. Sometimes I wonder if things would be different today if I had stuck it out for that last year. On the other hand I also see posts on the stage 4 boards by women who went the full 5 years of estrogen blockers.

I too have had achey joints, mostly hands, which worsens and remits since starting Femara. Took a couple of months to get really bad; sometimes it wakes me up at nights, other times it's barely noticeable. I did some PubMed searching, since I'm an RN.

Apparently there's a lot of AIA (aromatase inhibitor-related arthralgia) going on. Here's just one article:

J Clin Oncol. 2009 Oct 20;27(30):4955-60. Epub 2009 Sep 14.
Sonographic and electrodiagnostic evaluations in patients with aromatase inhibitor-related arthralgia. Dizdar et al.

Abstract

PURPOSE: To investigate the prevalence of arthralgia in breast cancer patients taking aromatase inhibitors (AIs) and perform a detailed rheumatologic assessment including autoimmune serology, musculoskeletal sonography, and electromyography (EMG) in these patients. PATIENTS AND METHODS: Postmenopausal patients with stage I to III breast cancer who were taking adjuvant AIs were enrolled (n = 92). Patients who were not receiving hormone treatment were included as a control group (n = 28). Musculoskeletal sonography and EMG were applied to the patients and the controls along with markers of autoimmunity. RESULTS: Thirty patients (32.6%) reported to have AI-related new-onset or worsening arthralgia. The most commonly affected joints were knee (70%), wrist (70%), and small joints of the hand (63%). Patients taking AIs had increased tendon thicknesses compared with those who never received AIs (P < .001). Patients with AI-related arthralgia had higher rates of effusion in hand joints/tendons than those without arthralgia (P = .033). More patients with AI-related arthralgia had EMG findings consistent with carpal tunnel syndrome (CTS) than those without arthralgia (P = .024). No significant difference was observed in erythrocyte sedimentation rates, C-reactive protein, antinuclear antibody, antidouble stranded DNA antibody, rheumatoid factor, or anticyclic citrullinated peptide levels between patients and controls or between those with and without arthralgia. CONCLUSION: Patients with AI-related arthralgia often show tenosynovial changes suggesting tenosynovitis, exerting local problems but lacking a systemic inflammatory component. Our finding of increased CTS frequency also supports this hypothesis.

OK, thicker tendons and more joint and tendon effusions (fluidy swelling). No wonder many of us hurt! 

I have been on Femara for a year and a half.  A couple of weeks ago my ring finger on my left hand was catching and I thought that maybe I had injured it.  Then the ring finger on my right hand started doing the same thing and now the index finger on my right hand started also. For a couple of days I started thinking about the Femara and decided that maybe I should do some research.  I cam back here and one of the first things I read was this thread.  When I read it, I was like..."Yeah!!!  that is what I'm experiencing!"

 Talking to some people, they suggest that I just quit the Femara and see what happens.  But to be honest, I'm not really sure that would be a wise thing right now.  Do I quit Femara and take the risk of the cancer coming back?  Or do I continue the Femara and deal with the fingers?   Decisions......................

Joy -- I had the same experience with the middle fingers -- first on one hand and then a few days later on the other.  That happened a year ago, and as of a few months ago, my fingers are back to normal.  I humbly suggest that this will be a temporary problem for you, and definitely not worth going off Femara.

Thank you all for your thoughts.  I am not going to stop the Femara.  It is good to know that maybe this thing with my fingers may go away some day. 

Hi all.  I also gave in and saw an Ortho doc today because the splint, what's it been about 6 weeks now, gave relief but only when wearing it.  When I took it off the trigger thumb was no better.  So it was not the answer for me.  Opted to try the cortisone shot (ouch, that hurt!) and have to return to him in 3 weeks to see if it's better.  Also put me on an anti-inflammatory until then.  If it's not better he would do a second shot but I think I may instead try the PT first.  Minor surgery is the last resort.   So, it's been about 15 hours and although the pain is somewhat better I can't bend the thumb without it triggering.  Paperwork says could be up to 72 hours before the pain goes away.  Will report back.

AJ, we do blame some things on AI's when it can be other things.  My PCP had Xray's taken because it's normally associated with arthritis but that test returned negative.  So, for me, it probably is the AI which definitely causes joint issues.  The ortho doc dx'd it even before he did an Xray.  He asked for symptoms and immediately said, "Oh, you have trigger thumb".

Have to report the anti-inflam he prescribed has helped tremendously and I can now bend the thumb almost all the way, but it's not back 100% quite yet.

AJ, according to the Mayo clinic site trigger finger/thumb can be caused by repetitive motion issues. But it apparently can arise from AI´s too. My Arimidex package insert cites it as an adverse reaction to the drug, though not as common as other more general joint issues.

Patoo, I hope the shot does the trick. I am kind of disappointed to be shuttled into PT instead of a cortisone shot. I just finished more than six months of PT for my frozen shoulder and I was heaving a sigh of relief that it was all over, now here I am back at the PT clinic 3 times a week. 

Ruby, do you find that yours triggers more when you use it? Mine gets worse when I havent been using it. I find moving my fingers helps make it better, but then it comes back if I stop. 

I woke up yesterday morning, and my right thumb clicked.  Oh crap.  I bought a finger splint a little later that day.  Hasn't clicked since, but I know how these things go -- it's just a matter of time...

Good point, Linda.  Sometimes trigger finger does self resolve with time. I've never taken any of the AI's, but a few years into natural menopause, I developed a left trigger thumb which was horribly painful.  I doubt it had anything at all to do with repeatative motion injury since I'm right handed and don't really do any repeative tasks.  I think it's purely a matter of estrogen deprivation - at least in my case. 

Anyway, I had a cortisone injection into the thumb twice which helped for a while (1 to 2 months) each time and was scheduled for surgery (rather than have a 3rd injection) when it suddenly began to resolve about a week before the surgery date, so I cancelled the surgery. It's been a few years and it's been fine ever since.  I really can't contribute doing or taking anything except that I stopped splinting it at night. I found that, aside from preventing the unintentional movement of the thumb and the resulting sudden pain during sleep (which of course, was wonderful), splinting it seemed to make it much worse in the mornings.  When using a splint during the night, I found it to be a lot more painful and stiff in the morning and trying to get it moving again caused extreme pain - much more so than when I didn't splint it. 

Ladies,

I´m reviving this thread to say that in early August my onc switched me to aromasin and after a few weeks the trigger finger and other achy joints went away.

Unfortunately then I frittered away to Africa and once there I ran out of aromasin and there was nowhere to buy more. So I was forced to dig into my arimidex stash in early September. After a few weeks, the aches and pains started to come back but so far are not as intense as before. Now that I am back home I will definitely see about going back on Aromasin.

How are y' all doing with the trigger fingers?

Lisa 

Ruby, I had the shot also a few months ago and, so far, it's still effective.  Seems it tried to come on the other hand as well but I occasionally use a splint at night and also exercise it and so the trigger thumb there never really took.  Occasionally some of my fingers will seem to snap but so far I'm okay.  Next month will be starting my 3rd year on Arimidex/Anastrozole.