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General Rehabilitation

Aromatase Inhibitors: Friend or Foe?: A case report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 1

    Primary Author(s)

  • Shahana Momin, DO

    Resident Physician
    University of Texas Health Science Center San Antonio Long SOM PM&R Program
    San Antonio, Texas

    • Co-Author(s)

  • Brian Fricke, MD (he/him/his)

    Associate Professor
    UT Health San Antonio
    San Antonio, Texas

Disclosure(s):
Shahana Momin, DO: No financial relationships to disclose
Brian Fricke, MD: No financial relationships to disclose
Case Diagnosis: Development of Rheumatoid Arthritis in a 65 year old woman with ER+ breast cancer on anastrozole

Case Description or Program Description: A 65-year-old female with a history of triple-positive breast cancer presented to clinic with diffuse musculoskeletal pain. Prior treatment included neoadjuvant therapy, left partial mastectomy with lymph node biopsy, and adjuvant radiation and chemotherapy. At time of presentation, she was taking Kadcyla (ado-trastuzumab emtansine) and anastrozole. Her symptoms were bilateral neck pain, trapezius pain radiating to her hands with numbness and tingling, bilateral knee pain, and morning stiffness lasting over 30 minutes. On exam, she had synovitis to multiple left hand metacarpophalangeal joints. On imaging, a cervical spine x-ray revealed a crowned dens, suggesting rheumatoid arthritis (RA).

Setting: Outpatient Cancer Rehabilitation Clinic

Assessment/Results: Given the patient's exam and imaging findings, lab studies (CRP and ESR) were ordered and were elevated. The patient was referred to a rheumatologist who confirmed a diagnosis of rheumatoid arthritis. The patient completed her aromatase inhibitor course and was placed on chronic low dose steroids.

Discussion (relevance): Estrogen receptor-positive breast cancer is a common subtype of breast cancer, often treated with aromatase inhibitors (AIs) which can cause side effects, including musculoskeletal symptoms. Studies suggest a link between aromatase inhibitors and the development of autoimmune diseases which may be influenced by the immunomodulatory effects of lowered estrogen levels. Estrogen has protective effects against autoimmune diseases, and its reduction may trigger the onset or exacerbation of RA. This case showcases the importance of being aware of commonly used medications in the cancer population with lesser known but severe side effects.

Conclusions: This case illustrates the importance of recognizing the potential link between AI therapy and development of RA in the cancer rehabilitation patient population. Increased awareness and monitoring are essential for managing symptoms and ensuring optimal care as early intervention may improve outcomes and quality of life.