{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T04:15:44Z","timestamp":1794456944848,"version":"4.9.1"},"reference-count":191,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T00:00:00Z","timestamp":1596672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Aromatase inhibitors (AIs) have radically changed the prognosis of hormone receptor positive breast cancer (BC) in post-menopausal women, and are a mainstay of the adjuvant therapy for BC after surgery in place of, or following, Tamoxifen. However, AIs aren\u2019t side effect-free; frequent adverse events involve the musculoskeletal system, in the form of bone loss, AI-associated arthralgia (AIA) syndrome and autoimmune rheumatic diseases. In this narrative review, we reported the main clinical features of these three detrimental conditions, their influence on therapy adherence, the possible underlying molecular mechanisms and the available pharmacological and non-pharmacological treatments. The best-known form is the AIs-induced osteoporosis, whose molecular pathway and therapeutic possibilities were extensively investigated in the last decade. AIA syndrome is a high prevalent joint pain disorder which often determines a premature discontinuation of the therapy. Several points still need to be clarified, as a universally accepted diagnostic definition, the pathogenetic mechanisms and satisfactory management strategies. The association of AIs therapy with autoimmune diseases is of the utmost interest. The related literature has been recently expanded, but many issues remain to be explored, the first being the molecular mechanisms.<\/jats:p>","DOI":"10.3390\/ijms21165625","type":"journal-article","created":{"date-parts":[[2020,8,6]],"date-time":"2020-08-06T09:41:21Z","timestamp":1596706881000},"page":"5625","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":95,"title":["Aromatase Inhibitors\u2014Induced Musculoskeletal Disorders: Current Knowledge on Clinical and Molecular Aspects"],"prefix":"10.3390","volume":"21","author":[{"given":"Sara","family":"Tenti","sequence":"first","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2154-6734","authenticated-orcid":false,"given":"Pierpaolo","family":"Correale","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Grand Metropolitan Hospital \u201cBianchi-Melacrino-Morelli\u201d, 89121 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1796-0422","authenticated-orcid":false,"given":"Sara","family":"Cheleschi","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7325-5579","authenticated-orcid":false,"given":"Antonella","family":"Fioravanti","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Pirtoli","sequence":"additional","affiliation":[{"name":"Sbarro Institute for Cancer Research and Molecular Medicine-Center for Biotechnology, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.5152\/tjbh.2015.1669","article-title":"Molecular Classification of Breast Carcinoma: From Traditional, Old-Fashioned Way to a New Age, and A New Way","volume":"11","author":"Zengel","year":"2015","journal-title":"J. Breast Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1001\/jama.2018.19323","article-title":"Breast Cancer Treatment: A Review","volume":"321","author":"Waks","year":"2019","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/978-3-319-16366-6_7","article-title":"Symptoms: Aromatase Inhibitor Induced Arthralgias","volume":"862","author":"Hershman","year":"2015","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1186\/bcr2818","article-title":"Aromatase inhibitor-associated bone and musculoskeletal effects: New evidence defining etiology and strategies for management","volume":"13","author":"Gaillard","year":"2011","journal-title":"Breast Cancer Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3784","DOI":"10.1200\/JCO.2009.26.3756","article-title":"American Society of Clinical Oncology clinical practice practice guideline: Update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer","volume":"28","author":"Burstein","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Meng, J., Wang, X., Guan, Y., and Zhang, D. (2020). Aromatase inhibitors plus ovarian function suppression versus tamoxifen plus ovarian function suppression for premenopausal women with early stage breast cancer: A systematic review and meta-analysis. Ann. Palliat. Med.","DOI":"10.21037\/apm-20-488A"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1007\/s10549-018-05086-8","article-title":"Aromatase inhibitor and tamoxifen use and the risk of venous thromboembolism in breast cancer survivors","volume":"174","author":"Xu","year":"2019","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"44","DOI":"10.17925\/EOH.2016.12.01.44","article-title":"Therapeutic Place of Fulvestrant in the Management of Hormone-receptor Positive Breast Cancer","volume":"12","author":"Belagali","year":"2016","journal-title":"Eur. Oncol. Haematol."},{"key":"ref_9","unstructured":"NICE National Institute for Health and Care Excellence (2020, July 28). Managing Advanced Breast Cancer, Available online: https:\/\/pathways.nice.org.uk\/pathways\/advanced-breast-cancer."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1093\/annonc\/mdt037","article-title":"Aromatase inhibitor-induced arthralgia: A review","volume":"24","author":"Niravath","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e15052","DOI":"10.1097\/MD.0000000000015052","article-title":"Primary antiphospholipid syndrome during aromatase inhibitors therapy: A case report and review of the literature","volume":"98","author":"Tenti","year":"2019","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1210\/er.2008-0016","article-title":"History of aromatase: Saga of an important biological mediator and therapeutic target","volume":"30","author":"Santen","year":"2009","journal-title":"Endoc. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1586\/era.11.96","article-title":"Current role and safety profile of aromatase inhibitors in early breast cancer","volume":"11","author":"Tomao","year":"2011","journal-title":"Expert Rev. Anticancer Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2948","DOI":"10.1002\/1097-0142(197706)39:6<2948::AID-CNCR2820390681>3.0.CO;2-9","article-title":"Kinetic, hormonal and clinical studies with aminoglutethimide in breast cancer","volume":"39","author":"Santen","year":"1977","journal-title":"Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1517\/14740338.2010.515977","article-title":"Anastrozole","volume":"9","author":"Kelly","year":"2010","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1185\/030079906X120940","article-title":"Defining the role of aromatase inhibitors in the adjuvant endocrine treatment of early breast cancer","volume":"22","author":"Buzdar","year":"2006","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1517\/14656560902953738","article-title":"Comparative review of anastrozole, letrozole and exemestane in the management of early breast cancer","volume":"10","author":"Nabholtz","year":"2009","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11912-020-00917-8","article-title":"Sequencing Endocrine Therapy for Metastatic Breast Cancer: What Do We Do After Disease Progression on a CDK4\/6 Inhibitor?","volume":"22","author":"Xi","year":"2020","journal-title":"Curr. Oncol. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1517\/17425250903540246","article-title":"Letrozole","volume":"6","author":"Dellapasqua","year":"2010","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1517\/14740338.2011.567264","article-title":"Drug safety evaluation of exemestane","volume":"10","author":"Lintermans","year":"2011","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.breast.2016.01.006","article-title":"Aromatase inhibitors alone or sequentially combined with tamoxifen in postmenopausal early breast cancer compared with tamoxifen or placebo\u2014Meta-analyses on efficacy and adverse events based on randomized clinical trials","volume":"26","author":"Vitols","year":"2016","journal-title":"Breast"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ejca.2018.02.026","article-title":"Health-related quality of life from the FALCON phase III randomised trial of fulvestrant 500 mg versus anastrozole for hormone receptor-positive advanced breast cancer","volume":"94","author":"Robertson","year":"2018","journal-title":"Eur. J. Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1517\/14740338.2015.1053458","article-title":"Safety of aromatase inhibitor therapy in breast cancer","volume":"14","author":"Lintermans","year":"2015","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3647","DOI":"10.1210\/jc.2017-01138","article-title":"Managing Menopausal Symptoms and Associated Clinical Issues in Breast Cancer Survivors","volume":"102","author":"Santen","year":"2017","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1200\/JOP.18.00710","article-title":"Managing Genitourinary Syndrome of Menopause in Breast Cancer Survivors Receiving Endocrine Therapy","volume":"15","author":"Sussman","year":"2019","journal-title":"J. Oncol. Pract."},{"key":"ref_26","unstructured":"(2020, July 28). American College of Obstetrics and Gynecologists: Committee Opinion: The Use of Vaginal Estrogen in Women with a History of Estrogen-Dependent Breast Cancer. Available online: https:\/\/www.acog.org\/Resources-And-Publications\/Committee-Opinions\/Committee-onGynecologic-Practice\/The-Use-of-Vaginal-Estrogenin-Women-With-a-History-of-Estrogen-Dependent-Breast-Cancer."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1093\/annonc\/mdw673","article-title":"Cardiotoxicity of aromatase inhibitors and tamoxifen in postmenopausal women with breast cancer: A systematic review and meta-analysis of randomized controlled trials","volume":"28","author":"Filion","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1200\/JCO.2013.54.2258","article-title":"Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American society of clinical oncology clinical practice guideline focused update","volume":"32","author":"Burstein","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"He, Y., Zhang, J., Shen, G., Liu, L., Zhao, Q., Lu, X., Yang, H., and Hong, D. (2019). Aromatase inhibitors and risk of cardiovascular events in breast cancer patients: A systematic review and meta-analysis. BMC Pharmacol. Toxicol., 20.","DOI":"10.1186\/s40360-019-0339-1"},{"key":"ref_30","first-page":"1758835920909660","article-title":"Thromboembolic, cardiovascular and overall mortality risks of aromatase inhibitors, compared with tamoxifen treatment: An outpatient-register-based retrospective cohort study","volume":"12","author":"Tusquets","year":"2020","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1093\/clinchem\/45.2.252","article-title":"Influence of aromatase inhibitors on plasma total homocysteine in postmenopausal breast cancer patients","volume":"45","author":"Anker","year":"1999","journal-title":"Clin. Chem."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1152\/physrev.00036.2014","article-title":"Estrogen effects on cognitive and synaptic health over the lifecourse","volume":"95","author":"Hara","year":"2015","journal-title":"Physiol. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"610","DOI":"10.3389\/fendo.2018.00610","article-title":"Cognitive Effects of Aromatase and Possible Role in Memory Disorders","volume":"9","author":"Rosenfeld","year":"2018","journal-title":"Front. Endocrinol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s10549-017-4627-4","article-title":"Cognitive sequelae of endocrine therapy in women treated for breast cancer: A meta-analysis","volume":"168","author":"Underwood","year":"2018","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s10549-016-3906-9","article-title":"Endocrine treatment-associated cognitive impairment in breast cancer survivors: Evidence from published studies","volume":"158","author":"Lee","year":"2016","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5305","DOI":"10.1200\/JCO.2006.07.5382","article-title":"Aromatase inhibitors and bone health in women with breast cancer","volume":"24","author":"Chien","year":"2006","journal-title":"J. Clin. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"411","DOI":"10.21037\/gs.2018.07.05","article-title":"Osteoporosis and musculoskeletal complications related to therapy of breast cancer","volume":"7","author":"Suskin","year":"2018","journal-title":"Gland Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.bone.2013.04.021","article-title":"Genetic polymorphism at Val80 (rs700518) of the CYP19A1 gene is associated with aromatase inhibitor associated bone loss in women with ER + breast cancer","volume":"55","author":"Napoli","year":"2013","journal-title":"Bone"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s10549-015-3608-8","article-title":"Associations between genetic variants and the effect of letrozole and exemestane on bone mass and bone turnover","volume":"154","author":"Oesterreich","year":"2015","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1530\/JME-15-0079","article-title":"CYP11A1 expression in bone is associated with aromatase inhibitor-related bone loss","volume":"55","author":"Servitja","year":"2015","journal-title":"J. Mol. Endocrinol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1210\/me.2014-1147","article-title":"Aromatase inhibitor-associated bone fractures: A case-cohort GWAS and functional genomics","volume":"28","author":"Liu","year":"2014","journal-title":"Mol. Endocrinol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Wang, J., Lu, K., Song, Y., Zhao, S., Ma, W., Xuan, Q., Tang, D., Zhao, H., Liu, L., and Zhang, Q. (2015). RANKL and OPG Polymorphisms Are Associated with Aromatase Inhibitor-Related Musculoskeletal Adverse Events in Chinese Han Breast Cancer Patients. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0133964"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"5717","DOI":"10.1158\/1078-0432.CCR-04-0438","article-title":"Effects of the steroidal aromatase inhibitor exemestane and the nonsteroidal aromatase inhibitor letrozole on bone and lipid metabolism in ovariectomized rats","volume":"10","author":"Goss","year":"2004","journal-title":"Clin. Cancer Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/S1470-2045(10)70257-6","article-title":"Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial","volume":"11","author":"Cuzick","year":"2010","journal-title":"Lancet Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S1470-2045(11)70389-8","article-title":"Bone density and structure in healthy postmenopausal women treated with exemestane for the primary prevention of breast cancer: A nested substudy of the MAP.3 randomised controlled trial","volume":"13","author":"Cheung","year":"2012","journal-title":"Lancet Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/S0140-6736(13)62292-8","article-title":"Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): An international, double-blind, randomised placebo-controlled trial","volume":"383","author":"Cuzick","year":"2014","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.critrevonc.2008.07.013","article-title":"Aromatase inhibitor-associated bone loss in breast cancer patients is distinct from postmenopausal osteoporosis","volume":"69","author":"Hadji","year":"2009","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1093\/jnci\/djr242","article-title":"Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: A systematic review and meta-analysis","volume":"103","author":"Amir","year":"2011","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"R111","DOI":"10.1530\/JOE-19-0077","article-title":"The effects of adjuvant endocrine therapy on bone health in women with breast cancer","volume":"241","author":"Ramchand","year":"2019","journal-title":"J. Endocrinol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s42000-019-00164-y","article-title":"Bone health care in women with breast cancer","volume":"19","author":"Paschou","year":"2020","journal-title":"Hormones"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.maturitas.2016.10.007","article-title":"Osteoporosis management in patients with breast cancer: EMAS position statement","volume":"95","author":"Ceausu","year":"2017","journal-title":"Maturitas"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1093\/annonc\/mdu103","article-title":"ESMO Guidelines Working Group. Bone health in cancer patients: ESMO Clinical Practice Guidelines","volume":"25","author":"Coleman","year":"2014","journal-title":"Ann. Oncol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/cen.13735","article-title":"Assessment and management of bone health in women with oestrogen receptor-positive breast cancer receiving endocrine therapy: Position statement of the Endocrine Society of Australia, the Australian and New Zealand Bone & Mineral Society, the Australasian Menopause Society and the Clinical Oncology Society of Australia","volume":"89","author":"Grossmann","year":"2018","journal-title":"Clin. Endocrinol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1093\/annonc\/mdr017","article-title":"Management of aromatase inhibitor-associated bone loss in postmenopausal women with breast cancer: Practical guidance for prevention and treatment","volume":"22","author":"Hadji","year":"2011","journal-title":"Ann. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/S2213-8587(18)30047-0","article-title":"Bone health during endocrine therapy for cancer","volume":"6","author":"Rachner","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jbo.2017.03.001","article-title":"Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG","volume":"7","author":"Hadji","year":"2017","journal-title":"J. Bone Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e1911080","DOI":"10.1001\/jamanetworkopen.2019.11080","article-title":"Association of Fat Body Mass with Vertebral Fractures in Postmenopausal Women with Early Breast Cancer Undergoing Adjuvant Aromatase Inhibitor Therapy","volume":"2","author":"Pedersini","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1200\/JCO.2006.08.7080","article-title":"Changes in bone mineral density after adjuvant aromatase inhibitors and fracture risk in breast cancer patients","volume":"25","author":"Berruti","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.bone.2016.08.008","article-title":"TBS and BMD at the end of AI-therapy: A prospective study of the B-ABLE cohort","volume":"92","author":"Marta","year":"2016","journal-title":"Bone"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1002\/jbmr.3886","article-title":"Increased Fracture Risk in Women Treated with Aromatase Inhibitors Versus Tamoxifen: Beneficial Effect of Bisphosphonates","volume":"35","author":"Servitja","year":"2020","journal-title":"J. Bone Miner. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S0140-6736(15)60995-3","article-title":"Adjuvant denosumab in breast cancer (ABCSG-18): A multicentre, randomised, double-blind, placebo-controlled trial","volume":"386","author":"Gnant","year":"2015","journal-title":"Lancet"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.breast.2007.01.011","article-title":"Aromatase inhibitor-associated arthralgia syndrome","volume":"16","author":"Burstein","year":"2007","journal-title":"Breast"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s10549-007-9774-6","article-title":"Prospective characterization of musculoskeletal symptoms in early stage breast cancer patients treated with aromatase inhibitors","volume":"111","author":"Henry","year":"2008","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1007\/s00520-017-3824-3","article-title":"Prevalence of aromatase inhibitor-induced arthralgia in breast cancer: A systematic review and meta-analysis","volume":"25","author":"Leysen","year":"2017","journal-title":"Support. Care Cancer"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1200\/JCO.2017.76.3250","article-title":"What Is the Role of Symptom Management and Patient-Reported Outcomes in Adherence to Aromatase Inhibitors?","volume":"36","author":"Rocque","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1186\/bcr2746","article-title":"Genome-wide case-control study of musculoskeletal adverse events and functional genomics in women receiving aromatase inhibitors: Going beyond associations","volume":"12","author":"Ingle","year":"2010","journal-title":"Breast Cancer Res."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s10549-013-2638-3","article-title":"Genetic determinants of aromatase inhibitor-related arthralgia: The B-ABLE cohort study","volume":"140","author":"Servitja","year":"2013","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1177\/1099800419895114","article-title":"Genetic Underpinnings of Musculoskeletal Pain during Treatment with Aromatase Inhibitors for Breast Cancer: A Biological Pathway Analysis","volume":"22","author":"Zhu","year":"2020","journal-title":"Biol. Res. Nurs."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.breast.2019.10.008","article-title":"Clinical and genetic risk factors for aromatase inhibitor-associated arthralgia in breast cancer survivors","volume":"49","author":"Romero","year":"2020","journal-title":"Breast"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1111\/bcp.13130","article-title":"Polymorphisms in ABCB1 and CYP19A1 genes affect anastrozole plasma concentrations and clinical outcomes in postmenopausal breast cancer patients","volume":"83","author":"Gervasini","year":"2017","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1007\/s00280-011-1615-y","article-title":"Single nucleotide polymorphisms of CYP19A1 predict clinical outcomes and adverse events associated with letrozole in patients with metastatic breast cancer","volume":"68","author":"Park","year":"2011","journal-title":"Cancer Chemother. Pharmacol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s10549-014-2873-2","article-title":"Germline variants in the CYP19A1 gene are related to specific adverse events in aromatase inhibitor users: A substudy of Dutch patients in the TEAM trial","volume":"144","author":"Fontein","year":"2014","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Wang, J., Lu, K., Song, Y., Xie, L., Zhao, S., Wang, Y., Sun, W., Liu, L., Zhao, H., and Tang, D. (2013). Indications of clinical and genetic predictors for aromatase inhibitors related musculoskeletal adverse events in Chinese Han women with breast cancer. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0068798"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1007\/s10549-013-2504-3","article-title":"Genetic associations with toxicity-related discontinuation of aromatase inhibitor therapy for breast cancer","volume":"138","author":"Henry","year":"2013","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.clbc.2017.10.009","article-title":"Vitamin D Levels, Vitamin D Receptor Polymorphisms, and Inflammatory Cytokines in Aromatase Inhibitor-Induced Arthralgias: An Analysis of CCTG MA.27","volume":"18","author":"Niravath","year":"2018","journal-title":"Clin. Breast Cancer"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ejca.2015.12.013","article-title":"Genetic variant in the osteoprotegerin gene is associated with aromatase inhibitor-related musculoskeletal toxicity in breast cancer patients","volume":"56","author":"Lintermans","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"3146","DOI":"10.12659\/MSM.916254","article-title":"Estrogen Modulates Cartilage and Subchondral Bone Remodeling in an Ovariectomized Rat Model of Postmenopausal Osteoarthritis","volume":"25","author":"Xu","year":"2019","journal-title":"Med. Sci. Monit."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.ejphar.2011.08.027","article-title":"Raloxifene protects cultured human chondrocytes from IL-1\u03b2 induced damage: A biochemical and morphological study","volume":"670","author":"Tinti","year":"2011","journal-title":"Eur, J. Pharmacol"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s12038-012-9282-7","article-title":"Potential of Raloxifene in reversing osteoarthritis-like alterations in rat chondrocytes: An in vitro model study","volume":"38","author":"Kavas","year":"2013","journal-title":"J. Biosci."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"R202","DOI":"10.1186\/ar761","article-title":"Hormone replacement therapy in rheumatoid arthritis is associated with lower serum levels of soluble IL-6 receptor and higher insulin-like growth factor 1","volume":"5","author":"Mattsson","year":"2003","journal-title":"Arthritis Res. Ther."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s10549-006-9394-6","article-title":"Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: Associated tenosynovial changes on magnetic resonance imaging","volume":"104","author":"Morales","year":"2007","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13058-015-0599-7","article-title":"Arthralgia among women taking aromatase inhibitors: Is there a shared inflammatory mechanism with co-morbid fatigue and insomnia?","volume":"17","author":"Bauml","year":"2015","journal-title":"Breast Cancer Res."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1111\/ajco.12845","article-title":"Efficacy of management strategies for aromatase inhibitor-induced arthralgia in breast cancer patients: A systematic review","volume":"14","author":"Nahm","year":"2018","journal-title":"Asia Pac. J. Clin. Oncol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s10549-009-0495-x","article-title":"Effect of vitamin D supplementation on serum 25-hydroxy vitamin D levels, joint pain, and fatigue in women starting adjuvant letrozole treatment for breast cancer","volume":"119","author":"Khan","year":"2010","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1007\/s10549-012-2013-9","article-title":"Vitamin D threshold to prevent aromatase inhibitor-related bone loss: The B-ABLE prospective cohort study","volume":"133","author":"Servitja","year":"2012","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s10549-011-1644-6","article-title":"Vitamin D and aromatase inhibitor-induced musculoskeletal symptoms (AIMSS): A phase II, double-blind, placebo-controlled, randomized trial","volume":"129","author":"Rastelli","year":"2011","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s10549-016-3710-6","article-title":"Randomized, blinded trial of vitamin D3 for treating aromatase inhibitor-associated musculoskeletal symptoms (AIMSS)","volume":"155","author":"Shapiro","year":"2016","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s10549-017-4429-8","article-title":"Randomized trial of vitamin D3 to prevent worsening of musculoskeletal symptoms in women with breast cancer receiving adjuvant letrozole. The VITAL trial","volume":"166","author":"Khan","year":"2017","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s10549-019-05319-4","article-title":"Randomized controlled trial of high-dose versus standard-dose vitamin D3 for prevention of aromatase inhibitor-induced arthralgia","volume":"177","author":"Niravath","year":"2019","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1200\/JCO.2014.59.5595","article-title":"Randomized Multicenter Placebo-Controlled Trial of Omega-3 Fatty Acids for the Control of Aromatase Inhibitor-Induced Musculoskeletal Pain: SWOG S0927","volume":"33","author":"Hershman","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10549-018-4946-0","article-title":"Omega-3 fatty acid use for obese breast cancer patients with aromatase inhibitor-related arthralgia (SWOG S0927)","volume":"172","author":"Shen","year":"2018","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s10549-017-4559-z","article-title":"Randomized placebo-controlled pilot trial of omega 3 fatty acids for prevention of aromatase inhibitor-induced musculoskeletal pain","volume":"167","author":"Lustberg","year":"2018","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1200\/JCO.2017.74.6651","article-title":"Randomized, Multicenter, Placebo-Controlled Clinical Trial of Duloxetine Versus Placebo for Aromatase Inhibitor-Associated Arthralgias in Early-Stage Breast Cancer: SWOG S1202","volume":"36","author":"Henry","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1002\/cncr.32024","article-title":"Association between body mass index and response to duloxetine for aromatase inhibitor-associated musculoskeletal symptoms in SWOG S1202","volume":"125","author":"Henry","year":"2019","journal-title":"Cancer"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.pain.2007.01.020","article-title":"A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain","volume":"129","author":"Goldberg","year":"2007","journal-title":"Pain"},{"key":"ref_96","first-page":"2331","article-title":"Short-term and low-dose prednisolone administration reduces aromatase inhibitor-induced arthralgia in patients with breast cancer","volume":"32","author":"Kubo","year":"2012","journal-title":"Anticancer Res."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1007\/s00520-012-1628-z","article-title":"Phase II study of glucosamine with chondroitin on aromatase inhibitor-associated joint symptoms in women with breast cancer","volume":"21","author":"Greenlee","year":"2013","journal-title":"Support. Care Cancer"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1111\/tbj.12951","article-title":"Single arm phase II study of oral vitamin B12 for the treatment of musculoskeletal symptoms associated with aromatase inhibitors in women with early stage breast cancer","volume":"24","author":"Campbell","year":"2018","journal-title":"Breast J."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"3525","DOI":"10.31557\/APJCP.2018.19.12.3525","article-title":"The Role of Diuretics in Treatment of Aromatase Inhibitors Induced Musculoskeletal Symptoms in Women with Non Metastatic Breast Cancer","volume":"19","author":"Alhanafy","year":"2018","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s10549-018-4811-1","article-title":"A phase II study evaluating the efficacy of zoledronic acid in prevention of aromatase inhibitor-associated musculoskeletal symptoms: The ZAP trial","volume":"171","author":"Bardia","year":"2018","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1136\/annrheumdis-2016-210860","article-title":"Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: The ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT)","volume":"76","author":"Reginster","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s40520-019-01305-4","article-title":"A retrospective observational study of glucosamine sulfate in addition to conventional therapy in hand osteoarthritis patients compared to conventional treatment alone","volume":"32","author":"Tenti","year":"2020","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.semarthrit.2019.04.008","article-title":"An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)","volume":"49","author":"Honvo","year":"2019","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.breast.2010.03.031","article-title":"New views on treatment of aromatase inhibitors induced arthralgia","volume":"19","author":"Xepapadakis","year":"2010","journal-title":"Breast"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s10549-009-0692-7","article-title":"Effect of a switch of aromatase inhibitors on musculoskeletal symptoms in postmenopausal women with hormone-receptor-positive breast cancer: The ATOLL (articular tolerance of letrozole) study","volume":"120","author":"Briot","year":"2010","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"COSA Exercise and Cancer Group Executive Committee (2019). Clinical Oncology Society of Australia position statement on exercise in cancer care. Med. J. Aust., 210, 54\u201354.e1.","DOI":"10.5694\/mja2.12039"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1249\/MSS.0000000000002116","article-title":"Exercise guidelines for cancer survivors: Consensus statement from international multidisciplinary roundtable","volume":"51","author":"Campbell","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1200\/jco.2011.29.15_suppl.636","article-title":"A randomized trial of exercise versus control for musculoskeletal symptoms from adjuvant anastrozole (A) for postmenopausal early breast cancer (PEBC)","volume":"29","author":"Lohrisch","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1200\/JCO.2014.57.1547","article-title":"Randomized exercise trial of aromatase inhibitor\u2013induced arthralgia in breast cancer survivors","volume":"33","author":"Irwin","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.jpainsymman.2016.03.010","article-title":"Nordic walking as an exercise intervention to reduce pain in women with aromatase inhibitor- associated arthralgia: A feasibility study","volume":"52","author":"Fields","year":"2016","journal-title":"J. Pain Symptom Manag."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"P5","DOI":"10.1158\/1538-7445.SABCS15-P5-12-04","article-title":"Abstract P5-12-04: Directed exercise intervention in breast cancer patients with arthralgias receiving aromatase inhibitors: A randomized pilot study","volume":"76","author":"Varadarajan","year":"2016","journal-title":"Cancer Res."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1634\/theoncologist.2017-0174","article-title":"Randomized controlled trial of a home-based walking program to reduce moderate to severe aromatase inhibitor associated arthralgia in breast cancer survivors","volume":"22","author":"Nyrop","year":"2017","journal-title":"Oncologist"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"P5","DOI":"10.1158\/1538-7445.SABCS16-P5-12-02","article-title":"Can a supervised exercise program compared to usual care prevent aromatase inhibitor-induced musculoskeletal pain in women with breast cancer?","volume":"77","author":"Sanmugarajah","year":"2017","journal-title":"Cancer Res."},{"key":"ref_114","first-page":"P6","article-title":"Final results of the randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia","volume":"78","author":"Tajaesu","year":"2018","journal-title":"Cancer Res."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1007\/s00520-019-05186-1","article-title":"The effect of exercise on aromatase inhibitor-induced musculoskeletal symptoms in breast cancer survivors: A systematic review and meta-analysis","volume":"28","author":"Lu","year":"2020","journal-title":"Support. Care Cancer"},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Roberts, K.E., Rickett, K., Feng, S., Vagenas, D., and Woodward, N.E. (2020). Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst. Rev., 1.","DOI":"10.1002\/14651858.CD012988.pub2"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s11912-019-0795-1","article-title":"Acupuncture and Vitamin D for the Management of Aromatase Inhibitor-Induced Arthralgia","volume":"21","author":"Anand","year":"2019","journal-title":"Curr. Oncol. Rep."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1200\/JCO.2009.23.4708","article-title":"Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer","volume":"28","author":"Crew","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1001\/jama.2018.8907","article-title":"Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical Trial","volume":"320","author":"Hershman","year":"2018","journal-title":"JAMA"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s10549-013-2427-z","article-title":"A dual-center randomized controlled double blind trial assessing the effect of acupuncture in reducing musculoskeletal symptoms in breast cancer patients taking aromatase inhibitors","volume":"138","author":"Bao","year":"2013","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1136\/acupmed-2012-010309","article-title":"Acupuncture for treatment of arthralgia secondary to aromatase inhibitor therapy in women with early breast cancer: Pilot study","volume":"31","author":"Oh","year":"2013","journal-title":"Acupunct. Med."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.ejca.2013.09.022","article-title":"A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use","volume":"50","author":"Mao","year":"2014","journal-title":"Eur. J. Cancer"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/ard.2006.066159","article-title":"Will steroidal aromatase inhibitors induce rheumatoid arthritis?","volume":"66","author":"Morel","year":"2007","journal-title":"Ann. Rheum. Dis."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1177\/039463201102400430","article-title":"Rheumatoid arthritis: A complication of aromatase inhibitor therapy?","volume":"24","author":"Bruzzese","year":"2011","journal-title":"Int. J. Immunopathol. Pharmacol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jbspin.2010.05.016","article-title":"Rheumathoid arthritis and aromatase inhibitors","volume":"78","author":"Bertolini","year":"2011","journal-title":"Jt. Bone Spine"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.3899\/jrheum.080648","article-title":"Accelerated cutaneous nodulosis associated with aromatase inhibitor therapy in a patient with rheumatoid arthritis","volume":"36","author":"Chao","year":"2009","journal-title":"J. Rheumatol."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/RHU.0b013e31821bfc48","article-title":"Rheumatic complaints in women taking aromatase inhibitors for treatment of hormone-dependent breast cancer","volume":"17","author":"Scarpa","year":"2011","journal-title":"J. Clin. Rheumatol."},{"key":"ref_128","first-page":"2259","article-title":"Joint pain with aromatase inhibitors: Abnormal frequency of Sj\u00f6gren\u2019s syndrome","volume":"34","author":"Laroche","year":"2007","journal-title":"J. Rheumatol."},{"key":"ref_129","first-page":"653","article-title":"Sj\u00f6gren\u2019s syndrome and aromatase inhibitors treatment: Is there a link?","volume":"31","author":"Guidelli","year":"2013","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_130","first-page":"181","article-title":"Does Aromatase Inhibitors Cause Sjogren\u2019s Syndrome and Polyneuropathy?","volume":"5","author":"Korkmaz","year":"2014","journal-title":"World J. Oncol."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"126","DOI":"10.5606\/ArchRheumatol.2014.3429","article-title":"Letrozole-induced very early systemic sclerosis in a patient with breast cancer: A case report","volume":"29","author":"Pokhai","year":"2014","journal-title":"Arch. Rheumatol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1177\/0394632016651086","article-title":"Aromatase inhibitors and antisynthetase syndrome","volume":"29","author":"Mascella","year":"2016","journal-title":"Int. J. Immunopathol. Pharmacol."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1093\/rheumatology\/33.6.583","article-title":"Acute inflammatory polyarthritis in association with tamoxifen","volume":"33","author":"Creamer","year":"1994","journal-title":"Br. J. Rheumatol."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1093\/rheumatology\/33.10.998","article-title":"Acute inflammatory polyarthritis in association with tamoxifen","volume":"33","author":"Richards","year":"1994","journal-title":"Br. J. Rheumatol."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1002\/art.27584","article-title":"2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology\/European League Against Rheumatism collaborative initiative","volume":"62","author":"Aletaha","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/0049-0172(84)90001-5","article-title":"Primary Sjogren syndrome: Clinical and immunopathologic features","volume":"14","author":"Fox","year":"1984","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1136\/ard.61.6.554","article-title":"European Study Group on Classification Criteria for Sj\u00f6gren\u2019s SyndromeClassification criteria for Sj\u00f6gren\u2019s syndrome: A revised version of the European criteria proposed by the American-European Consensus Group","volume":"61","author":"Vitali","year":"2002","journal-title":"Ann. Rheum. Dis."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1538-7836.2006.01753.x","article-title":"International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)","volume":"4","author":"Miyakis","year":"2006","journal-title":"J. Thromb. Haemost."},{"key":"ref_139","first-page":"55","article-title":"Low dose intravenous immunoglobulin in systemic lupus erythematosus: Analysis of 62 cases","volume":"10","author":"Sherer","year":"2008","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_140","first-page":"877","article-title":"Long-term treatment of antiphospholipid syndrome with intravenous immunoglobulin in addition to conventional therapy","volume":"31","author":"Tenti","year":"2013","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/j.autrev.2018.02.010","article-title":"Intravenous Immunoglobulins as a new opportunity to treat discoid lupus erythematosus: A case report and review of the literature","volume":"17","author":"Tenti","year":"2018","journal-title":"Autoimmun. Rev."},{"key":"ref_142","doi-asserted-by":"crossref","unstructured":"Inno, A., Basso, M., Vecchio, F.M., Marsico, V.A., Cerchiaro, E., D\u2019Argento, E., Bagal\u00e0, C., and Barone, C. (2011). Anastrozole-related acute hepatitiswith autoimmune features: A case report. BMC Gastroenterol., 11.","DOI":"10.1186\/1471-230X-11-32"},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1007\/s12328-014-0512-4","article-title":"A case of anastrazole-related drug-induced autoimmune hepatitis","volume":"7","author":"Islam","year":"2014","journal-title":"Clin. J. Gastroenterol."},{"key":"ref_144","first-page":"4173","article-title":"Anastrozole-induced autoimmune hepatitis: A rare complication of breast cancer therapy","volume":"37","author":"Klapko","year":"2017","journal-title":"Anticancer Res."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s13555-020-00353-3","article-title":"Anastrozole-Induced Dermatitis: Report of a Woman with an Anastrozole-Associated Dermatosis and a Review of Aromatase Inhibitor-Related Cutaneous Adverse Events","volume":"10","author":"Kim","year":"2020","journal-title":"Dermatol. Ther."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"55","DOI":"10.5152\/ejbh.2019.5128","article-title":"Rheumatological Findings in Patients with Breast Cancer","volume":"16","author":"Tarhan","year":"2019","journal-title":"Eur. J. Breast Health"},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"55","DOI":"10.3899\/jrheum.140367","article-title":"The effect of antiestrogen agents on risk of autoimmune disorders in patients with breast cancer","volume":"42","author":"Chen","year":"2015","journal-title":"J. Rheumatol."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"e000523","DOI":"10.1136\/rmdopen-2017-000523","article-title":"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","volume":"3","author":"Caprioli","year":"2017","journal-title":"RMD Open"},{"key":"ref_149","doi-asserted-by":"crossref","unstructured":"Chien, H.C., Kao Yang, Y.H., Kwoh, C.K., Chalasani, P., Wilson, D.L., and Lo-Ciganic, W.H. (2020). Aromatase Inhibitors and Risk of Arthritis and Carpal Tunnel Syndrome among Taiwanese Women with Breast Cancer: A Nationwide Claims Data Analysis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020566"},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1136\/annrheumdis-2019-216756","article-title":"Risk of breast cancer before and after rheumatoid arthritis, and the impact of hormonal factors","volume":"79","author":"Pettersson","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"3192","DOI":"10.1200\/JCO.2008.18.6213","article-title":"Endocrine effects of adjuvant letrozole compared with tamoxifen in hormone-responsive postmenopausal patients with early breast cancer: The HOBOE trial","volume":"27","author":"Rossi","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"3278","DOI":"10.1158\/0008-5472.CAN-09-3024","article-title":"Variation in anastrozole metabolism and pharmacodynamics in women with early breast cancer","volume":"70","author":"Ingle","year":"2010","journal-title":"Cancer Res."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s10549-011-1611-2","article-title":"Androgens and musculoskeletal symptoms among breast cancer patients on aromatase inhibitor therapy","volume":"130","author":"Gallicchio","year":"2011","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"A460","DOI":"10.1016\/j.autrev.2011.11.014","article-title":"Estrogen metabolism and autoimmunity","volume":"11","author":"Cutolo","year":"2012","journal-title":"Autoimmun. Rev."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/nyas.12398","article-title":"Aromatase and regulation of the estrogen-to-androgen ratio in synovial tissue inflammation: Common pathway in both sexes","volume":"1317","author":"Capellino","year":"2014","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"102468","DOI":"10.1016\/j.autrev.2020.102468","article-title":"Estrogen, estrogen-like molecules and autoimmune diseases","volume":"19","author":"Merrheim","year":"2020","journal-title":"Autoimmun. Rev."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.exger.2009.03.003","article-title":"Immoderate inhibition of estrogen by anastrozole enhances the severity of experimental polyarthritis","volume":"44","author":"Jingxuan","year":"2009","journal-title":"Exp. Gerontol."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1158\/1078-0432.CCR-08-1507","article-title":"Immunomodulation of FOXP3+ regulatory T cells by the aromatase inhibitor letrozole in breast cancer patients","volume":"15","author":"Generali","year":"2009","journal-title":"Clin. Cancer Res."},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.2217\/imt-2019-0160","article-title":"Could PD-1\/PDL1 immune checkpoints be linked to HLA signature?","volume":"11","author":"Correale","year":"2019","journal-title":"Immunotherapy"},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"12628","DOI":"10.1073\/pnas.0405099101","article-title":"Aromatase-deficient mice spontaneously develop a lymphoproliferative autoimmune disease resembling Sjogren\u2019s syndrome","volume":"101","author":"Shim","year":"2004","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1182\/blood.V95.6.2059","article-title":"Estrogen influences the differentiation, proliferation, and survival of early B-lineage precursors","volume":"95","author":"Medina","year":"2000","journal-title":"Blood"},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.ajpath.2014.09.006","article-title":"Aromatase controls Sj\u00f6gren syndrome-like lesions through monocyte chemotactic protein-1 in target organ and adipose tissue-associated macrophages","volume":"185","author":"Iwasa","year":"2015","journal-title":"Am. J. Pathol."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.1002\/jcp.25743","article-title":"Human White Adipocytes Convert into \u201cRainbow\u201d Adipocytes In Vitro","volume":"232","author":"Maurizi","year":"2017","journal-title":"J. Cell. Physiol."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.autrev.2018.02.007","article-title":"Impact of obesity on autoimmune arthritis and its cardiovascular complications","volume":"17","author":"Umar","year":"2018","journal-title":"Autoimmun. Rev."},{"key":"ref_165","first-page":"293","article-title":"Tocilizumab modulates serum levels of adiponectin and chemerin in patients with rheumatoid arthritis: Potential cardiovascular protective role of IL-6 inhibition","volume":"37","author":"Fioravanti","year":"2019","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1038\/sj.ijo.0801488","article-title":"Relationships between tamoxifen use, liver fat and body fat distribution in women with breast cancer","volume":"25","author":"Nguyen","year":"2001","journal-title":"Int. J. Obes."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s10549-010-1223-2","article-title":"The impact of an aromatase inhibitor on body composition and gonadal hormone levels in women with breast cancer","volume":"125","author":"Perera","year":"2011","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"3670","DOI":"10.1210\/jc.2018-02339","article-title":"Higher Insulin Resistance and Adiposity in Postmenopausal Women with Breast Cancer Treated with Aromatase Inhibitors","volume":"104","author":"Gibb","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4081\/br.2020.30","article-title":"Breast cancer anti-hormonal therapy and rheumatic diseases: Linking the clinical to molecular world","volume":"2","author":"Melillo","year":"2020","journal-title":"Beyond Rheumatol."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"R41","DOI":"10.1186\/bcr3137","article-title":"Aromatase inhibitors, estrogens and musculoskeletal pain: Estrogen-dependent T-cell leukemia 1A (TCL1A) gene-mediated regulation of cytokine expression","volume":"14","author":"Liu","year":"2012","journal-title":"Breast Cancer Res."},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"i10","DOI":"10.1093\/rheumatology\/keaa039","article-title":"Enthesitis in psoriatic arthritis (Part 1): Pathophysiology","volume":"59","author":"Araujo","year":"2020","journal-title":"Rheumatology"},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.mce.2007.08.014","article-title":"17beta-Estradiol utilizes the estrogen receptor to regulate CD16 expression in monocytes","volume":"279","author":"Kramer","year":"2007","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1038\/sj.bjc.6605768","article-title":"Inflammatory cytokines and aromatase inhibitor-associated musculoskeletal syndrome: A case-control study","volume":"103","author":"Henry","year":"2010","journal-title":"Br. J. Cancer"},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.phrs.2016.12.038","article-title":"Vitamin D in autoimmune rheumatic diseases: A view inside gender differences","volume":"117","author":"Vasile","year":"2017","journal-title":"Pharmacol. Res."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.autrev.2012.07.007","article-title":"Can supplementation with vitamin D reduce the risk or modify the course of autoimmune diseases? A systematic review of the literature","volume":"12","author":"Antico","year":"2012","journal-title":"Autoimmun. Rev."},{"key":"ref_176","first-page":"438","article-title":"Vitamin D and Autoimmune Diseases: Is Vitamin D Receptor (VDR) Polymorphism the Culprit?","volume":"19","author":"Bizzaro","year":"2017","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"116744","DOI":"10.1016\/j.lfs.2019.116744","article-title":"Vitamin D and autoimmune diseases","volume":"233","author":"Ruiz","year":"2019","journal-title":"Life Sci."},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s11154-017-9423-2","article-title":"Vitamin D, sub-inflammation and insulin resistance. A window on a potential role for the interaction between bone and glucose metabolism","volume":"18","author":"Garbossa","year":"2017","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_179","first-page":"934","article-title":"1, 25-dihydroxyvitamin D3 downregulates aromatase expression and inflammatory cytokines in human macrophages","volume":"30","author":"Villaggio","year":"2012","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_180","doi-asserted-by":"crossref","first-page":"409","DOI":"10.4103\/2230-8210.95684","article-title":"Vitamin D deficiency in newly diagnosed breast cancer patients","volume":"16","author":"Imtiaz","year":"2012","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_181","doi-asserted-by":"crossref","unstructured":"Coleman, R.E., Rathbone, E.J., Marshall, H.C., Wilson, C., Brown, J.E., Gossiel, F., Gregory, W.M., Cameron, D., and Bell, R. (2012). Vitamin D, but not bone turnover markers, predict relapse in women with early breast cancer: An AZURE translational study. Cancer Res., 72.","DOI":"10.1158\/0008-5472.SABCS12-S6-4"},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1084\/jem.20090585","article-title":"Loss of the lupus autoantigen Ro52\/Trim21 induces tissue inflammation and systemic autoimmunity by disregulating the IL-23-Th17 pathway","volume":"206","author":"Espinosa","year":"2009","journal-title":"J. Exp. Med."},{"key":"ref_183","doi-asserted-by":"crossref","first-page":"3687","DOI":"10.2147\/CMAR.S175470","article-title":"Decreased expression of TRIM21 indicates unfavorable outcome and promotes cell growth in breast cancer","volume":"10","author":"Zhou","year":"2018","journal-title":"Cancer Manag. Res."},{"key":"ref_184","doi-asserted-by":"crossref","first-page":"453","DOI":"10.2174\/138920207783591690","article-title":"The HLA region and autoimmune disease: Associations and mechanisms of action","volume":"8","author":"Gough","year":"2007","journal-title":"Curr. Genomics"},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1007\/s00432-012-1192-4","article-title":"The bodies fight against cancer: Is human leucocyte antigen (HLA) class 1 the key?","volume":"138","author":"Powell","year":"2012","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1179\/joc.2010.22.3.201","article-title":"Oral metronomic chemo-hormonal-therapy of metastatic breast cancer with cyclophosphamide and megestrol acetate","volume":"22","author":"Licchetta","year":"2010","journal-title":"J. Chemother."},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/clpt.2011.278","article-title":"Biologics-based therapy for the treatment of rheumatoid arthritis","volume":"91","author":"Scott","year":"2012","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_188","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.rdc.2016.09.006","article-title":"Malignancy and the Risks of Biologic Therapies: Current Status","volume":"43","author":"Seror","year":"2017","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.2147\/CMAR.S137772","article-title":"Clinical utility of fulvestrant in the treatment of breast cancer: A report on the emerging clinical evidence","volume":"10","author":"Rocca","year":"2018","journal-title":"Cancer Manag. Res."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"4594","DOI":"10.1200\/JCO.2010.28.8415","article-title":"Results of the CONFIRM phase III trial comparing fulvestrant 250 mg with fulvestrant 500 mg in postmenopausal women with estrogen receptor-positive advanced breast cancer","volume":"28","author":"Jerusalem","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_191","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1136\/annrheumdis-2019-215694","article-title":"EULAR points to consider for the use of big data in rheumatic and musculoskeletal diseases","volume":"79","author":"Gossec","year":"2020","journal-title":"Ann. Rheum. Dis."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/21\/16\/5625\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:57:00Z","timestamp":1760176620000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/21\/16\/5625"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,6]]},"references-count":191,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2020,8]]}},"alternative-id":["ijms21165625"],"URL":"https:\/\/doi.org\/10.3390\/ijms21165625","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,6]]}}}