Abstract

Tfarah El Joumani*, Latifa Tahiri, Imane Bensaghir, Hanan Rkain and Fadoua Allali

ABSTRACT

The occurrence of rheumatoid arthritis triggered by aromatase inhibitors is rarely reported in the literature. We report the clinical case of a Moroccan patient who developed rheumatoid arthritis after treatment with aromatase inhibitors. This is a 57-year-old female patient, G0P0, menopause at age 51, with no notable personal history, having a family history of a sister followed for uterine cancer (declared cured). The patient had a left breast cancer in December 2021. It was a NST infiltrating breast carcinoma, SBR grade 1, classified as pT1bN0. She was treated by surgery with a left lumpectomy and homolateral axillary lymph node dissection (on 12/2021), then she received 25 sessions of radiotherapy (from 01/02/2022 to 03/03/2022), and then started taking a non-steroidal aromatase inhibitor "Letrozole GT" hormone therapy (on 05/03/2022); the patient received no chemotherapy. 20 days later, she presented with bilateral and symmetrical polyarthritis of the hands sparing the distal interphalangeal joints. Blood tests were ordered which revealed an accelerated sedimentation rate of 57 mm at the first hour and a negative C-reactive protein. Anti-cyclic citrulline peptide (Anti-CCP) antibodies were positive at 413 IU/ml and rheumatoid factor was positive at 102 IU/ml. Magnetic resonance imaging of both hands was performed (on May 24, 2022) and showed subchondral bone erosions associated with bone edema and grade 1 synovitis, suggesting a rheumatoid arthritis-type inflammatory origin without signs of activity. The patient met the American College of Rheumatology criteria for rheumatoid arthritis (ACR/EULAR 2010).