Variations in Incidence of Trigger Finger and Response to Corticosteroid Injection after Aromatase Inhibitor Therapy for Breast Cancer

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This retrospective study examined whether aromatase inhibitors (AIs) used to treat hormone receptor–positive breast cancer are associated with trigger finger and whether treatment outcomes differ by medication type. Researchers reviewed 25,144 breast cancer patients treated from 2014 to 2018. Of these, 5,764 received AI therapy, and trigger finger occurred more often in AI users than in non-AI breast cancer patients (4.5% vs. 2.3%). Letrozole and anastrozole were both independently associated with higher odds of trigger finger, while tamoxifen and trastuzumab were not.<br /><br />The study then focused on 211 AI-treated patients with trigger finger. Most were treated with steroid injections, and overall outcomes were similar to those reported for trigger finger in general. However, patients who had switched between letrozole and anastrozole because of side effects were more likely to have paused therapy and had a much higher steroid injection failure rate (45.2% vs. 23.5% in those who never switched). They also had a higher, though not statistically significant, rate of surgical release.<br /><br />Diabetes was another important predictor of poor response: patients with diabetes, especially those with hemoglobin A1c greater than 6.5, were significantly more likely to fail steroid treatment. In contrast, radiation therapy did not affect treatment success.<br /><br />The authors conclude that AI therapy, especially letrozole and anastrozole, increases the incidence of trigger finger. While treatment generally works as well as it does in other trigger finger patients, those with significant AI-related musculoskeletal symptoms requiring medication changes, as well as poorly controlled diabetics, are at greater risk of steroid failure.

Keywords

aromatase inhibitors

trigger finger

breast cancer

letrozole

anastrozole

tamoxifen

steroid injection

diabetes

hemoglobin A1c

surgical release