Manifestations Ostéoarticulaires Associées à l’Utilisation des Antiaromatases dans le Traitement du Cancer du Sein au CHU Hassan II de Fès

Romaric Affleck Angalla, Taoufik Harzy, Honoré Ntsiba

Abstract


RÉSUMÉ
Objectif. Décrire manifestations ostéoarticulaires au décours du traitement par les antiaromatases dans un groupe de patientes suivies pour un cancer du sein. Matériels et Méthodes. Étude transversale descriptive et prospective, menée de 2011 à 2014, soit 4 ans. Le diagnostic des manifestations ostéoarticulaires des antiaromatases a été retenu sur la base des critères cliniques, biologiques, radiologiques et évolutifs sous traitement. Résultats. Cent patientes sous antiaromatases de 3eme génération pour un cancer du sein ont été recrutées. Leur âge moyen était de 57,2 ans avec des extrêmes de 43 et 89 ans. Toutes les patientes avaient des arthralgies. Les sièges des arthralgies les plus retrouvés étaient : le genou (75 fois), la hanche (41 fois), les MCP (35 fois), le poignet (32 fois), les IPP (25 fois), la cheville (19 fois), le coude (15 fois) , l’épaule (10 fois). Les douleurs osseuses  ont été notées chez 19 patientes (19%). Les sièges des douleurs osseuses étaient : région lombaire (16 fois), fémur (4 fois), jambe (3 fois), avant-bras (2 fois) et diffus (1 fois). Les myalgies étaient présentes dans 7 cas. Les anomalies radiologiques observées étaient: la gonarthrose (39%), la lombarthrose (35%), l’arthrose digitale (9%), la déminéralisation osseuse diffuse (9%) et la fracture ostéoporotique L1-L2-L3 (9%). Les anomalies ostéodensitometriques étaient : l’ostéoporose lombaire (42 fois) et fémorale (17 fois) ; l’ostéopénie lombaire (45 fois) et fémoral (38 fois). L’évolution à court terme a été marquée par l’arrêt d’antiaromatases dans 10 cas. Conclusion. Les atteintes ostéoarticulaires sous antiaromatases sont fréquentes. Elles peuvent être invalidantes et aboutir à l’interruption du traitement.

ABSTRACT
Objective. To report osteoarticular manifestations in patients treated with antiaromatase agents for breast cancer. Materials and methods. This was a cross sectional descriptive and prospective study, conducted from 2011 to 2014, i.e. 4 years. The diagnosis of osteoarticular manifestations related to antiaromatase agents was based on clinical, biological, radiological criteria and evolution with treatment. Results. One hundred patients followed for breast cancer treated with third-generation antiaromatase agents were studied. Their mean age was 57.2 years (range: 43 - 89). All patients had arthralgia. The most common sites of arthralgia were: knee (75), hip (41), metacarpophalangeal (35), wrist (32), proximal interphalangeal (25), ankle (19), elbow (15), shoulder (10). Bone pain was found in 19 cases (19%). The most common sites of bone pain were: lumbar (16), femur (4), leg (3), forearm (2) and diffuse (1). Myalgia was found in 7 cases. The main radiological lesions were: knee osteoarthritis (39%), low back osteoarthritis (35%), digital osteoarthritis (9%), diffuse bone demineralization (9%) and osteoporotic fracture L1-L2-L3 (9%). CT Skeletal findings were: lumbar (42) and femoral (17) osteoporosis; lumbar (45) and femoral (38) osteopenia. The short-term follow-up was marked by the interruption of antiaromatase agents in 10 cases. Conclusion. Osteoarticular problems associated with the use of antiaromatase agents are common. They can be debilitating and lead to the interruption of treatment.

Keywords


Cancer du sein, arthralgies, antiaromatases.

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