What Drugs Cause Toxic Tendonitis?

[Nelson Vergel]

Toxic tendinopathy is a rare but reproducible complication in humans, given agents of four drug classes: aromatase inhibitors, fluoroquinolone antibiotics, glucocorticoids (long-term regimens), and statins. Toxic tendinopathy in humans has been linked less consistently to treatment with anabolic steroids, antiretroviral agents (mainly protease inhibitors), metalloproteinase inhibitors (MMPI), and isotretinoin. Classic drug-induced tendinopathies appear as “tendinosis” (i.e., progressive tendon degeneration without inflammation), although cases associated with aromatase inhibitors exhibit mainly tenosynovitis. Any tendon may be affected, but fluoroquinolones, glucocorticoids, and statins most frequently affect large load-bearing tendons in the lower limb, especially the calcaneal (“Achilles”) tendon—which ruptures in approximately 30 to 40% of cases. The time to symptom onset ranges from days (fluoroquinolones) to weeks, months, or even years. The pathogenesis is incompletely understood, but proposed mechanisms include apoptosis of tenoblasts and tenocytes, deficient tenocyte function (leading to abnormal extracellular matrix maintenance and repair as well as disrupted intercellular signaling), and structural disintegration (via a combination of increased expression of lytic enzymes, lessened cholesterol content in cell membranes, and neoangiogenesis within highly ordered tendon tissue). Nonclinical safety assessment of therapeutic candidates in these drug classes should incorporate tendon routinely as a protocol-specified tissue for pathology evaluation.

Mini-Review: Toxic Tendinopathy - PubMed

Toxic tendinopathy is a rare but reproducible complication in humans, given agents of four drug classes: aromatase inhibitors, fluoroquinolone antibiotics, glucocorticoids (long-term regimens), and statins. Toxic tendinopathy in humans has been linked less consistently to treatment with anabolic...

pubmed.ncbi.nlm.nih.gov

 

[Nelson Vergel]

Nutraceutical supplement in the management of tendinopathies: a systematic review - PMC

nutraceuticals are common support therapy for management of tendinopathies. Even if they are widely diffused, our knowledge is still poor. The aim of this systematic review is to analyze the most commonly used nutraceuticals and their effects on ...

www.ncbi.nlm.nih.gov

 

[Nelson Vergel]

The risks and benefits of glucocorticoid treatment for tendinopathy: A systematic review of the effects of local glucocorticoid on tendon

Our primary objective was to summarise the known effects of locally administered glucocorticoid on tendon tissue and tendon cells.We conducted a syste…

www.sciencedirect.com

 

[Nelson Vergel]

Aromatase Inhibitors and Joint Pain: Causes and Ways of Managing - OWise UK

Joint pain is a common amongst breast cancer patients using aromatase inhibitors, such as anastrozole. Learn more about the various ways of managing this symptom.

owise.uk

Aromatase inhibitor–associated musculoskeletal pain: An overview of pathophysiology and treatment modalities - PMC

Since their introduction into clinical use in the 1970s, aromatase inhibitors have been a cornerstone of therapy for estrogen-receptor positive breast cancer in postmenopausal women. Unfortunately, this therapy leads to estrogen depletion in the ...

www.ncbi.nlm.nih.gov

 

[Forty2]

How about Accutane?