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AIMSS — RACP Adult Medicine MCQ

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ModerateMedical OncologyAIMSSRACP Adult Medicine

A 60-year-old woman with breast cancer on aromatase inhibitor (anastrozole) develops progressive joint pain and stiffness in her hands and knees. Her CRP and ESR are normal. Rheumatoid factor and anti-CCP are negative. What is the most likely cause?

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Correct answer: C — Aromatase inhibitor-associated musculoskeletal syndrome (AIMSS)

AIMSS occurs in up to 50% of women on aromatase inhibitors. It presents with joint pain, stiffness (especially in hands), and myalgia, typically appearing within weeks to months of starting therapy. It is caused by oestrogen depletion in joints and tendons. Management includes exercise, analgesics, and switching to an alternative AI or tamoxifen if intolerable. Normal inflammatory markers and negative autoantibodies distinguish it from inflammatory arthritis.

Reference: Cancer Council Australia – 2024 – Breast Cancer Guidelines; AMH – 2025 – Aromatase Inhibitors