TY - JOUR T1 - Accelerated Cutaneous Nodulosis Associated with Aromatase Inhibitor Therapy in a Patient with Rheumatoid Arthritis JF - The Journal of Rheumatology JO - J Rheumatol SP - 1087 LP - 1088 DO - 10.3899/jrheum.080648 VL - 36 IS - 5 AU - JEANNIE CHAO AU - BARBARA A. PARKER AU - NATHAN J. ZVAIFLER Y1 - 2009/05/01 UR - http://www.jrheum.org/content/36/5/1087.abstract N2 - To the Editor:Aromatase inhibitors have become widely used for the treatment of breast cancer. We describe a patient with rheumatoid arthritis (RA) treated with the aromatase inhibitor letrozole who subsequently developed accelerated cutaneous nodulosis.A 71-year-old woman with a 21-year history of RA had established care at the University of California San Diego 7 years after her initial diagnosis, where she was noted to have a symmetric inflammatory arthritis of the metacarpophalangeal and proximal interphalangeal joints, wrists, elbows, and knees with an elevated titer of rheumatoid factor (RF) and anti-cyclic citrullinated antibody. She was given sulfasalazine and eventually methotrexate (MTX). However, because nodules appeared on the fingers and pressure areas such as the Achilles tendon, leflunomide was substituted for MTX. This was eventually discontinued due to inactive disease.In December 2005, when she was no longer taking MTX or leflunomide, a chest radiograph disclosed lesions in the breast and lung suggestive of metastatic breast cancer. In March 2006, she started the aromatase inhibitor letrozole 2.5 mg daily. In April 2006, a mastectomy and sentinel node biopsy revealed an invasive, mixed ductal … Address reprint requests to Dr. Chao; E-mail: J5Chao{at}ucsd.edu ER -