Hello and thanks for your enquiry,

I am sorry to learn about your current symptoms and can appreciate that this is concerning for you.

Yes, aromatase inhibitors like letrozole can cause or significantly contribute to wrist and hand complications, including tendon inflammation and swelling. While joint aches are a widely known side effect, letrozole is also highly associated with debilitating tenosynovial changes (inflammation of the tendon sheaths), trigger finger, and carpal tunnel syndrome.

Calcifications occur when calcium crystals deposit within inflamed tendons. This can lead to sudden, excruciating flare-ups of "agonising" pain and severe swelling, often mimicking a fracture or an infection. Ossification refers to soft tissue or ligaments becoming harder, usually as a response to chronic inflammation, repetitive stress, or long-term metabolic changes (such as those induced by lowered estrogen).

Do contact your hospital Breast Care Team and maybe discuss a "drug holiday" or alternative medication. Do not stop taking your medication on your own. However, ask your oncologist if you can temporarily pause letrozole (a "drug holiday") to see if the inflammation subsides. If letrozole is the culprit, they can switch you to a different aromatase inhibitor (like anastrozole or exemestane) or an alternative hormone therapy like tamoxifen.

Since X-rays only show bones and calcifications, ask your GP and/or hospital specialist doctors for an ultrasound or MRI of your wrist. These scans can clearly evaluate fluid buildup, nerve compression, and tendon sheath thickening. You may need a referral to a hand and arm specialist for a formal assessment. Do also ask for a physiotherapy referral for hand and arm exercise advice. An immobilising wrist splint or brace may be recommended to use to give the inflamed tendons a chance to rest while you wait for the swelling to clear.

If you experience any progressive numbness, a constant "pins and needles" sensation, or a cold feeling in your fingers (which indicates nerve or blood vessel compression from severe swelling) then do seek prompt medical advice about these symptoms.

I do hope that this is useful, and that you are able to get assistance soon with this issue,

With best wishes,

Vanda 

Thank you Vanda that’s really helpful.  

I’m going to take a short “holiday” of 10 days off the Letrozole until this wrist calms down.  I was Grade and Stage 1 IDC T1b N0 M0 HER2 low ER/PR + 8/8.  I wouldn’t normally stop but for me, I think it will be ok for a short time.

It’s interesting that you advise other aromatase inhibitors may help.  I’ll definitely look into this with my breast clinic and maybe change.  I think up to now I’ve been quite lucky.  I’ve taken my hormone blockers every day and I’ve had minimal problems.  This wrist issue has absolutely flawed me and the pain is on another level!  Despite this, I’m still going to continue to take my Letrozole after a short break.  If my wrist flares again then I can look into switching.  I started on Tamoxifem and it was fine for two years.

I’m seeing the practice physio tomorrow for more assessment.

Thanks again for your brilliant response.

Thank you Vanda that’s really helpful.  

I’m going to take a short “holiday” of 10 days off the Letrozole until this wrist calms down.  I was Grade and Stage 1 IDC T1b N0 M0 HER2 low ER/PR + 8/8.  I wouldn’t normally stop but for me, I think it will be ok for a short time.

It’s interesting that you advise other aromatase inhibitors may help.  I’ll definitely look into this with my breast clinic and maybe change.  I think up to now I’ve been quite lucky.  I’ve taken my hormone blockers every day and I’ve had minimal problems.  This wrist issue has absolutely flawed me and the pain is on another level!  Despite this, I’m still going to continue to take my Letrozole after a short break.  If my wrist flares again then I can look into switching.  I started on Tamoxifem and it was fine for two years.

I’m seeing the practice physio tomorrow for more assessment.

Thanks again for your brilliant response.