Foot and Ankle Insufficiency Fractures in Rheumatoid Arthritis

Trickey, Jeanette; Barkham, Nick

doi:10.15406/mojor.2015.03.00091

Cited by 4 publications

(6 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another study reported that the combined use of MTX and GC may have a greater effect on stress fractures than the individual use of each drug [13]. Thirdly, the chronic inflammation and changes in bone structure, including osteopenia, may lead to bone erosion that are associated with RA, causing stress on the bones and contributing to fractures [14]. Finally, the postmenopausal state is also related to bone loss [15].…”

Section: Discussionmentioning

confidence: 99%

Delayed Diagnosis of a Tibial Stress Fracture Associated with Glucocorticoid and Methotrexate Therapy in a Patient with Rheumatoid Arthritis: A Case Report

et al. 2022

View full text Add to dashboard Cite

The risk of stress fractures is associated with rheumatoid arthritis (RA), which can aggravate bone loss. We report the case of a patient who was on long-term medication for RA presenting with lower extremity pain on the left and swelling without trauma. Magnetic resonance imaging and plain radiographs at the previous hospital showed no signs of fracture, but radiographs performed later, revealed a stress fracture of the left distal tibia. The stress fracture may have occurred due to multiple reasons such as long-term use of methotrexate and glucocorticoids, active RA, postmenopausal state, and immobility. Suspicion of a stress fracture should not be ruled out especially in RA patients with persistent pain, even if the radiographical findings are normal. Additional imaging and follow-ups are essential. The patient’s pain was relieved with Korean medicine treatments, which suggests their potential application for stress fractures in RA patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Delayed Diagnosis of a Tibial Stress Fracture Associated with Glucocorticoid and Methotrexate Therapy in a Patient with Rheumatoid Arthritis: A Case Report

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Trickey et al in their case series of three patients with rheumatoid arthritis who presented with acute swollen ankle joints have reported that the diagnosis would be mistaken for an acute flare up of the arthritis, thereby delaying the diagnosis of insufficiency fractures. They concluded that a high index of suspicion was needed in spite of normal plain radiographs to diagnose insufficiency fractures in rheumatoid arthritis patients 5 . Our patient has been taking Methotrexate for 20 years.…”

Section: Discussionmentioning

confidence: 99%

Atraumatic Insufficiency Fractures of the Tarsal Bones - An Unusual Cause of Recurrent Heel Pain in a Patient with Rheumatoid Arthritis: A Case Report

Rajeev

2018

MOJ

View full text Add to dashboard Cite

The incidence of insufficiency fractures is approximately 1% in rheumatoid arthritis patients. The predisposing factors are chronic inflammation, skeletal deformities, biomechanical stresses and osteoporosis. The medications used in the treatment of rheumatoid arthritis such as Glucocorticosteroids and Methotrexate also contribute to the development of osteoporosis and insufficiency fractures. A 68-year old lady who was suffering from rheumatoid arthritis and on long term Methotrexate was seen in the outpatient clinic with recurrent episodes of heel pain. Examination revealed diffuse tenderness around the heel with full range of ankle movements but painful limitation of subtalar joint movements. Radiographic examination of the ankle showed a highly suspicious fracture of the calcaneus and confirmed on MRI as an insufficiency fracture. She was treated successfully with oral bisphosphonates and moon boot brace. She presented after two years with recurrent episodes of heel pain. The plain radiograph and MRI scan confirmed an insufficiency fracture of the talus. She was treated non-operatively with intravenous Zolendronic acid and bracing. In chronic rheumatoid arthritis patients especially on Methotrexate and Glucocorticoids a high index of suspicion of insufficiency fractures should be considered if they present with bone pain. MRI scan is the investigation of choice and is conclusive.

show abstract

“…Common sites for stress fractures including those seen in RA patients are the weight-bearing bones such as the tibia, metatarsals, calcaneum, femur and pubic ramus. 1,2,4,5 Although the distal radius is a common site for fragility fractures in osteoporotic patients, in a medical literature search we could not find any previously reported case of bilateral radial stress fractures in RA. Stress fractures in our patient were likely a result of repeated mechanical stress due to the use of for support while getting up owing to proximal muscle weakness.…”

mentioning

confidence: 84%

“…3,4 The mechanisms by which RA predisposes to stress fractures include a higher incidence of osteoporosis, poor bone health due to RA itself and the use of corticosteroids. 4,5 Corticosteroids may alter the bone architecture or modelling in addition to the well-known effects on bone mineral density (BMD), leading to the increased risk of fracture. 4 The increased risk persists even after stopping the steroids, particularly if higher doses have been used.…”

mentioning

confidence: 99%

“…4 Methotrexate has also been proposed as a risk factor for stress fractures in patients with inflammatory arthritis. 3,5 Methotrexate used in high doses in oncology has been associated with the development of osteopathy, and there is conflicting evidence about the effects of low-dose methotrexate on bone metabolism. 3,5 However, this needs to be studied further in RA.…”

mentioning

confidence: 99%

See 1 more Smart Citation