Insufficiency fractures of the knee, ankle, and foot in rheumatoid arthritis: A case series and case-control study

Yurtsever, Aysun; Fagerberg, Steen Kåre; Rasmussen, Claus

doi:10.5152/eurjrheum.2020.19196

Cited by 6 publications

(17 citation statements)

References 15 publications

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“…Causes of stress fractures in patients with R A include inflammation, immobility, and the use of glucocorticoids (GC) or methotrexate (MTX) [4][5][6]. Inflammation due to RA, reduced physical activity, and GC cause bone loss near the affected joints and other distant points [4,5].…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Introductionmentioning

confidence: 99%

“…Inflammation due to RA, reduced physical activity, and GC cause bone loss near the affected joints and other distant points [4,5]. A case-control study has linked MTX administration to fractures [6].…”

Section: Introductionmentioning

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

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“…Rheumatologists in the North Denmark Regional Hospital noticed some cases in which new-onset knee or ankle pain was misinterpreted as arthritis activity by the clinicians but was later shown to be insufficiency fractures [ 15 ]. X-ray examination did not show the insufficiency fractures, but MRI examination did reveal them.…”

Section: Introductionmentioning

confidence: 99%

“…X-ray examination did not show the insufficiency fractures, but MRI examination did reveal them. The fractures are at risk of being overlooked, and this fact may lead to a delay in diagnosis and the risk of ineffective treatment with, for example, steroid injections [ 12 , 13 , 15 , 16 ]. The included patients’ RA status was well known, and they often experienced symptoms such as pain, reduced functionality, and loss of quality of life (QOL).…”

Section: Introductionmentioning

confidence: 99%

“…The included patients’ RA status was well known, and they often experienced symptoms such as pain, reduced functionality, and loss of quality of life (QOL). The insufficiency fractures were treated conservatively, and the patients were immobilised for several weeks [ 15 ]. Due to their RA, the patients had difficulty using crutches and wheelchairs, and they often became care-dependent [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Missing Diagnosis, Pain, and Loss of Function in Older Adults with Rheumatoid Arthritis and Insufficiency Fractures: A Qualitative Study of the Patient’s Perspective

et al. 2020

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Rheumatoid arthritis (RA) is characterised by a chronic, progressive inflammation in the joints and leads to substantial pain, disability, and other morbidities. Few studies document the occurrence of insufficiency fractures, but no studies document the patient’s perspective on incurring an insufficiency fracture. The aim of this qualitative study was to explore the patients’ perspective on how insufficiency fractures influence their level of activity and to detect their need for rehabilitation. Two focus-group interviews were performed with 10 patients diagnosed with RA and insufficiency fractures. The data from the focus-group interviews were subjected to thematic analysis to provide a sense of the important themes. The 10 patients were all females, aged 57–88 years. Magnetic resonance imaging were performed at a mean of six months and seven days. All patients identified the delayed diagnosis of fracture as a significant burden. They experienced pain but did not receive a diagnosis. When the patients were immobilised, some of them were offered aids such as crutches, which they were unable to use due to their RA. The patients needed a focus on diagnosis and individually customised rehabilitation, taking into account RA and including guidance concerning daily activities, aids, and the regain of physical function.

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Experimental treatment with bone void filler for lower extremity insufficiency fractures in rheumatoid arthritis patients – Early clinical results

Larsen,

Studstrup,

Kold

et al. 2024

jocr

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Introduction : The aim is to report early clinical results of an experimental surgical procedure, injecting bone void filler, for patients with lower extremity rheumatoid arthritis (RA) insufficiency fractures. Case Report: We used a cross-sectional design with retrospective follow-up. Patient-reported outcomes were reported by the body-region specific questionnaires, knee injury and osteoarthritis outcome score (KOOS), or foot and ankle outcome score (FOAS). The Eq5D-5L questionnaire reported overall health-related quality of life (QoL). Furthermore, patient satisfaction (semi-structured interview), pain reactions, and adverse events were reported. Results from the first five patients were included. The median age was 70 years (range 50–80). Fracture localizations were proximal tibia (2), distal tibia (2), and distal femur (1). Four out of five patients reported a high degree of patient satisfaction following treatment. Four out of five patients at follow-up reported no pain from the fracture location. The median improvement from baseline to follow-up on the KOOS/FAOS subscale scores was pain 65 (range 42–69), symptoms 39 (range 25–50), the activity of daily living 41 (range 29–51), sport and recreational activities (sport/rec) 48 (range 40–60), and QoL 60 (range 57–72). The median improvement for the Eq5D index was 0.30 (range 0.26–0.36). Conclusion: Surgical treatment of insufficiency fractures in RA patients with bone void filler seems promising. Four out of five patients reported considerable improvement in function and QoL and substantially lower pain scores following treatment. More research is needed to investigate the efficacy of this novel surgical procedure. Keywords: Bone void filler, insufficiency fractures, surgical.

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Insufficiency fractures of the knee, ankle, and foot in rheumatoid arthritis: A case series and case-control study

Cited by 6 publications

References 15 publications

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

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

Missing Diagnosis, Pain, and Loss of Function in Older Adults with Rheumatoid Arthritis and Insufficiency Fractures: A Qualitative Study of the Patient’s Perspective

Experimental treatment with bone void filler for lower extremity insufficiency fractures in rheumatoid arthritis patients – Early clinical results

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