RESEARCH - Insufficiency fractures in patients with chronic inflammatory joint diseases

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Clin Exp Rheumatol. 2002 Jan-Feb;20(1):77-9. Links

Insufficiency fractures in patients with chronic inflammatory joint

diseases.

Rheumatism Foundation Hospital, Department of Orthopedics, Heinola, Finland.

heikki.maenpaa@...

OBJECTIVE: To describe the typical sites of stress fractures in the lower

extremities and pelvis in rheumatoid patients (rheumatoid arthritis,

juvenile chronic arthritis, psoriatic arthritis, ankylosing spondylitis).

METHODS: Thirty-three patients with 52 stress fractures [mean age 44 years

(range 11-73)] were studied at the authors' institution when they were being

treated for their rheumatic diseases. Fourteen patients had RA, 9 JCA, 5

PsoA, and 5 SPA. Stress fractures were detected from patient documents and

from series radiographs in suspected cases. In some cases magnetic resonance

imaging was also performed. RESULTS: One patient presented with 5 fractures,

2 patients with 4 and 3 fractures, and 7 patients with 2 fractures each.

Other patients (n = 19) had only one fracture each. The metatarsal (MT)

bones were the most common site of involvement. Twenty-five of the 52

fractures were located on MT I-V. The second and third most common sites

were thefibula (n = 13) and tibia (n = 6). All fractures of the lower tibia

or fibula were associated with valgus malalignment of the ankle.

CONCLUSION: If a patient with rheumatic disease experiences sudden and

unexplained pain localised in the forefoot, above the ankle, below the knee,

or in the pelvis, a stress fracture should be suspected. Patients with

severe osteoporosis, high-load corticosteroid or methotrexate therapy, or

marked joint deformity are at high risk of developing stress fracture.

PMID: 11894837

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=11894837

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