RESEARCH - Increased RA pain may be due to stress fracture

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Increased RA pain may be due to stress fracture

12/27/2004

By: Reuters Health

NEW YORK (Reuters Health), Dec 27 - Patients with rheumatoid arthritis (RA)

who have an increase in pain at a single site could have a stress fracture,

especially if they have a history of steroid use, UK researchers report in

the December ls of the Rheumatic Diseases.

As senior investigator Dr. Philip N. Platt told Reuters Health, " pain in

limbs of patients with RA is not always due to their joint disease directly.

They are predisposed to getting stress fractures or insufficiency fractures,

which are often not recognized. "

Dr. Platt and colleagues at Freeman Hospital in Newcastle upon Tyne reviewed

data on 24 stress fractures in 18 RA patients seen at a single center over

nearly a decade. These 18 RA stress fracture patients, all of whom were

women, comprised only 0.8% of the entire RA clinic population.

However, the investigators believe that the true prevalence of stress

fractures in RA patients is likely to be higher. The retrospective nature of

the study and the difficulty in diagnosing stress fractures, they say, may

lead to under-recording.

Bone mineral densitometry revealed that median T scores were -3.06 at the

hip and -2.27 at the lumbar spine. Eleven of the 18 stress fracture patients

were current oral corticosteroid users and 14 were past users.

The team then conducted a case-control study, matching the 18 RA stress

fracture patients with 18 RA patients without stress fractures.

Steroid use was significantly more common in stress fracture patients than

in control patients. Past steroid doses were also significantly higher in

the stress fracture group.

Bone mineral density (BMD) at the hip and spine, however, did not differ

significantly between groups. This finding is in contrast to those in a

number of previous studies that have suggested that low BMD may explain the

risk of stress fractures in RA.

Nevertheless, the researchers urge clinicians treating RA patients to

" maintain a high degree of awareness of the possible presence of stress

fracture in patients presenting with an increase in pain at a single site,

particularly when the pain is periarticular in origin. "

Last Updated: 2004-12-24 4:00:24 -0400 (Reuters Health)

Ann Rheum Dis 2004;63:1690-1692.

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