RESEARCH - Insufficiency and stress fractures of the long bones occurring in patients with RA

August 17, 2005

Eur J Radiol. 1997 Dec;26(1):54-63.

Insufficiency and stress fractures of the long bones occurring in patients

with rheumatoid arthritis and other inflammatory diseases, with a

contribution on the possibilities of computed tomography.

Lingg GM, Soltesz I, Kessler S, Dreher R.

Zentrales Rontgeninstitut, Rheumakliniken, Bad Kreuznach, Germany.

In patients with long standing rheumatoid arthritis and other rheumatoid

disorders, stress fractures and insufficiency fractures are not uncommon.

The cause may be osteoporosis due to rheumatoid arthritis, corticosteroid

therapy, joint stiffness, and deformity of the joints caused by the

inflammatory process. Also, unaccustomed exercise after reconstructive joint

surgery may be a cause of fractures in these patients. Fractures can be

documented on conventional X-ray-pictures and tomograms. Computed tomography

can show the medullary extent of these fractures and gives, in several

cases, additional information showing the combination of insufficiency

fractures with fragmentations of parts of the involved bone. Reconstructive

surgery with total joint replacement may be another cause of the development

of these fractures. This unaccustomed increase in ambulation may lead to

stress fractures in other joints of the same extremity or of contralateral

extremity. Pain beginning in joint of the lower extremity in a patient with

chronic rheumatoid arthritis should, besides arthritis, raise the

possibility of a stress fracture. Also with cases of angular deformity of a

joint and unaccustomed exercise after reconstructive surgery patients stress

fractures may be seen and can be established by Plainfilm, Computed

Tomography scintimetric bone scanning and MRI.

PMID: 9481588

481588 & dopt=Abstract

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s Hopkins Medicine

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