Foot and Ankle Insufficiency Fractures in Rheumatoid Arthritis

Abstract

Objectives: To evaluate causes of foot and ankle insufficiency fractures in patients with rheumatoid arthritis. To conduct a literature review of low dose methotrexate induced osteopathy. Case series: Three patients with rheumatoid arthritis who sustained foot and ankle insufficiency fractures which were only detected on MRI. All three patients were on biologic treatment and methotrexate for RA, and two had evidence of hind-foot deformity. All had evidence of osteoporosis on bone density scan, and two were already on intravenous zolendronic acid. Conclusion: Insufficiency fractures occur in approximately 1% of patients with rheumatoid arthritis [1]. Contributing factors include chronic inflammation; skeletal deformities; biomechanical stresses; use of glucocorticoids; and osteoporosis. An additional pathophysiological mechanism may be low-dose methotrexate induced osteopathy. However, there is currently insufficient evidence to conclude this.