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  • An exceptional radiographic presentation of bilateral insufficiency fractures of the proximal tibia in a patient with rheumatoid arthritis

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Letter
An exceptional radiographic presentation of bilateral insufficiency fractures of the proximal tibia in a patient with rheumatoid arthritis
  1. J Vanhoof1,
  2. S Landewe1,
  3. J Vandevenne2,
  4. P Geusens3
  1. 1Clinical Research Centre for Bone and Joint Diseases, Biomedical Research Institute, Limburg University Centre, Diepenbeek, Belgium
  2. 2Department of Radiology, Z.O.L. Campus St Jan, Schiepse Bos 6, Genk, Belgium
  3. 3Department of Rheumatology, Academisch Ziekenhuis, Maastricht, The Netherlands
  1. Correspondence to:
    Dr P Geusens;
    piet.geusens{at}ping.be

https://doi.org/10.1136/ard.62.3.277

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    We report an exceptional radiographic presentation of bilateral insufficiency fractures of the proximal tibia in a 67 year old women with rheumatoid arthritis (RA). The patient developed RA at the age of 55. She was consecutively treated with several disease modifying drugs : parenteral gold (1989–90), sulfasalazine (1990–91), and methotrexate (MTX; started in 1991 and discontinued in 2001 because of bone marrow suppression); chloroquine was added from 1993 until 1999. Oral corticosteroids (prednisone 5 mg/day) were started in 1990. Because of persistent hydrops of both knees a bilateral chemical synovectomy (osmium acid) was undertaken in 1990. Afterwards three intra-articular infiltrations with depot corticosteroids were given, and the arthritis of the knees resolved. Bone mineral densitometry (BMD) in 1994 showed a T score (compared with young adults) at the lumbar spine of −2.6 standard deviation (SD) and at the femoral neck of −2.7SD, compatible with osteoporosis. Treatment with calcium supplements and alfacalcidol (50 μg/day) was started as this was the only treatment for glucocorticoid osteoporosis which was reimbursed. Because of further bone loss (follow up BMD still showed a …

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