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

In patients with long standing rheumatoid arthritis and other rheumato id disorders, stress fractures and insufficiency fractures are not unc ommon. The cause may be osteoporosis due to rheumatoid arthritis, cort icosteroid therapy, joint stiffness, and deformity of the joints cause d by the inflammatory process. Also, unaccustomed exercise after recon structive joint surgery may be a cause of fractures in these patients. Fractures can be documented on conventional X-ray-pictures and tomogr ams. Computed tomography can show the medullary extent of these fractu res and gives, in several cases, additional information showing the co mbination of insuffciency fractures with fragmentations of parts of th e involved bone. Reconstructive surgery with total joint replacement m ay be another cause of the development of these fractures. This unaccu stomed increase in ambulation may lead to stress fractures in other jo ints of the same extremity or of contralateral extremity. Pain beginni ng in joint of the lower extremity in a patient with chronic rheumatoi d arthritis should, besides arthritis, raise the possibility of a stre ss fracture. Also with cases of angular deformity of a joint and unacc ustomed exercise after reconstructive surgery patients stress fracture s may be seen and can be established by Plainfilm, Computed Tomography scintimetric bone scanning and MRI. (C) 1997 Elsevier Science Ireland Ltd.