title: Insufficiency fractures of the distal tibia misdiagnosed as cellulitis in three patients with rheumatoid arthritis.
abstract: We describe 3 patients with rheumatoid arthritis who presented with diffuse pain, swelling, and erythema of the distal aspect of the lower extremity, suggestive of either cellulitis or thrombophlebitis, but were found to have insufficiency fractures of the distal tibia. The value of technetium-99m diphosphonate bone scintigraphy in the early recognition of these fractures and a possible explanation for the associated inflammatory symptoms are discussed.
authors.affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham 35294.
authors.forename: K V
authors.initials: KV
authors.lastname: Straaton
authors.forename: A
authors.initials: A
authors.lastname: López-Méndez
authors.forename: G S
authors.initials: GS
authors.lastname: Alarcón
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002481:Cellulitis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004164:Diphosphonates; D005260:Female; D005596:Fractures, Closed / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D011877:Radionuclide Imaging; D013667:Technetium; D017556:Technetium Compounds; D013978:Tibial Fractures / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging
chemical_list: D004164:Diphosphonates; D017556:Technetium Compounds; D013667:Technetium; C029045:technetium Tc 99m diphosphonate