title: Insufficiency fractures in patients with chronic inflammatory joint diseases.
abstract: OBJECTIVE
  To describe the typical sites of stress fractures in the lower extremities and pelvis in rheumatoid patients (rheumatoid arthritis, juvenile chronic arthritis, psoriatic arthritis, ankylosing spondylitis).
  
  
  METHODS
  Thirty-three patients with 52 stress fractures [mean age 44 years (range 11-73)] were studied at the authors' institution when they were being treated for their rheumatic diseases. Fourteen patients had RA, 9 JCA, 5 PsoA, and 5 SPA. Stress fractures were detected from patient documents and from series radiographs in suspected cases. In some cases magnetic resonance imaging was also performed.
  
  
  RESULTS
  One patient presented with 5 fractures, 2 patients with 4 and 3 fractures, and 7 patients with 2 fractures each. Other patients (n = 19) had only one fracture each. The metatarsal (MT) bones were the most common site of involvement. Twenty-five of the 52 fractures were located on MT I-V. The second and third most common sites were thefibula (n = 13) and tibia (n = 6). All fractures of the lower tibia or fibula were associated with valgus malalignment of the ankle.
  
  
  CONCLUSIONS
  If a patient with rheumatic disease experiences sudden and unexplained pain localised in the forefoot, above the ankle, below the knee, or in the pelvis, a stress fracture should be suspected. Patients with severe osteoporosis, high-load corticosteroid or methotrexate therapy, or marked joint deformity are at high risk of developing stress fracture.
authors.affiliation: Rheumatism Foundation Hospital, Department of Orthopedics, Heinola, Finland. heikki.maenpaa@scanpoint.fi
authors.forename: H M
authors.initials: HM
authors.lastname: Mäenpää
authors.forename: I
authors.initials: I
authors.lastname: Soini
authors.forename: M U K
authors.initials: MU
authors.lastname: Lehto
authors.forename: E A
authors.initials: EA
authors.lastname: Belt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001171:Arthritis, Juvenile / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D015535:Arthritis, Psoriatic / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D002648:Child; D005260:Female; D015775:Fractures, Stress / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011859:Radiography; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology