Hillyard Katherine C L, Shabbir Shabnam, Sirisena Udawattage Nadeeka, Hogarth Maxine, Sahu Ajay
Radiology Department, Ealing Hospital, Uxbridge Rd, Southall, London UB1 3HW, UK.
Radiol Case Rep. 2018 Jun 29;13(4):855-861. doi: 10.1016/j.radcr.2018.05.016. eCollection 2018 Aug.
Insufficiency fractures are recognized but rare complications in patients with longstanding rheumatoid arthritis. Such fractures are typically solitary and are rarely seen to affect the foot and ankle. We describe 3 women with longstanding rheumatoid arthritis, treated with one, or a combination of, corticosteroids, DMARDs and anti-TNF, presenting with foot and ankle pain with no prior history of trauma. MRIs showed rare multiple florid insufficiency fractures of the foot and ankle, in 2 cases bilaterally, which were managed conservatively. These cases highlight the importance of considering insufficiency fractures in similar patients presenting with foot and ankle pain. Radiographs may fail to demonstrate these lesions, delaying diagnosis, and worsening patient outcome, therefore in such cases MRI is a valuable modality.
应力性骨折在长期类风湿性关节炎患者中虽已被认识到，但却是罕见的并发症。此类骨折通常为单发，很少累及足踝部。我们描述了3例长期类风湿性关节炎女性患者，她们接受了皮质类固醇、改善病情抗风湿药（DMARDs）和抗肿瘤坏死因子（anti-TNF）单一或联合治疗，出现足踝部疼痛且无既往创伤史。磁共振成像（MRI）显示足部和踝部罕见的多发活动性应力性骨折，2例为双侧受累，均采用保守治疗。这些病例强调了在出现足踝部疼痛的类似患者中考虑应力性骨折的重要性。X线片可能无法显示这些病变，从而延误诊断并使患者预后恶化，因此在这种情况下，MRI是一种有价值的检查方式。
