Kurose Rie, Wakai Yuji
Department of Orthopaedic Surgery, Hirosaki Memorial Hospital, Hirosaki, Japan.
J Orthop Case Rep. 2022 Feb;12(2):86-89. doi: 10.13107/jocr.2022.v12.i02.2678.
Patients with rheumatoid arthritis (RA) have generalized bone loss and deterioration of bone quality, leading to a relatively higher risk of vertebral and non-vertebral fractures. It has been previously reported that patients who cause fragility fractures such as vertebral fractures, had statistically higher scores of RA disease activity, but there are no case reports.
The case described in this report is an elderly woman with RA who was receiving treatment including glucocorticoids. Her state of RA activity had been in remission for a long time, and she was also receiving treatment to prevent osteoporosis. However, the worsening of the disease activity triggered a fracture cascade starting from a vertebral fracture and her activities of daily living deteriorated rapidly.
This report highlights the difficulties in treating osteoporosis and preventing fragility fractures in an elderly patient with RA and the importance of managing RA disease activity.
类风湿关节炎（RA）患者存在全身性骨质流失和骨质量下降的情况，导致椎体和非椎体骨折的风险相对较高。此前有报道称，发生椎体骨折等脆性骨折的患者，其RA疾病活动度评分在统计学上较高，但尚无病例报告。
本报告所述病例为一名老年RA女性患者，正在接受包括糖皮质激素在内的治疗。她的RA活动状态长期处于缓解期，同时也在接受预防骨质疏松的治疗。然而，疾病活动度的恶化引发了从椎体骨折开始的骨折连锁反应，她的日常生活活动迅速恶化。
本报告强调了在老年RA患者中治疗骨质疏松和预防脆性骨折的困难，以及控制RA疾病活动度的重要性。
