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Bone non-union after osteotomy in patients treated with methotrexate
J C Gerster1, R Bossy, J Dudler
1University Rheumatology and Rehabilitation Center, CHUV, Lausanne, Switzerland.
The Journal of Rheumatology
|December 22, 1999
Summary
Seronegative rheumatoid arthritis patients on methotrexate (MTX) experienced delayed bone healing after surgery. Stopping MTX treatment promoted prompt bone healing, suggesting temporary cessation is beneficial for surgical recovery.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Pharmacology
Background:
- Rheumatoid arthritis (RA) management often involves disease-modifying antirheumatic drugs (DMARDs).
- Methotrexate (MTX) is a common and effective DMARD for RA treatment.
- Bone healing complications can impact surgical outcomes in RA patients.
Observation:
- Two male patients with seronegative RA presented with non-union of bone following tibial and metatarsal osteotomies.
- Both patients were undergoing treatment with low-dose oral methotrexate.
- Delayed bone healing was observed in both cases during MTX therapy.
Findings:
- Cessation of methotrexate treatment led to accelerated bone healing in both patients.
- The prompt healing suggests a direct link between MTX and impaired bone repair.
- Seronegative rheumatoid arthritis patients may exhibit altered bone healing responses to methotrexate.
Implications:
- Temporary discontinuation of methotrexate should be considered for RA patients undergoing bone surgery with delayed healing.
- Further research is warranted to elucidate the precise mechanism of MTX's effect on bone healing.
- Optimizing perioperative management in RA patients can improve surgical success rates and reduce complications.