Multiple pelvic insufficiency fractures in rheumatoid patients with mutilating changes

Area of Science:

• Orthopedics
• Rheumatology
• Geriatric Medicine

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease causing joint inflammation and damage.
• Long-term glucocorticoid therapy and multiple lower-extremity surgeries (e.g., total hip/knee arthroplasty) are common in severe RA.
• These factors increase the risk of insufficiency fractures, particularly in the pelvis and lumbosacral region.

Purpose of the Study:

• To report on two cases of multiple pelvic insufficiency fractures in patients with mutilating rheumatoid arthritis.
• To highlight the potential complications and outcomes associated with these fractures.
• To emphasize the need for proactive management strategies in at-risk RA patients.

Main Methods:

• Case report of two patients with rheumatoid arthritis.
• Review of medical history including long-term glucocorticoid use and surgical interventions.
• Clinical assessment and conservative management of pelvic and lumbosacral insufficiency fractures.

Main Results:

• Both patients experienced substantial disability due to multiple insufficiency fractures.
• One patient achieved bony union and resumed activities with conservative treatment.
• The second patient did not regain ambulation, indicating a poorer outcome.

Conclusions:

• Rheumatoid arthritis patients with combined risk factors (long-term glucocorticoids, prior surgeries) are susceptible to severe insufficiency fractures.
• Aggressive preventive interventions and prompt clinical assessment are essential for early detection and management.
• Outcomes can be variable, underscoring the importance of individualized care plans.