Methotrexate osteopathy in rheumatoid arthritis

Area of Science:

• Rheumatology
• Bone Metabolism
• Pharmacology

Background:

• Methotrexate (MTX) is a common treatment for inflammatory rheumatic diseases.
• MTX-associated osteopathy, a side effect affecting bone mineral density and fracture risk, is debated in adults on low-to-moderate doses.
• The exact cause and clinical importance of MTX-associated osteopathy are not fully understood.

Purpose of the Study:

• To investigate MTX-associated osteopathy in adult patients with rheumatic diseases.
• To review clinical and radiological features of MTX-associated osteopathy.
• To assess the impact of MTX on bone mineral density and fracture risk.

Main Methods:

• Case series of four female patients with rheumatoid arthritis (RA) presenting with stress fractures.
• Systematic literature review focusing on clinical and radiological characteristics of MTX-associated osteopathy.
• Analysis of MTX effects on bone mineral density and fracture risk.

Main Results:

• Four RA patients experienced stress fractures of the tibia and calcaneus, some with multiple fractures.
• Patients showed rapid clinical improvement after discontinuing MTX, suggesting MTX-associated osteopathy.
• The review highlighted common clinical and imaging findings, including band- or meander-shaped fractures.

Conclusions:

• MTX-associated osteopathy is a potential cause of stress fractures in adults with rheumatic diseases, particularly RA.
• Diagnosis requires careful exclusion of other fracture causes and consideration of MTX discontinuation.
• Further research is needed to fully elucidate the pathogenesis and clinical significance of MTX-associated osteopathy.