Dear friends
Thank you for commenting on this case. Obviously, there are fractures, probably insufficiency fractures due to altered bone or bone metabolism in this patient with psoriasis arthropathy, DM2, osteoporosis, medicated with methotrexate (but not alendronate).
However, the appearance is not the everyday insufficiency fracture, and some of you had experience with these findings in the context of low dose methotrexate treatment, and there were a couple of references as well. These fractures are more meandering or band-like, along the growth plate. MTX impairs bone metabolism, and I guess the healing of a stress fracture is impaired as well as the bone quality.
All in all, probably not the best known mechanism and imaging appearance, but not everything is easy and common in our world.
3 references:
https://link.springer.com/article/10.1007/s00198-020-05664-x
https://www.sciencedirect.com/science/article/abs/pii/S0049017222000038?via%3Dihub
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819927/
Thank you all, and have a nice day!
Best wishes
Roar
man. 17. juni 2024 kl. 12:40 skrev Roar Pedersen <pedersen70>:
Dear friends
We have across this strange case with chronic changes looking like insufficiency fractures, unchanged for a year, but the first fracture in our PACS was seen already in 2019.
This is a F60 with psoriasis arthropathy for almost 20 years, medicated with methotrexate 8and others). She has DM2, osteoporosis, adipositas.Q: Is this a typical appearance of methotrexate osteoarthropathy, or are the changes unspecific in the setting of osteoporosis?
Thank you for input or good references to literature!
Best wishes
Roar Pedersen
Norway
