Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis.

The occurrence of stress and insufficiency fractures in patients with long-standing rheumatoid arthritis has not been sufficiently emphasized. Osteoporosis due to rheumatoid arthritis and corticosteroid therapy, joint stiffness, contracture, and angular deformity of the extremity, and the unaccustomed exercise after reconstructive joint surgery combine to predispose to the occurrence of these fractures in these patients. The pain and disability caused by these fracture is often attributed to rheumatoid joint involvement. The fracture may not be visible on radiographs obtained near the onset of symptoms, and serial examinations may be needed for diagnosis.