Journal of Acupuncture Research

Korean Acupuncture & Moxibustion Medicine Society (대한침구의학회)
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Delayed Diagnosis of a Tibial Stress Fracture Associated with Glucocorticoid and Methotrexate Therapy in a Patient with Rheumatoid Arthritis: A Case Report

  • Shin, Hye Jeong (Department of Acupuncture and Moxibustion Medicine, Korean Medicine Hospital of Woosuk University) ;
  • Lim, Yi Gun (Department of Acupuncture and Moxibustion Medicine, Korean Medicine Hospital of Woosuk University) ;
  • Lee, Gi Hyang (Department of Internal Medicine, College of Korean Medicine, Woosuk University) ;
  • Lee, Hyun Seok (Department of Acupuncture and Moxibustion Medicine, Bundang Jaseng Hospital of Korean Medicine) ;
  • Song, Beom Yong (Department of Acupuncture and Moxibustion Medicine, Korean Medicine Hospital of Woosuk University) ;
  • Choi, Yoo Min (Department of Acupuncture and Moxibustion Medicine, Korean Medicine Hospital of Woosuk University)
  • Received : 2021.10.13
  • Accepted : 2021.12.29
  • Published : 2022.02.28
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Abstract

The risk of stress fractures is associated with rheumatoid arthritis (RA), which can aggravate bone loss. We report the case of a patient who was on long-term medication for RA presenting with lower extremity pain on the left and swelling without trauma. Magnetic resonance imaging and plain radiographs at the previous hospital showed no signs of fracture, but radiographs performed later, revealed a stress fracture of the left distal tibia. The stress fracture may have occurred due to multiple reasons such as long-term use of methotrexate and glucocorticoids, active RA, postmenopausal state, and immobility. Suspicion of a stress fracture should not be ruled out especially in RA patients with persistent pain, even if the radiographical findings are normal. Additional imaging and follow-ups are essential. The patient's pain was relieved with Korean medicine treatments, which suggests their potential application for stress fractures in RA patients.

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