Page 27 - MRS Abstracts March 2023

Insufficiency fractures in Rheumatoid arthritis patients – A case series of Methotrexate Osteopathy.
Introduction:
Naveen Ravichandran Senior Clinical Fellow Pallavi Vij, Senior Clinical Fellow
James Bateman, Consultant Rheumatologist
Nick Barkham, Consultant Rheumatologist
Hem Sapkota, Consultant Rheumatologis Srinivasan Venkatachalam, Consultant Rheumatologist
New Cross and Cannock Chase Hospital
Methotrexate osteopathy is a rare but known side effect of the drug. It is characterized by bone pain and insufficiency fractures predominantly in the lower limb with or without osteoporosis. We report a series of four patients with the entity from our unit.
Case Summary:
1. 67-year-old female with rheumatoid arthritis on Methotrexate for 3 years when she had a right proximal tibial fracture. She was on proton pump inhibitors for 12 years. Methotrexate was stopped and she had Pamidronate.
2. 67-year-old male with psoriatic arthritis on Methotrexate for 5 years had fractures in multiple vertebrae, distal femur, proximal and distal tibia, and neck of humerus. (Fig. 1) He was drinking over 3 units of alcohol daily. He was initially treated with Alendronic acid, then Zoledronate and later Teriparatide. Methotrexate was stopped after 5 years as he was having more fractures.
3. 75-year-old female with rheumatoid arthritis for 40 years and was on multiple Disease modifying antirheumatic drugs including Methotrexate. She was also on Prednisolone. She had