Burnt-out stage of Rheumatoid arthritis
A 67 years old female presented with low back pain for the last few months. Examination revealed a burnt-out phase of rheumatoid arthritis who never received any treatment for the disease. She is unable to walk for many years as her feet are severely deformed due to rheumatoid arthritis (Image 1,2) making her bedridden for years. Xray of the Lumbosacral spine revealed severe osteoporosis and blood investigations showed Vitamin D level <8 ng/ml. Injection Vit D3 (6L units) was given intramuscularly and the standard treatment of osteoporosis including tablet Alendronate 70 mg once weekly was started. Assessing her condition and the irreversibility of the disease, we decided to go for palliative and conservative management
Rheumatoid arthritis is a chronic inflammatory joint disease causing cartilage and bone damage and also frequent disability affecting every aspect of life(1). Like our patient who never received any medical care for her disease, she ended up being so much disabled that she was totally unable to walk. Her complaint of chronic low back pain was investigated to be due to osteoporosis-a sequelae of her overall condition.
Rheumatoid arthritis is an inflammatory condition and bedridden patients are at risk of osteoporosis and fractures through multi-pathogenic processes(2,3).
It is important to identify and treat patients with rheumatoid arthritis early in the stage of the disease to avoid such catastrophic consequences.
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Adami G, Saag KG. Osteoporosis Pathophysiology, Epidemiology, and Screening in Rheumatoid Arthritis. Curr Rheumatol Rep. 2019 May 23;21(7):34. doi: 10.1007/s11926-019-0836-7. PMID: 31123839.
Eimori K, Endo N, Uchiyama S, Takahashi Y, Kawashima H, Watanabe K. Disrupted Bone Metabolism in Long-Term Bedridden Patients. PLoS One. 2016 Jun 8;11(6):e0156991. doi: 10.1371/journal.pone.0156991. PMID: 27275738; PMCID: PMC4898699.