PRIKAZ BOLESNICE S REUMATOIDNIM ARTRITISOM I VIŠESTRUKIM OSTEOPOROTSKIM PRIJELOMIMA

Mateja Kisić, Vinka Vukosav, Ana Marija Valetić, Melanie-Ivana Čulo, Jadranka Morović-Vergles

Bolesnici s reumatoidnim artritisom imaju povišen rizik od razvoja osteoporoze i osteoporotskih prijeloma. Više čimbenika utječe na gubitak koštanog tkiva u bolesnika s reumatoidnim artritisom, primjerice, kronična upala, primjena glukokortikoida i tjelesna neaktivnost. U radu je prikazana bolesnica s višegodišnjim reumatoidnim artritisom u koje su se razvili prijelomi više rebara. Bolesnica je prethodno liječena metotreksatom, sulfasalazinom, glukokortikoidima i biološkim lijekom infliksimabom. Nakon isključenja malignoma kao uzroka višestrukih prijeloma zaključeno je da se radi o osteoporotskim prijelomima rebara pa je nastavljeno liječenje osteoporoze i osnovne bolesti. Prikaz bolesnice upozorava na važnost liječenja i kontrole reumatoidnog artritisa u skladu s principom liječenja prema zadanom cilju (engl. treat to target – T2T) da bi se smanjio utjecaj aktivne bolesti na nastanak / progresiju osteoporoze.

Patients with rheumatoid arthritis have increased risk for the development of osteoporosis and osteoporotic bone fractures. There are several risk factors, including chronic ongoing inflammation, glucocorticoid therapy, and immobility due to joint deformations. Here we present a patient with longstanding rheumatoid arthritis that developed spontaneous rib fractures. The patient was previously treated with methotrexate, sulfasalazine, glucocorticoids, and lastly with a biologic disease-modifying antirheumatic drug infliximab. After the exclusion of malignant etiology of multiple fractures we concluded that the patient had osteoporotic fractured ribs and we continued treatment of osteoporosis and treatment of rheumatoid arthritis. This shows the importance of employing the treat-to-target strategy while treating patients with rheumatoid arthritis to prevent the influence of active disease on osteoporosis formation and prevent joint damage and immobility to overall prevent or postpone the development of osteoporosis.