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Rheumatoid arthritis (RA) can lead to insufficiency fractures due to bone weakness associated with the disease and its pharmacologic management. We report a 56 year old female with three weeks history of progressive non-traumatic pain and swelling in her right leg with inability to bear weight. X ray revealed a healing fracture of the lower third of right tibia and fibula. She had been using steroids for two years and currently was on methotrexate (MTX). Her serum vitamin D levels were sub-optimal. She was managed with POP back slab and immobilization for four weeks, vitamin D replacement therapy and rehabilitation. She was asymptomatic on follow up visit. Insufficiency fractures should be suspected in RA as they are often missed, leading to increased morbidity since the symptoms mimic disease relapse. Bone scan, CT scan, Magnetic resonance imaging can help in early diagnosis as X rays may appear normal initially.
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