{
  "abstract": "Methotrexate-induced osteopathy (MTX-IO) is a rare condition typically involving the lower limbs, especially tibia or foot fractures, among patients with well-controlled rheumatoid arthritis (RA) or psoriatic arthritis (PsA). This study aimed to identify the affected population, describe fracture characteristics and identify risk factors for poor clinical outcome. A multicentre retrospective study included patients with MTX-IO diagnosed by bone specialists or identified through French pharmacovigilance. The data collected included clinical presentation, imaging features, bone mineral density and biochemical markers. Between 2012 and 2024, 92 patients were included, predominantly postmenopausal women with seropositive RA. A history of major fractures was noted for 22% of the patients, and 56% presented osteoporosis at diagnosis. Fractures were most common in the tibial metaphysis (distal and proximal) (88%) and the foot bones (49%), with multiple fractures often present at diagnosis (76%), and frequently repeated fractures in the patients’ recent histories (63%). Diagnosis was conducted using MRI of the painful sites (84%), but bone scintigraphy was also used (41 patients, 45%). Management involved methotrexate discontinuation in 79% of the cases. Fracture healing and pain relief were achieved in 77% of the cases, with a significant difference in outcomes between those who discontinued methotrexate (91%) versus those who continued (29%) (p<0.001). MTX-IO is a rare but significant condition, especially among postmenopausal women with RA or PsA. Early diagnoses via MRI or bone scintigraphy and the discontinuation of methotrexate are critical, as stopping the drug significantly improves outcomes and prevents further fractures.",
  "authors": [
    {
      "affiliations": [
        "Univ Rennes, INSERM, INRAE, CHU Rennes, UMR 1317 1341, Institut NuMeCan (Nutrition Metabolisms and Cancer), Rennes, France",
        "Rheumatology department, Rennes University Hospital, Rennes, France"
      ],
      "name": "François Robin"
    },
    {
      "affiliations": [
        "Paris Cité and Sorbonne Paris Nord University, Inserm, INRAe, Centre for Research in Epidemiology and Statistics (CRESS), Paris, France"
      ],
      "name": "Roba Ghossan"
    },
    {
      "affiliations": [
        "Rheumatology Department, Centre hospitalier universitaire Bordeaux, Groupe hospitalier Pellegrin, Bordeaux, France"
      ],
      "name": "Nadia Mehsen-Cetre"
    },
    {
      "affiliations": [
        "Regional Center of Pharmacovigilance, Pharmacoepidemiology and Drug Information – CHU Rennes, Rennes, France"
      ],
      "name": "Louise Triquet"
    },
    {
      "affiliations": [
        "University of Poitiers, LITEC laboratory, Rheumatology Department, CHU Poitiers, Poitiers, France"
      ],
      "name": "Guillaume Larid"
    },
    {
      "affiliations": [
        "Rheumatology department, CH Dinan, Dinan, France"
      ],
      "name": "Guillaume Coiffier"
    },
    {
      "affiliations": [
        "University of Liège, Rheumatology department, CHU Sart Tilman, Liège",
        "Centre de Rhumatologie et de médecine sportive, Brussels, Belgium"
      ],
      "name": "Marine Mina"
    },
    {
      "affiliations": [
        "Rheumatology department, CHU Gabriel-Montpied, Clermont-Ferrand, France"
      ],
      "name": "Marie Eva Pickering"
    },
    {
      "affiliations": [
        "Service de Rhumatologie, CHU Lille et Université de Lille, Lille, France"
      ],
      "name": "Claire Barthe"
    },
    {
      "affiliations": [
        "Service de Rhumatologie, CHU Lille et Université de Lille, Lille, France"
      ],
      "name": "Julien Paccou"
    },
    {
      "affiliations": [
        "Service de Rhumatologie, CH la Roche-sur-Yon, la Roche-sur-Yon, France"
      ],
      "name": "Julien Herman"
    },
    {
      "affiliations": [
        "Université de Lyon, France, Centre Expert des Métastases Osseuses (CEMOS) - Service de Rhumatologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France"
      ],
      "name": "Emmanuel Massy"
    },
    {
      "affiliations": [
        "Service de rhumatologie, CH Perpignan, Perpignan, France"
      ],
      "name": "Isabelle Roitg"
    },
    {
      "affiliations": [
        "University Hospital of Bordeaux, Pellegrin Hospital Group, Rheumatology Department, Bordeaux, France"
      ],
      "name": "Martine Branquet"
    },
    {
      "affiliations": [
        "University Hospital of Bordeaux, Pellegrin Hospital Group, Rheumatology Department, Bordeaux, France"
      ],
      "name": "Julien Lasnier Siron"
    },
    {
      "affiliations": [
        "Service de Rhumatologie, CH Aurillac, Aurillac, France"
      ],
      "name": "Manon Guillouard"
    },
    {
      "affiliations": [
        "Hôpital de Dieppe, Service de Rhumatologie, Dieppe, France"
      ],
      "name": "Camille Desmonet Trousset"
    },
    {
      "affiliations": [
        "University of Liège, Rheumatology department, CHU Sart Tilman, Liège",
        "Centre de Rhumatologie et de médecine sportive, Brussels, Belgium"
      ],
      "name": "Aurore Aubrun"
    },
    {
      "affiliations": [
        "University of Liège, Rheumatology department, CHU Sart Tilman, Liège",
        "Centre de Rhumatologie et de médecine sportive, Brussels, Belgium"
      ],
      "name": "Bertrand Godfrin"
    },
    {
      "affiliations": [
        "University of Liège, Rheumatology department, CHU Sart Tilman, Liège",
        "Centre de Rhumatologie et de médecine sportive, Brussels, Belgium"
      ],
      "name": "Jean-Philippe Hauzeur"
    },
    {
      "affiliations": [
        "Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France"
      ],
      "name": "Emmanuel Chatelus"
    },
    {
      "affiliations": [
        "Rheumatology Department, Cochin Hospital, AP-HP Centre-Paris University",
        "Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital",
        "Paris Cité University, INSERM UMR 1163, Imagine Institute, Paris, France"
      ],
      "name": "Eugénie Koumakis"
    },
    {
      "affiliations": [
        "Rheumatology Department, Centre hospitalier universitaire Bordeaux, Groupe hospitalier Pellegrin, Bordeaux, France"
      ],
      "name": "Jean-Louis Legrand"
    },
    {
      "affiliations": [
        "Rheumatology Department, Centre hospitalier universitaire Bordeaux, Groupe hospitalier Pellegrin, Bordeaux, France"
      ],
      "name": "Thierry Schaeverbeke"
    },
    {
      "affiliations": [
        "Université de Lyon, France, Centre Expert des Métastases Osseuses (CEMOS) - Service de Rhumatologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France"
      ],
      "name": "Alexia Leloix"
    },
    {
      "affiliations": [
        "Rheumatology Center, Toulouse University Hospital, Toulouse, France/ INFINITY, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, Toulouse University, Inserm, Toulouse, France"
      ],
      "name": "Maeva Masson"
    },
    {
      "affiliations": [
        "Hôpital de Dieppe, Service de Rhumatologie, Dieppe, France"
      ],
      "name": "Julia Nicolau"
    },
    {
      "affiliations": [
        "Service de rhumatologie, CH Perpignan, Perpignan, France"
      ],
      "name": "Charles Ghiringhelli"
    },
    {
      "affiliations": [
        "Service de rhumatologie, CH Perpignan, Perpignan, France"
      ],
      "name": "Marijke Decrock"
    },
    {
      "affiliations": [
        "Service de médecine interne, Hôpital Saint Joseph Saint Luc, 20 quai Claude Bernard, Lyon cedex Univ Angers, Nantes université, ONIRIS, Inserm, RMeSUMR, Angers, France22 Service de Rhumatologie, Centre Hospitalier Ouest Réunion, Lyon, France"
      ],
      "name": "Cécile-Audrey Durel"
    },
    {
      "affiliations": [
        "Univ Rennes, INSERM, INRAE, CHU Rennes, UMR 1317 1341, Institut NuMeCan (Nutrition Metabolisms and Cancer), Rennes, France"
      ],
      "name": "Béatrice Bouvard"
    },
    {
      "affiliations": [
        "Service de Rhumatologie, CHU Lille et Université de Lille, Lille, France"
      ],
      "name": "Bernard Cortet"
    },
    {
      "affiliations": [
        "Univ Rennes, INSERM, INRAE, CHU Rennes, UMR 1317 1341, Institut NuMeCan (Nutrition Metabolisms and Cancer), Rennes, France"
      ],
      "name": "Charlotte Casadepax-Soulet"
    },
    {
      "affiliations": [
        "University of Liège, Rheumatology department, CHU Sart Tilman, Liège",
        "Centre de Rhumatologie et de médecine sportive, Brussels, Belgium"
      ],
      "name": "Olivier Malaise"
    },
    {
      "affiliations": [
        "Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France"
      ],
      "name": "Rose-Marie Javier"
    },
    {
      "affiliations": [
        "Paris Cité and Sorbonne Paris Nord University, Inserm, INRAe, Centre for Research in Epidemiology and Statistics (CRESS), Paris, France"
      ],
      "name": "Karine Briot"
    },
    {
      "affiliations": [
        "Univ Rennes, INSERM, INRAE, CHU Rennes, UMR 1317 1341, Institut NuMeCan (Nutrition Metabolisms and Cancer), Rennes, France",
        "Rheumatology department, Rennes University Hospital, Rennes, France"
      ],
      "name": "Pascal Guggenbuhl"
    }
  ],
  "title": "METHOFRACT, a methotrexate osteopathy multicentre cohort study",
  "uid": "e0d02b9f-e6b4-574a-849a-59f50df00739"
}