The onset of rheumatoid arthritis following trauma

Abstract

Background

Rheumatoid arthritis (RA) is known to have many predisposing factors.

Objective

We studied individuals whose RA was initiated by physical injuries.

Patients and methods

Sixty patients (43 females), previously well, developed RA following trauma. No other known environmental or familial influences were present. Fourteen sustained a fracture; of the 46 who did not, 36 sustained multiple injuries that in part involved the axial skeleton. Subsequent unremitting daily pain, stiffness, limited motion, pain on motion, and/or swelling in the injured areas were mandatory for inclusion.

Results

Nine months after injuries (span: 2 weeks–36 months), more obvious signs of inflammation (IM) appeared in multiple other joints that were previously not affected by the original trauma. In those with laboratory tests done prior to the spread of IM (30/60), 22 (73%) were normal until an average 8 months after the spread of IM. Of the entire cohort of 60, only 23% had a positive rheumatoid factor, but 43% had a positive antinuclear antibody.

Conclusion

It seems apparent that any severe trauma to a joint may precipitate an ongoing localized chronic inflammatory disorder for an indefinite period of time, which may then lead to the spread of IM to multiple other joints. The initiation of RA following trauma warrants consideration as a legitimate entity.

Keywords:

• rheumatoid arthritis
• trauma
• injuries
• inflammation
• antinuclear antibody
• rheumatoid factor

Disclosure

There have been no grants, no financial support, nor any other benefits from any commercial source for the work reported in this manuscript. The authors report no other conflicts of interest in this work.