The onset of rheumatoid arthritis following trauma

Abstract

BackgroundRheumatoid arthritis (RA) is known to have many predisposing factors.ObjectiveWe studied individuals whose RA was initiated by physical injuries.Patients and methodsSixty 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.ResultsNine 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.ConclusionIt 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.

Structural cartilage damage attracts circulating rheumatoid arthritis synovial fibroblasts into affected joints

“…Currently, not much is known about pathological changes that initiate and drive the progression of RA in very early stages of the disease, despite a consensus that there are molecular and cellular alterations, including changes in cartilage structure, that precede the onset of synovitis in RA [ 33 – 38 ]. Furthermore, why certain joints are more likely to be affected than others remains almost completely unexplored, although there are some data derived from microanatomical studies suggesting that mechanically exposed areas in joints are more prone to developing synovitis [ 39 , 40 ]. In the present study, we provide evidence that structural cartilage changes that may be present in very early phases of the disease facilitate the homing of SFs and thus promote the spread and progression of RA.…”

Is Silicone Breast Implant Toxicity an Extreme Form of a More Generalized Toxicity Adversely Affecting the Population as a Whole?

“…Stated another way, although observations by clinicians toiling on the front lines are not usually the source of double blind placebo controlled randomized clinical trials, nonetheless the experiences of such colleagues often provide valuable insights into mechanisms of disease causation. As an example, when rheumatoid arthritis is initiated by physical trauma, the orchestration of continuing inflammation in injured joints is quite different from the spontaneous evolution of inflammatory and autoimmune responses described by immunologists (7) . In addition, immunologists have not yet deduced why the risk of developing rheumatoid arthritis and systemic lupus erythematosus is statistically higher if one is chronically exposed to pesticides and insecticides (7) .…”

“…As an example, when rheumatoid arthritis is initiated by physical trauma, the orchestration of continuing inflammation in injured joints is quite different from the spontaneous evolution of inflammatory and autoimmune responses described by immunologists (7) . In addition, immunologists have not yet deduced why the risk of developing rheumatoid arthritis and systemic lupus erythematosus is statistically higher if one is chronically exposed to pesticides and insecticides (7) . One-third of individuals who became systemically ill after 25 years of water usage contaminated with trichloroethylene developed a positive antinuclear antibody (ANA) test (19) .…”

“…Exposures to organosiloxanes occur from inhalation, dermal absorption, ingestion, and implantation into the body (1,2,3,4,5,6,15,16) . Regarding inhalation exposure, published studies on the adverse effects of volatile organosiloxanes parallels evidence that smoking is a predisposing risk factor for rheumatoid arthritis (2,7) . Regarding dermal absorption, the lipophilic nature of these compounds can be expected to promote biointegration into the subcutaneous fat, and is paralleled by research indicating that lipocytes (adipocytes) produce a variety of cytokines capable of initiating and/or augmenting inflammatory events (3,8) .…”

Medical expert testimony as conflict of interest regarding the onset of rheumatoid arthritis following trauma

“…I read with interest the article by Brawer and Goel in the August 2016 issue of journal Open Access Rheumatology: Research and Reviews on the onset of rheumatoid arthritis following trauma 1. However, I was troubled by the lack of transparency in, at least, the lead author’s case regarding conflict of interest.…”