Did Chernobyl cause my RA?

I went to live in Germany in the fall of 1986, just seven months after the ill-fated nuclear reactor in Chernobyl, Ukraine, USSR melted down and spread deadly radiation across the region and high into the atmosphere, where jet-stream winds wafted it over much of Europe.

But no. It probably had nothing to do with my RA because first, there’s no proof that radiation can trigger RA, and second, Germany measured only harmless, trace amounts of radioactive fallout as a result of the Chernobyl nuclear accident, and third, after seven months even that tiny bit of radioactivity was, for all intents and purposes, gone.

Right. I scratched Chernobyl off my list of possible reasons for my RA a long time ago.

Still, if you’re anything like me, you sometimes wonder what triggered your RA (or any other autoimmune disease, for that matter). While it’s not terribly rare, RA isn’t nearly as common as, say, osteoarthritis, the “wear-and-tear” variety of arthritis that most people develop, to varying degrees, as they age.

I was thinking about it all again last night. Why? Well, yesterday was a pretty good day, rheuma-dragon-wise. In fact, he hadn’t made an appearance all day. Only the hip bursitis bothered me, and even that had turned itself down to merely annoying background noise. It was sorta nice, you know?

Yes, I know you do.

So. There I was last evening, reading a news story on my laptop and enjoying a lovely after-dinner cup of coffee. I was working the laptop’s scrolling keys with my right hand. My lefthand was wrapped loosely around the warm coffee cup, which rested on the arm of the chair I was sitting in. I lifted the cup to take a swallow …

… and a breathtaking stab of pain flashed across the back of my hand and through my knuckles. My delicate metacarpals screamed with outrage and my knucklebones started an angry, insulted throbbing. I put the cup down fast and massaged my suddenly painful hand, frowning. WTF? That coffee cup hardly weighed anything!

“What happened?!” Mom asked from the sofa, startled.”What’s wrong?”

“It’s just my RA,” I sighed. “No big deal.”

And that was the truth. It wasn’t a big deal, except that lifting a coffee cup doesn’t usually hurt like a you-know-what. Once again, the rheuma-dragon had totally ambushed me.

As my hand twinged and throbbed I thought about it all again. Scary Chernobyl, while it sounded good as a reason for my RA, was out. I let my mind wander back to our arrival in the Old Country. It was Autumn. It was cold—far colder than we’d anticipated, so within two days of arriving, we’d had to run out and buy much heavier winter coats than we’d brought with us from the mild West coast of the U.S. We also bought ourselves some serious hats, scarves and gloves.

Our second weekend in Germany, my husband’s Air Force unit sponsored a Halloween hayride for off-duty personnel and their families at a German farm. My six-year-old daughter had never been on a hayride before, and the whole outing sounded like fun. Our German hosts were planning to serve grilled brats, pommes frites (French fries) and hot apple cider. I was excited.

Everything went great until it was time for the hayride. Drawn by a gigantic draft horse, the hay wagon was a huge affair made of rusted metal. It sat high off the ground, too; the lowest rail was about chest-high on me. There were no steps or any other obvious way to get in. My husband boosted himself up and over the rail, into the wagon. I handed Cary up to him, and then, hoping I wouldn’t make a fool of myself, I jumped and hoisted myself up.

Maybe I overdid it a little. With my waist at the top rail, my legs swung beneath the wagon bed. I hit my right shin, hard, against something sharp. The pain was excruciating; if you’ve ever barked your shinbone, even lightly, you can imagine it. But I didn’t cry out. I was too conscious of all the strangers around me; I was embarrassed. So I just climbed the rest of the way into the wagon and sat down on a hay bale next to my daughter and husband, forcing a smile and wondering if my shoe was filling with blood. I didn’t tell them I’d hurt myself.

My injured shin burned and throbbed for the rest of the afternoon, but no bloodstain ever showed up on my gray wool trousers (or in my shoe. So dramatic!). After we got home that evening, I closed myself into the bathroom, hiked up my trouser leg and looked, finally, at the damage.

There was a small hole in my shin about the size of the fingernail on my index finger. I’d worn pantyhose under my trousers for warmth; the nylon was stuck to it. I soaked it free, gently, and put some antibacterial salve and a adhesive bandage on it. The wound stung and burned, and my shin was tender for a few days, but I didn’t worry about it further. I didn’t see a doctor.

Fortunately, it didn’t get infected. Over time, the wound healed, leaving a shallow dent in my shinbone beneath the skin.  A couple of months later the first symptoms of rheumatoid arthritis started.

Could that shinbone injury have triggered an overactive immune response? Maybe. Last night I googled this question: “Can an injury trigger rheumatoid arthritis?” I didn’t expect much, so it was a surprise when pages of information showed up. One of the first five was this one:

http://rheumatology.oxfordjournals.org/content/40/3/262.full

Titled “A case–control study examining the role of physical trauma in the onset of rheumatoid arthritis” in Rheumatology, the official journal of the British Society for Rheumatology, the authors of this paper believe that yes, physical trauma, such as an injury like I got that day on the hayride, can trigger the onset of RA.

Read it—it’s an interesting study.  There’s no way of knowing, so many years later, whether my injured shinbone started it all or not, but the possibility is there. Does it make any difference?

Only in that I can, if I want to, call that long-ago day out at a German farm the probable reason I contracted severe rheumatoid arthritis when I was only 31 years old. There’s a certain comfort in being able to blame that rusty old German hay wagon for the debilitating disease that’s shaped so much of my life since, and that continues to shape each day, like it or not.

The big difference now is that the RA pain—after that first, savage bite—generally subsides to an annoying but bearable, twinging throb. Gone are the horrific, tortuous flares that lasted for days before fading as quickly as they’d started. Gone are the days when I limped on the right foot, then three days later limped on the left, no doubt making my co-workers think I was faking it. Gone are the times when walking at all required gathering all my courage.

And gone, thank goodness, is the awful, creeping, bewildered terror that accompanied each flare. Not knowing is awful. But now, thanks to the Internet and many good online blogger friends, I’m educated about RA and–just as important–I know I’m not alone. And I finally have a weapon—an Arava, sulfasalazine, and plaquenil bomb— that works just well enough to blunt my rheuma-dragon’s fangs.

For that I can thank medical research and studies like the one I cited above. Maybe one day they’ll come up with a cure.

Awake in the night

Crrrrack! Bam! KaaaBOOM BOOM BOOM boom kaabam boom …bamboom… boom…

Silence.

I lay awake in the dark, eyes wide, heart beating wildly as my mind reeled, trying to make sense of the stunning, fantabulous racket that had just jerked me so rudely out of a sound sleep. I blinked. There’s a busy road, one of just two main thoroughfares that traverse this densely populated foothill community from north to south. It runs just a hundred yards or so behind Mom’s condo. Traffic moves fast. You can hear cars whizzing by even during the darkest hours of the night.

Had there just been a horrific accident? Should I get up? Look out the window, try to see past the back yard fence and through the screen of trees t? Were there a couple of cars—at least!—laying crushed, mangled and upside-down out there? People hurt? Could anyone have survived such a catastrophic, violent collision?

I tested my sleep-stiffened hips and legs, gingerly preparing to sit up and go to the window when there was a startling flash of blue-white light. Almost at the same moment came the explosion, another otherworldly crashing, ear-splitting cacophony of booms, as if giants were rolling house-sized boulders instead of bowling balls down the road just outside my window.

And suddenly, I knew. It was thunder.

Thunder.  Now I remembered the weather guy on the evening news talking about thunderstorms possibly moving through the area overnight. No big deal, really, except for the threat of random wildfires caused by lightning strikes.

So the ear-splitting noise that had torn me so suddenly out of my sleep was nothing more fearsome than the concussion of sound caused by bolts of lightning.

Still. Thunderstorms are fairly rare in California at any time of year, but even more so in the summer. Along with their rarity, for some reason the storms have always been some distance from wherever I happened to be. For me, thunderstorms were nothing but rain, lightning flashes and thunder that was merely a soft rumble in the background.

Well, this was no quiet rumble. It sounded like the storm was hovering 10 feet or so above the roof.

As I laid there awake, I became aware of the RA and bursitis pain in my hips, hands and, oddly, ankles. It was relatively mild pain, a naggy throb that sort of waxed and waned along with the roiled air pressure accompanying the storm. At one point I could feel the pressure building up suddenly inside my right ankle, so intensely that I thought, a little wildly, it’s going to explode! A few seconds later the pressure eased back and it returned to that irritating little throb.

I considered getting up to take some tramadol, but a glance at the alarm clock on the nightstand reminded me that not enough time had passed since the dose I’d taken just before getting into bed. It had been about four hours, long enough for the drug to have mostly worn off, but I needed to wait for at least six hours to take any more.

I sighed, shifted and turned onto my side, cuddling down deeper into my pillow and blanket. The storm seemed to be moving along. There were no more flashes and thunderclaps. I drifted off, hoping vaguely that I’d just sleep on through the pain until morning, and that there would be no more storms to wake me up.

There weren’t. I slept.

Today, with the weather still very unstable and the big low pressure area stalled in place over northern California, I’m one big ache. It took more than an hour for the overnight stiffness in my joints, particularly my hips, knees and ankles, to ease. And while I’m certainly not moving like a nicely oiled machine, I could probably beat the tin man in a race to the liveoak trees down the street as long as I hid his oilcan.

The low pressure and unstable weather is supposed to move out later today. I’m anticipating some additional discomfort as the air pressure rises, but once it stabilizes I expect most of the pain to dissipate along with it. I’m never without some level of pain these days—so different from how the rheuma dragon used to attack me, when the intermittent flares were huge and intense and always disabling, and almost always lasted several days at a time before suddenly disappearing without warning or explanation—but I’ve learned over time to cope. Even given the intractable hip bursitis I live with now along with the rheumatoid arthritis, it could all be so much worse. I’m deeply grateful for the RA drugs  I have now that keep it under control. And grateful for tramadol and, occasionally, the stronger painkillers that allow me to keep on keeping on.

Autumn is on its way, and after that (if we’re very lucky; cross your fingers?) the western rainy season should begin. Bring on the thunderstorms. I can take it.