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:
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.