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.
I’m not sure about RA but I believe Chernobyl to be responsible for the overabundance of thyroid cancers and thyroid disaese, especially on Greece…ciao
Great post Wren. The journal article doesn’t surprise me as the suspected triggers of RA include environmental factors including infections. In fact, many scientists now believe that all RA is triggered by an immune reaction coupled with a genetic propensity for autuimmune problems. The dragon was lurking behind the scenes all along!
Three Mile Island wasn’t nearly as bad as Chernobyl but I was in the 5 mile radius when it occurred. I don’t think it is responsible for my Mixed Connective Tissue Disease/RA but many Cancers and Miscarriages in the area. I do believe early injuries and trauma damage the immune system and set off those with a genetic predisposition to autoimmune diseases to having them.
It is funny (funny odd, not funny ha ha) that you write about Chernobyl. We have a dog that was a stray that we got from the pound out in Indiana, PA. We are sure she ate all kinds of toxic things while she was a homeless puppy and we know she was abuse. She has a dogs version of arthritis and benign tumors all over her. As an affectionate nickname we call her “Chernobyl puppy”. The dragon also goes after dogs as well as humans and sticks fangs in them too.
My doctor thought mine may have been the result of the trauma from a car accident I was involved in. Of course I was also a smoker and that has a fairly strong connection also.
Interesting. I don’t have RA but another autoimmune disease and I have been told of several possible triggers (apart from a genetic disposition) including infection (unusual virus or bacteria), penicillin overdose and pregnancy, esp. in women who have experienced miscarriage(s) and/or premature delivery. In my case all three apply: I had three miscarriages and my daughter was born prematurely, three months before I was first diagnosed with autoimmune hepatitis I had septicemia after I cut my foot in a hotel pool and was treated with high dose penicillin.
Mind you, it does not make it any nicer…
Hope you also have positive memories of Germany.
It is interesting to hear about triggers for RA. Mine arthritis started at around the same age and decade as yours but I think stress was my trigger.
I feel sympathetic about that coffee cup. I had a sudden awful pain in my left hand from turning the page of the newspaper. Almost brought tears to my eyes.
Suzy’s Chernobyl puppy sounds like she had a tough life but ended up in a good place
I had a bad reaction to statins followed by a wicked flu – I really think this is what sent my immune system into overdrive myself, but, honestly, I suspect that the answer is different for everyone. Chernobyl is responsible for a lot – but you are likely right about your RA, lol! I agree with you about the meds – I took the leap and started humira – took my third shot last Saturday and feel better than I have in two years! There is a reason they call these game changers! I am now looking for an exercise program to try to rebuild these muscles that I have lost! How is your exercise program going?
OK so if I got this right…one shouldn’t eat, one shouldn’t breath, one shouldn’t dare injure themselves and by all means, one should never ever get stressed out. Now…had I done all of the above I can be assured I would never have gotten RA 🙂 I loved your post. But unfortunately I don’t think they have a clue yet as to what might or might not trigger ra. And I am betting that years ahead we will find that ra is in fact a multiple of diseases being put under the ra name by many ra specialists right now. Yup, something triggers it all but what the heck that might be…I don’t think anyone has a real clue yet. Now just imagine when they really truly know and can scientifically prove it…um…then and maybe just then we will have a cure.
Excellent article Wren. Get educated about your unique condition. There are over a hundred different types of arthritis, and learning about yours will only help you be able to manage it more effectively. Get a diagnosis from a doctor, and then do your own research to find out what to expect and how to deal with it.