title: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA.
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Brawer
authors.affiliation: Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA.
authors.forename: Noopur
authors.initials: N
authors.lastname: Goel
keywords: antinuclear antibody; inflammation; injuries; rheumatoid arthritis; rheumatoid factor; trauma