Severe Trauma as An Etiologic Factor in Rheumatoid Arthritis

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Abstract
Since the purpose of this investigation was to clarify the significance of a severe trauma as an etiological factor in rheumatoid arthritis an unselected material with an average of 4.2 fractures, or severe trauma, during the period 1968-71 was gathered from the intensive therapy unit of a casualty hospital. The material consisted of 204 patients, 26 % of them women, the average age being 31.1 years. Using a random sample method a comparison material of 103 subjects, of whom 32% were women, and whose age averaged 41.1, was gathered from the Helsinki city population at clinical health checks. A rheumatological examination was performed on the trauma subjects 2 years after the trauma, and the comparison subjects were examined in the same way. Previously existing rheumatoid arthritis (RA) was revealed in 2.5% of the casualty material and in 2.9% of the comparison subjects. Fresh cases of RA after the trauma, i.e. during the period 1968-71, were found in 2.9% of the trauma subjects but in none of the comparison subjects (p<0.1). Deforming arthrosis was revealed in 3.4% of the trauma subjects under 40 years of age. Fresh cases were revealed in 5.6% of the trauma patients, in whose families there were RA sufferers. Of the casualties 114 had morning stiffness, pain or swelling in joints after healing of the trauma. Rheumatoid arthritis was revealed in 4.4% of these patients and arthrosis in 6-1%, under the age of 40. Eleven different immunological tests were examined on the 1st, 3rd and 21st day after the traumatic injury. The examination was carried out on 69 cases. A rise in titre was established only in ASTA and antinuclear-antibodies. In Waaler-Rose, the titres did not rise. A positive antinuclear-antibody titre was established on the 1st and 3rd day in 7% and on the 21st day in 18% of these cases. There was a rise in IgG in 18% and in IgM in 9%. In 6 trauma patients the antinuclear-antibodies became positive on the 21st day, post trauma. Three of these patients were later afflicted with fresh RA. The study indicates that a severe trauma can cause the appearance of rheuma-serological factors in the serum, and in other cases it nay cause the onset of RA at a relatively early age.