the Link Between Injuries and Rheumatoid Arthritis Symptoms

Sprains and Rheumatoid Arthritis (RA)

Hello, Doctor Gao.
A while ago, I sustained an injury that resulted in some bruising on my body, and I have small hematomas at the metacarpophalangeal joints of my thumb and little finger.
Since the injury was not severe, I thought that resting and applying heat would gradually reduce the swelling.
I have diligently applied heat for a month and have seen an orthopedic specialist, who prescribed some anti-inflammatory and pain-relieving medications, as well as circulation-enhancing drugs.
However, my thumb joint is still significantly swollen (about 1/2 wider than the other thumb), can only bend 45 degrees, and is constantly painful.
Any action requiring the use of my thumb (writing, changing files, opening bottle caps, etc.) is restricted.
Additionally, other joints that are not easily visible also hurt more than usual.
I would like to ask: Is the swelling in my thumb possibly related to rheumatoid arthritis (RA)? Am I concerned that the bruising might trigger joint deformities associated with RA? Which specialist should I consult? What tests should I undergo? Besides applying heat, what else should I do?

Niming, 40~49 year old female. Ask Date: 2014/02/22

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your message.
Among the possible pathogenic causes of rheumatoid arthritis (RA), there is currently no mention of trauma as a triggering factor, so there is no need to be overly concerned about this correlation.
However, if the bruising has not improved after such a long period of treatment, it is indeed advisable to conduct a thorough examination, such as follow-up X-rays, and if necessary, an ultrasound of the joints.
You may also want to consult your orthopedic physician to assess the need for further imaging studies.
My recommendation is to follow up with your orthopedic doctor.
As for the possibility of RA being mixed in, you can visit a rheumatologist for evaluation.
RA often presents with polyarticular involvement, and rheumatologists typically perform joint examinations to avoid missing any cases.
Regarding treatment, if the area still feels warm, you can apply ice for 1-2 days; if there is no warmth in the joints, heat therapy can be applied.
If there are no other underlying conditions, anti-inflammatory and analgesic medications should be continued for a few more days to help accelerate the resolution of local inflammation or hematoma.
The affected area should also avoid heavy physical activities to promote recovery.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2014/02/22

More Info

Hello! Thank you for your question regarding the relationship between injuries and rheumatoid arthritis (RA) symptoms. It’s understandable to be concerned about how an injury might affect your existing RA condition, especially when you are experiencing persistent swelling and pain in your thumb joints.

Rheumatoid arthritis is an autoimmune condition characterized by chronic inflammation of the joints, which can lead to joint damage and deformities over time. When an RA patient experiences an injury, such as a bruise or strain, it can complicate the existing inflammatory processes in the body. In your case, the swelling and pain in your thumb could indeed be influenced by both the injury and your underlying RA.

Injuries can exacerbate RA symptoms for several reasons. First, trauma can trigger an inflammatory response, which may lead to increased swelling and pain in the affected area. Second, if the joint was already compromised due to RA, the injury could further destabilize it, leading to more pronounced symptoms. The fact that your thumb joint remains swollen and painful after a month of conservative treatment suggests that there may be more than just a simple bruise at play.

Given your symptoms, it would be prudent to consult a rheumatologist, as they specialize in autoimmune diseases and can provide a comprehensive evaluation of your condition. They may recommend imaging studies, such as X-rays or an MRI, to assess for any potential joint damage or inflammation that might not be visible through a physical examination alone. Additionally, they may consider performing a joint aspiration (arthrocentesis) to analyze the synovial fluid in your thumb joint. This can help determine if there is an inflammatory process occurring, such as a flare-up of RA or another condition like septic arthritis.

In terms of management, while heat therapy can be beneficial for muscle relaxation and pain relief, it’s essential to balance it with other treatments. You might consider incorporating gentle range-of-motion exercises to maintain joint function, but be cautious not to overexert the injured area. Physical therapy could also be beneficial, as a therapist can guide you through exercises tailored to your specific needs and help improve your thumb's mobility without exacerbating the pain.

Moreover, if your rheumatologist determines that your RA is contributing to the ongoing symptoms, they may adjust your medication regimen. This could involve increasing the dosage of your current medications or introducing new ones, such as disease-modifying antirheumatic drugs (DMARDs) or biologics, which can help manage inflammation more effectively.

In summary, the persistent swelling and pain in your thumb joint could indeed be influenced by your RA, and it’s crucial to seek a thorough evaluation from a rheumatologist. They will be able to provide a more accurate diagnosis and appropriate treatment plan. In the meantime, continue to monitor your symptoms and avoid activities that exacerbate the pain. Your health and comfort are paramount, and addressing these concerns early can help prevent further complications. Thank you for reaching out, and I wish you a speedy recovery!

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