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The term “post-traumatic arthritis” (PTA) refers to the onset of arthritis following a prior joint injury, months or years before.
PTA is estimated to occur in approximately 12 percent or more of cases. Degenerative arthritis (osteoarthritis) is the most common, but rheumatoid arthritis or other inflammatory types of arthritis may also be triggered by a prior injury.
Symptoms include swelling, inflammation, pain, tenderness, structural damage to the joint (e.g., torn meniscus or rotator cuff tear), and bleeding inside the joint. While there may be a full recovery in many patients, if joint pain continues >6 months, it may result in the development of chronic PTA.
An injury to a joint immediately triggers inflammatory cellular and biochemical changes. They include the release of inflammatory cytokines, notably interleukin-1 (IL-1), which recruits other pro-inflammatory cytokines into the joint. While these inflammatory changes are often self-limited, they can become sustained and persistent, resulting in chronic intra-articular (inside the joint) inflammation. [Ref: Punzi L, et al. “Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation.” BMJ, 2016.]
Asignificant injury to a joint may also trigger inflammation in uninjured joints, resulting in a chronic inflammatory arthritis, such as rheumatoid arthritis. [Ref: Brawer, A and Gopel, N. “The onset of rheumatoid arthritis following trauma.” Open Access Rheumatol. 2016; 8: 77–80.]
The American Academy of Orthopedic Surgeons (AAOS) estimates that “as many as 15 percent of people who have been diagnosed with osteoarthritis may have developed joint problems as a result of injury.” According to the AAOS, “damaging a joint raises your chances of developing arthritis sevenfold … many years after the initial injury.”
In a case-control study, 21% of patients with rheumatoid arthritis reported significant physical trauma in the 6 months before the onset of their disease, compared with only 6.5% of the controls. The authors concluded that “physical trauma in the preceding 6 months is significantly associated with the onset of rheumatoid arthritis.” [Ref:Al‐Allaf, A, et al. “A case–control study examining the role of physical trauma in the onset of rheumatoid arthritis.” Oxford Rheumatol. 2001; 40:3: 262–266.]
Isolated injury to a joint may be a significant factor in triggering osteoarthritis (more common) or rheumatoid arthritis (less common), but it doesn't “cause” arthritis because arthritis often occurs without trauma, and the real “cause” of arthritis is unknown.
Cumulative injury to a joint from repetitive trauma that occurs over months to years can lead to (or aggravate) degenerative arthritis.
Arthritis may become disabling when it causes pain, stiffness, or loss of motion (range of motion). For example, in a study of 460 patients with loss of motion in one or more joints due to arthritis, impaired shoulder abduction (moving the arm away from the body) had the highest impact on disability; impaired elbow flexion-extension significantly affected activities of daily living (ADL) such as dressing; decreased wrist flexion-extension impaired the ability to reach; and decreased hip or knee flexion-extension was a major limitation in walking. [Ref: Kojima T, et al. “Characteristics of functional impairment in patients with long-standing rheumatoid arthritis based on range of motion of joints: Baseline data from a multicenter prospective observational cohort study to evaluate the effectiveness of joint surgery in the treat-to-target era.” Mod Rheumatol. 2018 May;28(3):474-481.]
In addition to disability related to loss of motion, pain from arthritis in one or more joints can be completely disabling. In 1931, the French medical missionary Dr. Albert Schweitzer reminded us of that when he wrote, "Pain is a more terrible lord of mankind than even death itself." For example, back pain can limit the ability to sit, and if the most a person can sit is <6 hours (in an 8-hour day), that may preclude working at even a desk job (“less than sedentary”).
While pain is your body's normal reaction to an injury or illness, the pain associated with arthritis no longer serves a useful purpose when it becomes severe, chronic, and disabling.
At Law Med, we are knowledgeable and experienced in Social Security Disability (SSDI) and Long-Term Disability (LTD) claims governed under ERISA.