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Healing Choices for RA, Issue #020 --Broken bones and RA flares? Four tips
December 31, 2016

Broken bones can induce a rheumatoid arthritis flare: Four tips that may help

Fractures or broken bones in RA patients may induce a flare, indicates Koyama and colleagues in a recent article [1].

RA patients, like others, can break bones by falling, being in a traffic accident, and playing sports. Koyama et al recently wrote about a RA patient who had broken the seventh vertebra and then had a flare [1].

Koyama stated, ”…one month after treatment, her right wrist became swollen and tender. Her treatment was changed from…[increased dosage]; however, her disease activity worsened.”[1]

Do fractures induce a flare often?

Koyama et al checked the effect of fractures on RA symptoms and biomarkers in a large RA population at several centers in Japan [2]. They reviewed the hospital records of 470 patients admitted during 2011 through 2014. They compared the RA activity of 28 consecutive RA patients with bone fractures before and after bone union with RA patients without fractures.

Koyama wrote, “Sixteen patients (57%) experienced [RA] disease flare before bone union…” [1]. They defined a flare with the standard classification criteria [2].

Thus, more than half of RA patients (16 of 28) who broke a bone had developed a RA flare before the bone had healed.

How can fractures or broken bones cause a flare?

First, I have no definitive explanation, but I’ll suggest possible contributing factors.

The first step in healing bones is inflammation. After the inflammation brings in the necessary cells to stimulate repair, a healthy individual will have its osteoclasts clear out the damaged bone. The individual makes anti-inflammatory messengers from omega-3 fatty acids and sends them to the inflamed site to calm the inflammatory stage.

If the RA patient produces too much inflammation in the broken bone, the extra inflammatory cells may spill over into the blood and lodge in susceptible joints.

Maybe the RA patient does not make sufficient anti-inflammatory messengers / mediators to calm the inflammatory stage on time.

Physical trauma is associated with the onset of RA

Physical trauma, including falls, occurred in the 6 months before RA diagnosis in about 21% of patients [3].

Like healing broken bones, healing from physical trauma also involves inflammation as the first step.

Smolen and colleagues also noted that “…joint damage might be a cause of the active disease process, thus leading to a vicious cycle of events.” [4]

Four Tips that may help

First, methods that help prevent non-vertebral fractures remain important for the RA patient. Dr. Ochi encourages prevention of fractures, “regardless of the disease control in patients with RA.”[5]

We previously suggested that the type of cause of RA or RA flare affects the response to therapy.[6] We had suggested that people with sufficient essential nutrients may repair the bone or joint damage more rapidly than those with low nutrient status [6].

“Healing faster is better” is one of my modus operandi. Here are four tips that I use:

1. Eat nutrient dense foods that support healing bones. Most know the importance of calcium and vitamin D for building bones. Other nutrients such as vitamin K, several trace minerals, and magnesium also are essential for building bones. Thus, I enjoy a small 1-2 oz wedge of gouda cheese (a good source for vitamin K2), a sheet of seaweed for the trace minerals, and lots of colorful vegetables for the magnesium.

2. Walk at least 20 min a day, preferably outside. The fresh air smells good and invigorates. I personally walk my dog at least 3 times a day for 20 min—it’s good for both of us!

3. Let feet play while sitting. While writing at my desk, I allow my feet to play with a balance circle, tennis ball, or foam cylinder. My ankles move through their range of motion. The movement helps my feet and legs stay active, appears to increase their flexibility, and reduces stiffness (at least in me). It’s easier to get up and walk.

4. Boost anti-inflammatory mediators. Omega-3 fatty acids provide the building blocks for the anti-inflammatory mediators. Boost your intake of wild-caught Alaskan salmon, walnuts, and other good sources of omega-3 fatty acids and hopefully your body will make more of the anti-inflammatory mediators.

BTW, I’ve added a new page on “Why is diagnosing RA (rheumatoid arthritis) so challenging?”. Please check it out.

Wishing you and your family a very Happy, Healthy, Prosperous New Year and a rapid healing journey,


Kathy Molnar-Kimber, Ph.D.

Private consultations are available.

Please note: the information on this website is a sharing of information and knowledge from the research and experience of Dr. Molnar-Kimber and her community. It is not intended to replace your one on one relationship with a qualified health care professional. It also is not intended to be medical advice. However, it is often observed that patients who take a major interest in their disease and learn as much as they can about their disease and potential treatments often improve faster than those who don’t. Dr. Molnar-Kimber encourages you to make your own health care decisions based upon your own research and discussions with your qualified health care professional.

Selected References

1. Koyama K, Sakuma M, Ohba T, Suzuki K, Haro H: Fractures lead to worsening of disease activity in rheumatoid arthritis. Mod Rheumatol 2016:1-5.

2. van der Maas A, Lie E, Christensen R, Choy E, de Man YA, van Riel P, Woodworth T, den Broeder AA: Construct and criterion validity of several proposed DAS28-based rheumatoid arthritis flare criteria: an OMERACT cohort validation study. Ann Rheum Dis 2013, 72(11):1800-1805.

3. Al-Allaf AW, Sanders PA, Ogston SA, Marks JS: A case-control study examining the role of physical trauma in the onset of rheumatoid arthritis. Rheumatology (Oxford) 2001, 40(3):262-266.

4. Smolen JS, Aletaha D, Steiner G: Does damage cause inflammation? Revisiting the link between joint damage and inflammation. Ann Rheum Dis 2009, 68(2):159-162.

5. Ochi K, Inoue E, Furuya T, Ikari K, Toyama Y, Taniguchi A, Yamanaka H, Momohara S: Ten-year incidences of self-reported non-vertebral fractures in Japanese patients with rheumatoid arthritis: discrepancy between disease activity control and the incidence of non-vertebral fracture. Osteoporos Int 2015, 26(3):961-968.

6. Molnar-Kimber KL, Kimber CT: Each type of cause that initiates rheumatoid arthritis or RA flares differentially affects the response to therapy. Med Hypotheses 2012, 78(1):123-129.

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