The other day I read an interesting article that caught my attention, written by my friend Wren for RheumatoidArthritis.net: "The PTSD of RA." She wrote about RA or RD (rheumatoid disease) causing her PTSD symptoms. It's something that I've never thought about much, but it made me wonder if I, too, ever experience some of these symptoms as a result of RA. I really want to begin exploring the link between PTSD and RA more.

About PTSD

According to the National Institute for Mental Health (NIMH), Post-Traumatic Stress Disorder (PTSD) can develop after exposure to a potentially traumatic event that is beyond a typical stressor. Events that may lead to PTSD include, but are not limited to, violent personal assaults, natural or human-caused disasters, accidents, combat, and other forms of violence.1 I would also argue that personal physical injuries and physical harm caused by illness can be deeply traumatic.

According to the Mayo Clinic, symptoms of PTSD may start within one month of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships. They can also interfere with your ability to go about your normal daily tasks.2

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.2 PTSD is a complex disorder and can manifest itself in many complicated and overlapping ways.

Identifying with the symptoms

Looking through the long list of symptoms for each type of PTSD, I can definitely identify with some of them: flashbacks, unwanted distressing memories, severe emotional stress about things that remind me of the trauma, avoiding thinking or talking about the trauma, feelings of hopelessness about the future, negative thoughts about myself and others, difficulty maintaining close relationships, trouble sleeping, trouble concentrating, irritability, self-destructive behavior, guilt, shame. Many of these symptoms also result from living with chronic pain, so it's a bit complicated to know what's technically PTSD and what isn't--or if I even have it. This is something to bring up with my therapist, I realize. But I do believe that chronic pain (and illness) can be deeply traumatic, especially since it's a source of trauma that never goes away.

In her article, Wren describes a sudden and vicious attack of pain stabbing her wrist as she makes her bed. This violently painful assault on her body out of the blue immediately changes her carefree mood to one of weighed down with anxiety, fear, and upsetting memories of past debilitating flare-ups. Reading this, I was immediately reminded of something that I was just going through myself about a week ago.

Beyond broke this summer, I've begun doing some random odd jobs to help pay the bills (and put gas in the car). One of these jobs is very hard on my body: I'm helping my friend and former boss, an older and somewhat messy bachelor, by cleaning his house for him. I know I'm probably crazy to be doing this, with my constantly swollen feet and ankles and my damaged right wrist, but I honestly and rather desperately need the money. Before a day of cleaning for hours, I arm myself not only with a mop and bucket but with NSAID painkillers, ankle wraps, and a wrist brace. The wraps and the brace don't help much, admittedly.

After my first day of house cleaning, hours spent scrubbing kitchen walls and the floor wrecked havoc on my wrist--which is devoid of its cartilage thanks to RA inflammation. Feeling the all-too familiar "twinge" (as Wren puts it) reappear in my disease-battered wrist, I was immediately transported back to the years it first flared up and became damaged. During college I suffered through a too-late and unsuccessful synovectomy surgery and was forced to live with nearly unbearable pain, while also forced to wear an ugly beige wrist brace day and night. "Losing" my wrist at age 20 was incredibly traumatic. It was the first part of my body to become permanently damaged from RA and it set an always lurking sort of terror within me, afraid of which joints would be destroyed next.

When I came back home that night after an exhausting day cleaning, I immediately strapped an ice pack onto my wrist and took as much ibuprofen as safely possible. I debated upping my prednisone dose but I'm always trying so hard to get off of that drug that I didn't want to do it. The pain, though, was relentless. Sharp, throbbing jolts of agony seared through my wrist and I wanted to just cut the thing off.

The emotional pain of this flare burned even stronger, I'd argue. After thankfully enjoying several years of a strange remission of my wrist pain (I still have no idea why it suddenly got better like five years after surgery), I was thrust back into that hell. Oh my God, how could I forget what this was like? Will it go away again? Why did I do this to myself? The intense fear and guilt I felt that I had reignited my once horrendous wrist pain and inflammation gnawed at me.

Could it be PTSD?

Does my recent wrist flare-up and emotional changes/reactions sound like PTSD symptoms to you? I think they could possibly fit. Pain is traumatic. Fear of pain and disability is also traumatic. Living with the constant and cruel unpredictability of RA means that you're in a constant state of "fight or flight," bracing yourself for whatever horrible thing might attack you next.

With much relief I'm happy to report that my wrist got better and has returned to its former pre-housecleaning state. Swollen fingers also caused by hours of scrubbing bathroom walls have subsided, too (WHEW!). The pain and swelling in those joints is gone, but the anxiety remains. It's always there.

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