Doctor Gets Plant Thorn Arthritis (cont.)

I must at this point explain that I am an arthritis expert (a rheumatologist) and, while I had known about plant thorn arthritis, I had never seen a case. The development of the inflammation in the joint of plant thorn arthritis is a slow process that involves certain immune cells that gradually accumulate in the joint lining tissue (synovium). This immune response to the foreign material (thorn matter) within the joint is referred to as a foreign body granulomatous reaction. It is not as acutely inflamed with warmth and redness as is a bacterial infection, but it is just as dangerous and destructive to the joint, although slower. There is only one treatment for this form of arthritis -- surgically removing the inflamed tissue and all plant matter within the joint.

So, resigned to the facts of my miserable reality, I consulted with a true expert hand surgeon, Neil Jones, MD, professor of orthopedic surgery and director of the UC Irvine Hand Center at the University of California, Irvine Medical Center. We arranged a surgery date a week later and, after regional anesthesia "deadened" my right arm and with light general anesthesia, he opened my knuckle and removed the angry, inflamed tissue as well as a 1 millimeter thorn fragment! That tiny little beast was inflaming my joint and causing my misery.

Pathology photo showing multinucleated giant cell granulomatous reaction (triangle point), synovial hyperplasia, fibrosis, and adjacent foreign vegetable matter (arrow with thorn fragments) with H&E stain.
Pathology photo showing multinucleated giant cell granulomatous reaction (triangle point), synovial hyperplasia, fibrosis, and adjacent foreign vegetable matter (arrow with thorn fragments) with hematoxylin and eosin stain (H&E stain). Kindly provided by Xiaohui (Sheila) Zhao, MD, PhD, of the Department of Pathology and Laboratory Medicine, University of California, Irvine Medical Center.

Pathology photo showing thorn material (blue and yellow birefringent material) visualized under polarized light microscopy.
Pathology photo showing thorn material (blue and yellow birefringent material) visualized under polarized light microscopy. Kindly provided by Xiaohui (Sheila) Zhao, MD, PhD, of Department of Pathology and Laboratory Medicine, University of California, Irvine Medical Center.

Intraoperative photos of the author's right third metacarpophalangeal joint
With permission, these are intraoperative photos of the author's right third metacarpophalangeal joint exposing inflamed joint lining tissue (synovium) from which a 1 mm thorn tip from the common palm tree Phoenix roebelenii was surgically resected. Kindly provided by Gabriel Trainer, MD, and Neil Jones, MD, orthopedic hand surgery, University of California, Irvine Medical Center.

Photos of joint lining tissue resected from author's right third metacarpophalangeal joint
With permission, photos of joint lining tissue (yellowish synovium) resected from author's right third metacarpophalangeal joint after thorn puncture with 1 mm thorn tip (dark dot on thorn covered with joint lining tissue) from the common palm tree Phoenix roebelenii. Surgical resection of the inflamed tissue (synovitis), as well as all thorn fragments, is the key to curing plant thorn arthritis (plant thorn synovitis). Kindly provided by Gabriel Trainer, MD, and Neil Jones, MD, orthopedic hand surgery, University of California, Irvine Medical Center.

I had to keep my hand dry and elevated for the next five days. Then it was up to me to aggressively work the joint by moving it as much as possible to regain the range of motion and power. The stitches came out in 13 days. While I am still in the midst of rehabilitating my hand, I anticipate a complete recovery.

I recommend great caution when working around thorny plants. In spite of the fact that I had work gloves on, the palm thorn was sharp enough to easily pierce the glove material and puncture my hand without me actually noticing that I had been stabbed!

I must express my sincere gratitude for the wonderful professional care that I received from my rheumatologists, Catherine Driver, MD, Al Wehrle, MD, and Hernan Castro-Rueda, MD, from my internist, Don Pratt, MD, from my surgeons, Neil Jones, MD, and Gabriel Trainer, MD, and from my hospitals University of California, Irvine Medical Center and Mission Hospital in Mission Viejo, California.


Last Editorial Review: 1/19/2011 3:41:58 PM



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