rhematoid arthritis ppt.ppt kano state c

Med surg

1. M.S.S.D. Rheumatoid Arthritis

2. What is Rheumatoid Arthritis?  Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune inflammatory disorder that primarily affects synovial joints, leading to persistent synovitis, progressive joint destruction, deformity, and disability. It can also involve extra-articular organs such as the lungs, heart, eyes, and skin.

3. Statistics and Incidences Rheumatoid arthritis is common worldwide. Rheumatoid arthritis affects  1%  of the population worldwide. The ratio of female to male with RA is between  2:1 and 4:1 .

4. .Classification RA is classified based on:  a) Onset Acute – rapid onset with severe symptoms. Insidious/Chronic – gradual onset, common type.   b) Course Mild RA – minimal joint involvement. Moderate RA – progressive joint destruction with functional impairment. Severe RA – extensive joint deformity, disability, and systemic manifestations. c) 2010 ACR/EULAR Classification Criteria (≥ 6 points = RA): 1. Joint involvement – number & type of joints affected. 2. Serology – Rheumatoid factor (RF), anti-CCP antibodies. 3. Acute phase reactants – ESR, CRP. 4. Duration – ≥ 6 weeks.

5. Causes Causes of Rheumatoid Arthritis The exact cause is unknown, but several factors contribute:   1. Genetic factors Family history (HLA-DR4 and HLA-DR1 gene association). Certain genes increase susceptibility.   2. Autoimmune reaction The body’s immune system mistakenly attacks the synovial membrane of joints. 3. Environmental triggers Viral or bacterial infections may initiate autoimmune activity. Smoking is a strong risk factor. Exposure to silica and other occupational hazards.   4. Hormonal factors More common in women (especially between 30–50 years), suggesting estrogen influence. 5. Other risk factors Obesity, stress, and low vitamin D levels may contribute.

6. Clinical Manifestations Clinical manifestations of RA vary, usually reflecting the stage and severity of the disease. Joint pain.  One of the classic signs, joints that are painful are not easily moved. Swelling.  Limitation in function occurs as a result of swollen joints. Warmth.  There is warmth in the affected joint and upon palpation, the joints are spongy or boggy. Erythema.  Redness of the affected area is a sign of inflammation. Lack of function.  Because of the pain, mobilizing the affected area has limitations. Deformities.  Deformities of the hands and feet may be caused by misalignment resulting in swelling. Rheumatoid nodules.  Rheumatoid nodules may be noted in patients with more advanced RA, and they are non tender and movable in the subcutaneous tissue.

7. Pathophysiology Pathophysiology Autoimmune reaction triggered by genetic (HLA-DR4, HLA-DR1) and environmental factors. Synovial membrane inflammation → infiltration of immune cells (T-cells, B-cells, macrophages). Pannus formation (granulation tissue of fibroblasts and inflammatory cells) invades cartilage and bone. Release of cytokines (TNF-α, IL-1, IL-6) → cartilage destruction, bone erosion, and joint deformity. Leads to ankylosis (fusion) in late disease.

8. Assessment and Diagnostic Findings Diagnosis is based on history, clinical findings, lab tests, and imaging. a) History & Clinical Features Symmetrical joint pain, swelling, and stiffness (worse in morning > 1 hr ). Small joints (MCP, PIP, wrists, MTP) commonly affected. Fatigue, malaise, weight loss. 

9. Assessment and Diagnostic Findings b) Laboratory Tests Rheumatoid Factor (RF) – positive in ~70%. Anti-CCP antibodies – highly specific. ESR & CRP – elevated in active disease. CBC – anemia of chronic disease, leukocytosis, thrombocytosis.

10. Assessment and Diagnostic Findings c) Imaging X-ray: joint space narrowing, bone erosions. MRI/Ultrasound: early synovitis and erosions. 

11. Complications Joint deformities – ulnar deviation, swan neck, boutonniere deformity. Ankylosis – fusion of joints. Rheumatoid nodules (subcutaneous, extensor surfaces). Extra-articular manifestations: Vasculitis Interstitial lung disease Pericarditis, myocarditis Scleritis, keratoconjunctivitis sicca Felty’s syndrome (RA + splenomegaly + neutropenia) Functional disability and reduced quality of life.

12. Medical Management a) Pharmacological NSAIDs – for pain and inflammation. Glucocorticoids – short-term control of severe inflammation. DMARDs (Disease Modifying Anti-Rheumatic Drugs): Methotrexate (first-line) Leflunomide Hydroxychloroquine Sulfasalazine   Biologic agents: Anti-TNF (Etanercept, Infliximab, Adalimumab) IL-6 inhibitors (Tocilizumab) B-cell therapy (Rituximab) JAK inhibitors (Tofacitinib, Baricitinib).

13. Medical Management b) Non-pharmacological Rest during flares, exercise/physiotherapy, splints, occupational therapy.

14. Surgical Management Indicated in severe joint destruction or functional disability. Options: Synovectomy – removal of inflamed synovium. Arthroplasty (Joint replacement) – hip/knee replacement. Arthrodesis – joint fusion to relieve pain and stabilize joint. Tendon repair – in case of tendon rupture.

15. Nursing Management Nursing Management Assessment – pain, joint mobility, functional ability, emotional status. Pain management – NSAIDs, hot/cold application, relaxation techniques. Promote mobility – physiotherapy, ROM exercises, use of assistive devices. Prevent deformity – splints, positioning. Education – medication adherence, lifestyle modification, energy conservation. Psychosocial support – coping strategies, support groups. Monitor complications – infections (due to immunosuppressive therapy).

16. Nursing Diagnosis Bases on the assessment data, the major nursing diagnoses appropriate for the patient are: Acute and chronic pain  related to inflammation and increased disease activity, tissue damage, fatigue, or lowered tolerance level. Fatigue  related to increased disease activity, pain, inadequate sleep/rest, deconditioning , inadequate nutrition, and emotional stress/depression Impaired physical mobility  related to decreased range of motion, muscle weakness, pain on movement, limited endurance, lack or improper use of ambulatory devices. Self-care deficit related to contractures, fatigue, or loss of motion. Disturbed body image related to physical and psychological changes and dependency imposed by chronic illness. Ineffective coping  related to actual or perceived lifestyle or role changes.

17. Complications Medications used for treating rheumatoid arthritis may cause serious and adverse side effects. Bone marrow suppression.  Improper use of immunosuppressants could lead to bone marrow suppression. Anemia.  Immunosuppressive agents such as  methotrexate  and  cyclophosphamide  are highly toxic and can produce anemia. Gastrointestinal disturbances.  Some  NSAIDs  are likely to cause gastric irritation and ulceration.

18. Discharge and Home Care Guidelines Patient teaching is an essential aspect of discharge and home care. Disorder education.  The patient and family must be able to explain the nature of the disease and principles of disease management. Medications.  The patient or caregiver must be able to describe the medication regimen (name of medications, dosage, schedule pf administration, precautions, potential side effects, and desired effects. Pain management.  The patient must be able to describe and demonstrate use of pain management techniques. Independence.  The patient must be able to demonstrate ability to perform self-care activities independently or with assistive devices.