Rheumatoid arthritis

Nursing Medical Surgical Topic

1. Rheumatoid arthritis

2. Definition Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that causes inflammation of connective tissue, primarily in the joints. Rheumatoid arthritis, is an autoimmune, inflammatory disease in which the immune system attacks healthy cells in the body by mistake, causing inflammation (painful swelling) in the affected parts of the body usually joints.

3. Incidence It affects 1% of the population worldwide, with a female to- male ratio between 2:1 and 4:1.

4. Etiology RA is the result of an immune response in which the body’s immune system attacks its own healthy cells. The specific causes of RA are unknown.

5. Risk Factors Age- The onset of RA is highest among adults in their sixties. Sex- New cases of RA are typically two-to-three times higher in women than men. Genetics/inherited traits- People born with specific HLA (human leukocyte antigen) class II genotypes genes are more likely to develop RA. Smoking. Multiple studies show that cigarette smoking increases a person’s risk of developing RA. Obesity. Being obese can increase the risk of developing RA.

6. Clinical Manifestations With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission. Signs and symptoms of RA include: Pain or aching in more than one joint Stiffness in more than one joint Tenderness and swelling in more than one joint Weight loss Fever Fatigue or tiredness Weakness

7. In the early stages of disease, even before bony changes occur, limitation in function can occur when there is active inflammation in the joints. Joints that are hot, swollen, and painful are not easily moved. Deformities of the hands and feet are common in RA. The deformity may be caused by misalignment resulting from swelling, progressive joint destruction.

8. Diagnostic Evaluation The history and physical examination address manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. Rheumatoid factor is present in about three fourths of patients with RA. X-rays show bony erosions and narrowed joint spaces. Elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body

9. Management There is no cure for rheumatoid arthritis. Treatment includes education, a balance of rest and exercise, and referral to appropriate community agencies (such as the Arthritis Foundation) for support. Medical management begins with therapeutic doses of salicylates or NSAIDs. Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate ( Trexall , Otrexup , others), leflunomide ( Arava ), hydroxychloroquine

10. Biological therapy- Biologic response modifiers are a group of agents that consist of molecules produced by cells of the immune system or by cells that participate in the inflammatory reactions. Surgery If medications fail to prevent or slow joint damage, then it may be required to perform surgery to repair damaged joints. It may involve the following surgeries. Synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can be performed on knees, elbows, wrists, fingers and hips.

11. Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture so the repair of the tendons can be performed. Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief. Total joint replacement.  During joint replacement surgery the damaged parts of joint are removed, and prosthesis made of metal and plastic is inserted.

12. Physical and occupational therapy- Physical and occupational therapists can design and monitor individualized activity and rest programs. Heat and cold- Heat and cold are used for their analgesic and muscle-relaxing effects. Moist heat is generally the most effective and can be provided by a tub bath or shower. Joint pain is relieved in some patients through the application of cold. Assistive devices and splints- Assistive devices, such as a cane, walker, or raised toilet seat, are most useful for patients with significant hip or knee arthritis.

13. Nursing Management Pain Assessment and management. Discuss the effects of the disease on the patient’s career and other life roles. Encourage a balance of periods of activity with periods of rest. Demonstrate a caring, accepting attitude toward the patient for disturbed body image. Discuss the Disease process and treatments, including rest and exercise, Medications, Management of stiffness and pain, Energy conservation Demonstrate Use of assistive devices to maintain independence, including self-care aids such as handheld showers, long-handled brushes and shoehorns, and eating utensils with oversized or special handles Explain Clothing options such as elastic waist pants without zippers, Explain How to apply splints and take care of skin Explain Home and equipment modifications, such as a raised toilet seat, grab bars in the bathroom.