Rheumatoid arthritis For G.N.M 2nd & B.Sc.2nd & 3rd Year Nursing Student.

Musculo Skeletal Disorders For Nursing Student Under Medical Surgical Nursing For G.N.M & B.Sc. Nursing.

1. Rheumatoid arthritis Mr. Kush JOshi

2. Femur

3. DEFINATION Rheumatoid arthritis is a chronic systematic autoimmune connective tissue disorder which causes symmetrical inflammation of the synovial tissue of joints and surrounding tissues, characterized by destruction and Proliferation of synovial membrane resulting in joint destruction, ankylosis ( abnormal stiffening and immobility of a joint due to fusion of the bones) and deformity. An autoimmune disorder, rheumatoid arthritis occurs when immune system mistakenly attacks own body’s tissues.

4. Etiology and risk factors Exact cause is unknown Genetic factors may be involved in determining whether they will develop rheumatoid arthritis Gender- women are more likely to develop rheumatoid arthritis than men Age- can occur at any age, but mostly begins between age 30- 60 Family history of arthritis increases the risk

5. Hormonal factors:- changes or deficiencies in certain hormone may be involved Heavy long term smoking is a very strong risk factor Infection such as bacteria, fungi, viruses esp. Epstein barr virus An immunological response Metabolic and biochemical abnormalities

6. Clinical manifestations Most of the time, rheumatoid arthritis affects joints on both sides of the body equally. Fingers, wrists, knees, feet, elbows, ankles, hips and shoulders are the most commonly affected. The disease often begins slowly. Early symptoms may include: minor joint pain stiffness fatigue

7. Joint symptoms may include: Morning stiffness, which lasts more than 1 hour, is common Joint may feel warm, tender and stiff when not used for an hour. Joint pain is often felt in the same joint on both sides of the body Joints are often swollen Over time, joints may lose their range of motion and may become deformed.

8. Other symptoms include:- Chest pain when taking a breath ( pleurisy) Dry eyes and mouth ( sjogren syndrome) Eyes burning , itching and discharge Nodules under the skin ( most often a sign of more severe disease) Numbness, tingling, or burning in the hands and feet Sleep difficulties

9. Diagnostic evaluation History collection and physical examination Two laboratory tests that are positive in most people and often help in the diagnosis are:- Rheumatoid factor Anti- CCP antibody These tests are positive in most patients with RA . The anti-CCP antibody test is more specific for RA.

10. Rheumatoid factor test RF is a blood test that measures the amount of the rheumatoid factor ( RF) antibody in the blood. Anti- CCP antibody tests It is a type of blood test that looks for anti-CCP antibody ( also called anti-citrullinated protein antibodies or ACPAs) in the blood. Other tests include:- - complete blood count - joint X- ray, ultrasound and MRI scan - joint fluid analysis

11. Management Medical management Disease modifying antirheumatic drugs (DMARDs)- Commonly used to treat moderate to severe rheumatoid arthritis. Types of medications include those used to suppress immune system ( Imuran) , antimalarial medications (plaquenil), gold preparations ( Auranofin), Penicillamine and some medications normally used to treat cancer ( Methotrexate).

12. Nonsteroidal anti inflammatory drugs Relieve pain and reduce inflammation. Ex., ibuprofen and naproxen sodium (Aleve). Corticosteroids-Ex., Triamcinolone hexacetonide Immunosuppressive drugs- Ex., azathioprine and cyclosporine

13. Surgical management Total joint replacement :- during joint replacement surgery, surgeon removes the damaged parts of joint and inserts a prosthesis made of metal and plastic Synovectomy :- Removal of joint lining. It is used to remove inflamed tissue that causes pain, it can help to reduce swelling. Tendon repair :- Inflammation and joint damage may cause tendons around joints to loosen or rupture. Surgeon may be able to repair the tendons around joints.

14. Nursing management Check vital signs Administration of medications Monitor level of pain and duration of morning stiffness Position the patient comfortably Teach the use of hot and cold application Encourage to do yoga, relaxation techniques, breathing exercises etc.. Advice the patient to balance period of activity with rest.

15. Thank you…