Rheumatoid Arthritis.The initial goal of therapy is to control and halt the infective process.

The initial goal of therapy is to control and halt the infective process.

1. Rheumatoid Arthritis اعداد الطالب: احمد شاكر احمد العباسي اشراف: أ.د. حسين هادي عطيه

2. Objectives: At the end of this presentation the student will be able to: Define rheumatoid arthritis. Explain the causes. Understand the pathophysiology. Identify clinical manifestation. Identify the diagnosis procedures. Clarify the medical and nursing intervention. Compare between types of arthritis.

3. Definition: Rheumatoid arthritis (RA) is a chronic, progressive, systemic inflammatory disease that destroys synovial joints and other connective tissues, including major organs.

4. Causes: Genetic factors Environmental / Lifestyle risk factors: Smoking, Obesity Hormonal influences: RA is more common in women; pregnancy modulates disease activity; retrospective data on estrogen/prolactin Immune / Autoimmunity Possibly microbiome alterations (gut, mouth, lung) are increasingly seen as relevant.

5. Pathophysiology: Genetic & Environmental Susceptibility Initiation & Loss of Self-Tolerance / Autoimmunity Synovial Inflammation and Pannus Formation Cytokines & Mediators of Inflammation Cartilage and Bone Destruction

6. stages of RA:

7. Clinical manifestation I Onset and Course: Usually insidious onset: gradual development of joint pain, stiffness, swelling. Joint-related Symptoms: Pain : Tender joints, particularly affecting small joints of the hands (MCPs and PIPs), wrists, feet. Worsened by movement. Swelling : Synovial inflammation produces swelling, soft tissue swelling around joints Morning stiffness : Particularly characteristic; stiffness in/around joints lasting often 30 minutes or more Symmetry : Joint involvement tends to be symmetrical—similar joints on both sides of the body.

8. Clinical manifestation II Deformities and Physical Signs (with longstanding disease): Classic hand deformities: swan-neck deformity, boutonnière deformity (“button-hole” deformity), Z-thumb, ulnar deviation at MCP joints. Soft-tissue changes: synovial swelling, effusions; possibly subluxation (e.g. dorsal subluxation of the ulna at the distal radioulnar joint).

9. Clinical manifestation III Extra-articular / Systemic Features: Rheumatoid nodules : Subcutaneous nodules over extensor surfaces; may also occur in lung pleura, pericardium, sclera. General symptoms : Fatigue, malaise, possibly weight loss, occasionally low‐grade fever. Pulmonary : Interstitial lung disease (fibrosis), pleural effusions, pulmonary nodules.

10. Diagnostic procedures I Clinical Evaluation: History & physical exam remain central. Diagnosis is suggested by: Symmetrical, small-joint polyarthritis (especially MCP, PIP, wrists, MTP). Morning stiffness lasting >30 minutes. Symptoms >6 weeks duration. Extra-articular features (nodules, systemic symptoms).

11. Diagnostic procedures II Laboratory Tests: Inflammatory markers: ESR and CRP are usually raised but are nonspecific. Autoantibodies: Rheumatoid factor (RF): Positive in ~70% of patients, but not specific. General blood tests: Normocytic, normochromic anemia of chronic disease. Thrombocytosis, leukocytosis possible in active disease.

12. Diagnostic procedures III Imaging: X-rays (hands, wrists, feet early on): Early findings: periarticular soft-tissue swelling, osteopenia near affected joints. Later: joint space narrowing, marginal erosions, deformities. Ultrasound : Sensitive for detecting synovitis, effusion, and erosions earlier than plain radiographs. MRI : Very sensitive; shows synovitis, bone marrow edema, early erosions. Used in research or difficult cases.

13. Diagnostic procedures IV Synovial Fluid Analysis: Aspiration from swollen joints may show: Turbid, inflammatory fluid with high leukocyte count (mainly neutrophils). Helps exclude crystal arthropathies (gout, pseudogout) and septic arthritis.

14. Medical management I Pharmacological Management: Disease-Modifying Antirheumatic Drugs (DMARDs): Methotrexate, sulfasalazine, leflunomide, hydroxychloroquine. TNF inhibitors: infliximab, etanercept, adalimumab, rituximab. Glucocorticoids NSAIDs & Analgesics

15. Medical management II Non-Pharmacological Management: Physiotherapy & occupational therapy: to maintain joint mobility, muscle strength, function. Patient education & support: lifestyle advice, fatigue management. Orthoses/splints: for painful joints. Smoking cessation & weight management (important modifiable risk factors). Surgical Options (for severe, refractory cases) Synovectomy, tendon repair, joint replacement (hip, knee).

16. Nursing management I Assessment: Monitor pain intensity, stiffness, and joint function daily. Assess ability to perform activities of daily living (ADLs). Observe for fatigue, sleep disturbances, and psychosocial stress. Monitor for side effects of medications (DMARDs, steroids, NSAIDs). Check for extra-articular symptoms (nodules, lung/cardiac complications).

17. Nursing management II Pain & Symptom Management Administer prescribed analgesics, NSAIDs, DMARDs, or corticosteroids . Apply heat (warm packs, baths) for stiffness; cold packs for acute inflammation. Encourage rest during acute flares , but balance with activity to prevent stiffness. Support use of splints or assistive devices to reduce pain and prevent deformities.

18. Nursing management III Maintaining Mobility & Function: Encourage range-of-motion (ROM) exercises to maintain flexibility. Collaborate with physiotherapy and occupational therapy for tailored exercise and joint protection techniques. Teach energy-conservation strategies (pacing activities, frequent rest breaks). Promote independence in self-care with adaptive devices (special grips, raised toilet seats, etc.).

19. Nursing management IV Psychological & Emotional Support: Provide emotional support — RA is chronic, progressive, and may cause depression/anxiety. Encourage support groups and counseling. Involve family in care planning to reduce role strain.

20. Nursing management V Education: Explain the disease process and importance of early, consistent treatment . Teach about medication regimen, side effects, and need for regular monitoring (e.g., methotrexate requires CBC/LFT monitoring). Stress the importance of smoking cessation, balanced diet, weight control . Teach proper joint protection : avoid excessive strain, use correct body mechanics.

21. Comparison:

22. REFERNCES: Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer Health.

23. Thank you for listening لا وجود لمعرفة بريئة: كل معرفة مشروطة بزمانها، ومكانها، وغايات من يسعى إليها نيتشه