SUMMARY OF RHEUMATOID ARTHRITIS INCLUDING DEFINITION, CAUSES, RISK FACTORS, CLINICAL FEATURES, COMPLICATIONS, MANAGEMENT AND NURSING CARE

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by inflammation of the synovial joints leading to pain, swelling, stiffness, and progressive deformity. It commonly affects small joints symmetrically and is associated with fatigue and disability. Complications include joint destruction, deformities, nodules, and systemic involvement (lungs, heart, eyes). Management involves disease-modifying antirheumatic drugs (DMARDs), NSAIDs, corticosteroids, physiotherapy, lifestyle modifications, and surgery in severe cases. Nursing care focuses on pain relief, joint protection, promoting mobility, patient education, and psychological support

1. GROUP 6 MEMBERS
JOSHUAMUMO
RODGERSMUTHAMA
BABUH LILIAN
ANNETEONYANGO
SHEILA WANGUI
ARONROTICH

2. RHEUMATOID
ATHRITIS
•Rheumatoid arthritis is a chronic
autoimmune disorder that
causes inflammation of the
joints, leading to pain, swelling,
stiffness, and potential joint
deformity.

3. CAUSES
The exact cause is idiopathic(unknown), but several
contributing factors are recognized:
Genetic predisposition: family history of rheumatoid
arthritis.
Environmental triggers: Smoking, infections, trauma
Autoimmune reaction: immune system attacks joint tissues
leading to chronic inflammation.
Hormonal factors: RA is more common in women,
suggesting estrogen may play a role
Age and gender:commonly affects people between 30 -60
years and women are 2 -3 times more affected than men.
Life stylechanges: obesity adipose tissue secretes pro-
inflammatory cytokines worsening RA risk.

4. PATHOPHYSIOLOGY
•●RA is an autoimmune disease where the immune system
mistakenly attacks the synovial lining of the joints. In genetically
predisposed people especially those exposed to triggers such
as smoking or infection the immune system becomes
abnormally activated.Tlymphocytes release inflammatory
cytokines while b cells produce auto antibodies like rheumatoid
factor and anti-CCP antibodies. This antibodies form immune
complexes that settle in the joints, causing persistent
inflammation. Synovial membrane become swollen and thicken,
a process called synovitis. Over time, it develops into pannus, an
abnormal tissue that invades cartilage and bone. The pannus
releases enzymes and activates osteoclasts, which destroy
cartilage and bone leading to erosion, deformity and loss of
joint function. The inflammation also spreads behind the joints
causing systemic effects such as anemia, fatigue, rheumatoid
nodules, lung disease and cardiovascular problems. In this way
RA from local joint inflammation to wide spreadtissue and
organ involvement

5. CLINICAL
MANIFESTATION
•RA presents with both articular and extra-articular
symptoms:
•Articular:
•Persistent symmetrical joint pain and swelling
•Morning stiffness lasting >1 hour
•Reduced range of motion
•Joint deformities (e.g., ulnar deviation, swan-neck
fingers)
•Extra-articular:
•Fatigue, malaise, low-grade fever ● Rheumatoid
nodules
•Vasculitis, pleuritis, pericarditis
•Dry eyes/mouth (Sjögren’s syndrome)

6. DIAGNOSIS
• Is based on symptoms and
physical examination;
•X-ray joint space narrowing,
(osteophytes)
•MRI/ CT scan for details.
•Blood test to distinguish
rheumatoid from arthritis

7. MEDICAL
MANAGEMENT
•The goal is to control inflammation, prevent
joint damage, and preserve function:
•Pharmacologic:
•DMARDs: Methotrexate (first-line),
Leflunomide, Sulfasalazine
•Biologics: TNF inhibitors (Etanercept,
Adalimumab), IL-6 blockers
•NSAIDs: For pain relief
•Corticosteroids: Short-term use during flares
•Analgesics: For symptom control
•Non-pharmacologic:
•Physical therapy and occupational therapy
•Lifestyle changes: Smoking cessation, weight
control
•Surgery: Joint replacement in severe cases

8. NURSING
MANAGEMENT
•Nurses play a vital role in holistic care and patient education:
•Pain management: Administer medications, monitor effectiveness
•●Mobility support: Encourage gentle exercises, assist with ADLs
•●Education: Medication adherence, side effects, lifestyle
modifications
•●Monitor for complications: Infections, depression, medication toxicity
•●Emotional support: Help patients cope with chronic illness
•●Nutrition guidance: Promote anti-inflammatory diets
•

9. OSTEOARTHRITIS
Osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage,
leading to joint pain, stiffness, and reduced mobility.

10. OSTEOARTHRITIS

11. CAUSE
PRIMARY
1. Aging – Natural wear and tear of joints over time reduces cartilage quality.
2. Joint Overuse – Repetitive stress from work, sports, or activities
accelerates cartilage breakdown.
3. Obesity – Excess weight increases pressure on weight-bearing joints like
knees and hips.
. Genetics – Family history can increase susceptibility to cartilage
degeneration
.5. Previous Joint Injuries – Fractures or ligament tears can lead to early joint
wear
.6. Poor Joint Alignment – Abnormal joint structure causes uneven pressure
on cartilage.
7. Muscle Weakness – Weak muscles provide less support, increasing joint
stress.
8. Gender – Women, especially postmenopausal, are at higher risk due to
hormonal and biomechanical factors.
•SECONDARY
•1. Trauma or Injury – Past fractures or ligament tears can
damage joint cartilage.
•2. Inflammatory Joint Diseases – Conditions like
rheumatoid arthritis can lead to cartilage breakdown
•.3. Congenital Joint Disorders – Abnormal joint structure
from birth (e.g., hip dysplasia) increases wear.
•4. Metabolic Disorders – Diseases like hemochromatosis
or diabetes can affect joint health.
•5. Endocrine Disorders – Hormonal imbalances (e.g.,
hypothyroidism) may impact cartilage maintenance
•.6. Neuropathic Disorders – Conditions like Charcot joint
(from diabetes) reduce joint sensation and increase
damage.These causes lead to osteoarthritis secondary to
an underlying condition, unlike primary osteoarthritis,
which results from aging and wear.

12. RISK FACTORS
•Aging : usually > 45years.
•Obesity :extra weight stresses the knee and hip
joint.
•Joint injury or surgery
•Genetic predisposition; family history
•Female gender
•Occupations: involving repetitive joint stress
especially athletes or heavy labourers. ● Weak
muscles around joints.

13. PATHOPHYSIOLOGY
•OA is not just “wear and tear”—it’s a
complex biological process:
•Cartilage degradation: Chondrocytes
(cartilage cells) release enzymes that
break down collagen and
proteoglycans
•Subchondral bone changes: Bone
becomes sclerotic and forms
osteophytes (bone spurs)
•Joint space narrowing: Loss of
cartilage leads to reduced cushioning
•Inflammation: Mild synovial
inflammation contributes to pain and
stiffness
•Joint instability: Muscle weakness
and ligament laxity may develop
Y

14. CLINICAL
MANIFESTATIONS

15. S&S
OA symptoms develop
gradually and worsen
over time:
Joint pain: Worsens
with activity, relieved by
rest
Stiffness: Especially
after periods of
inactivity or in the
morning (usually <30
minutes)
Reduced range of
motion
Crepitus: Cracking or
grinding sounds during
movement
Joint deformities:
Heberden’s nodes (DIP
joints), Bouchard’s
nodes (PIP joints) ●
Swelling: Mild and non-
inflammatory

16. MEDICAL
MANAGEMENT
•The goal is to relieve symptoms, maintain function, and slow
progression:
•Pharmacologic:
•Analgesics: Acetaminophen (first-line)
•NSAIDs: Ibuprofen, naproxen for inflammation and pain
•Topical agents: Capsaicin, diclofenac gel
•Intra-articular injections: Corticosteroids or hyaluronic acid
•Supplements: Glucosamine and chondroitin (controversial
efficacy)
•Non-pharmacologic:
•Weight loss: Reduces joint stress
•Physical therapy: Strengthening and flexibility exercises
•Assistive devices: Canes, braces

17. NURSING
MANAGEMENT
•Pain assessment and management:
Monitor response to medications
•Mobility support: Encourage low-
impact exercises (e.g., swimming,
walking)
•Education: Teach joint protection
techniques and lifestyle changes
•Emotional support: Help patients
cope with chronic pain and limitations
•Fall prevention: Ensure safe home
environment
•Monitor for side effects: Especially
from NSAIDs (GI upset, renal issues)
•
•

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