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rheumatoid arthritis

rheumatoid arthritis

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Published by jamillium
This is a complete note on rheumatoid arthritis which I have presented in one of my classes at Philippine Orthopaedic Centre.
This is a complete note on rheumatoid arthritis which I have presented in one of my classes at Philippine Orthopaedic Centre.

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Published by: jamillium on Feb 12, 2010
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a kind of rheumatoid arthritis that affects children usually between six ti sixteen years of age
also known as juvenile idiopathic arthritis because its cause is unknown unlike adult rheumatoidarthritis
Predisposing Factors
An immune system that is too active and attacks joint tissues.
Viruses or other infections that cause the immune system to attack joint tissues.
Having certain genes that make the immune system more likely to attack joint tissues.
Clinical Manifestation
 joint pain
 joint swelling
 joint stiffness
trouble in sleeping
 problems in walking
Oligoarticular JRA
, which affects four or fewer joints. Symptoms include pain, stiffness, or swelling in the joints. The knee and wrist joints are the most commonly affected. Aninflammation of the iris (the colored area of the eye) may occur with or without active jointsymptoms. This inflammation, called iridocyclitis, iritis, or uveitis, can be detected early by anophthalmologist.2.
Polyarticular arthritis
, which affects more girls than boys. Symptoms include swelling or painin five or more joints. The small joints of the hands are affected as well as the weight-bearing joints such as the knees, hips, ankles, feet, and neck. In addition, a low-grade fever may appear,as well as bumps or nodules on the body on areas subjected to pressure from sitting or leaning.3.
Systemic JRA,
which affects the whole body. Symptoms include high fevers that often increasein the evenings and then may suddenly drop to normal. During the onset of fever, the child mayfeel very ill, appear pale, or develop a rash. The rash may suddenly disappear and then quicklyappear again. The spleen and lymph nodes may also become enlarged. Eventually many of the body's joints are affected by swelling, pain, and stiffness.
Diagnostic Procedures
To diagnose JRA, the doctor will take a detailed medical history and conduct a thorough physical examination. The doctor may order X-rays or blood tests to exclude other conditions that can produce similar symptoms.Other tests that may be done include:
III Bachelor of Science in NursingCavite State University
, a common blood test used to evaluate all the basic cellular components of blood, including red blood cells, white blood cells, and platelets. Abnormalitiesin the numbers and appearances of these cells can be useful in the diagnosis of many medicalconditions.
, a test to detect bacteria that cause infections in the bloodstream. This may bedone to rule out infections.
Bone marrow examination
, a test that allows doctors to look at blood where it's formed (in the bone marrow) to rule out conditions such as leukemia.
Erythrocyte sedimentation rate
, which checks how rapidly red blood cells settle to the bottomof a test tube. This rate often increases in people when inflammation is occurring in the body.
A test for rheumatoid factor
, an antibody produced in the blood of children with some formsof JRA. But it's much more commonly found in adults with rheumatoid arthritis.
ANA (antinuclear antibody)
, a blood test to detect autoimmunity. It's also useful in predictingwhich children are likely to have eye disease with JRA.
A bone scan
, to detect changes in bone and joints to evaluate the causes of unexplained boneand joint pain.
Treatment begins with a multidisciplinary approach. A number of factors must be consideredwhen one plans treatment. The specific diagnosis must be established first. Thereafter, psychosocialfactors should be assessed, and long-term prognoses should be explained and discussed with the parent.A comprehensive treatment plan involves a therapist, a clinician, and a surgeon workingtogether. The physician must keep in mind the adverse effects of therapy while starting and maintainingmedical treatment. Because of the special problems encountered in young and unique patient populations—notably their different functional and rehabilitation needs—surgical options must be planned well. Results in pediatric patients may vary from those observed in adults with RA.Given the principles described above, the management of JRA must focus on the following areas
Psychosocial factors - Including counseling for patients and parents
Medical care - Use of nonsteroidal anti-inflammatory drugs (NSAIDs) and immunosuppressants
School performance - Academic counseling, school-life adjustments, physical educationadjustments
 Nutrition - Particularly to address anemia and generalized osteoporosis
Physical therapy - To relieve pain and to address range of motion, muscle strengthening,activities of daily living, and conditioning exercises
Occupational therapy - Including joint protection, a program to relieve pain, range of motion,and attention to activities of daily living
Specific indications for referral to a pediatric rheumatologist
III Bachelor of Science in NursingCavite State University
Referral to a pediatric rheumatologist may be indicated when the following situations arise
Unclear diagnosis
Unexplained fever 
Loss of function
Regression of physical skills with an inability to attend school
 Normal laboratory findings but clinically significant local signs
Abnormal laboratory findings but a clinical picture that does not fit that of arheumatologic disorder 
Unexplained physical findings of joint involvement, fever, and rash
 Need for diagnostic evaluation and long-term management of childhood rheumatologic andconnective tissue disorders, including JRA and spondyloarthropathies
 Need to confirm the diagnosis listed below and to help formulate treatment:
Reactive (postinfectious) arthritis
Other diagnoses
 Need to evaluate a diagnostic or treatment plan for an autoimmune disorder associated withother primary diseases (eg, immunodeficiency, cancer)
Desire for a second opinion or confirmatory evaluation (eg, when a primary care physicianrequests an expert opinion because the family requires information from a subspecialist to copewith the patient's disease process, to accept the treatment plan, to allay anxiety, and/or to receiveeducation)
Goals of Medical Therapy
 The ultimate goals in managing RA are to prevent or control joint damage, to prevent loss of function,and to decrease pain. These goals are particularly important in JRA, for which the rate of progressionand the onset of debility can be rapid.Complete remission is a condition wherein the following criteria are met
 No inflammatory joint pain
 No morning stiffness
 No fatigue
 No synovitis
 No progression of damage, as determined in sequential radiographic examinations
 No elevation of the ESR and CRP levels
Modes of Medical Therapy
 Rest and splinting 
: The mainstay of all therapy in the acute phase is rest and splinting to relieve pain. Splinting may be alternated with traction. These methods not only relieve pain but alsoallow for early recovery.
 Range-of-motion exercises and hydrotherapy
Range of motion should be instituted to maintain nutrition of the cartilage. At the same
III Bachelor of Science in NursingCavite State University

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