RHEUMATOID ARTHRITIS

What is RA?
A Chronic,
systemic inflammatory disease,
characterised by symmetrical
joint involvement which is
typically erosive/destructive.
hallmark feature: persistent
symmetric polyarthritis (synovitis)
Recap on the anatomy and physioIogy
Function of JOINTS:
W To aIIow articuIation between two
or more bones and
W secondariIy to permit movement
by contraction of opposing
muscIes.
WUnknown
W Genetic
W Autoimmune
EtioIogy
!athophysioIogy
Antigen ÷
Environmental agent, infectious agent
Activates CD4 helper
T cells and probably
B lymphocytes
T cells stimulates
synovial macrophage
and fibroblast
Activates
B lymphocytes
Genetic
Susceptibility
HLA-DR4
HLA-DQ
HLA- DP
Cytokines
!athophysioIogy
Pannus formation
Joint destruction
Cartilage fibrosis
Ankylosis
Joint injury
RANKL
Activates
osteoclast
Formation of
rheumatoid
factor
Formation of
autoimmune complexes
and probable deposition
in the joint
Cytokines
Fibroblast
Chondrocytes
Synovial cells
Enzymes release
(collagenase, streptomelysin,
elactase, PGE2 and matrix
metalloproteinases, others)
T cells stimulates
synovial macrophage
and fibroblast
Activates B lymphocytes
Proliferation
INTERLEUKIN 1
IL-1 is a potent stimuIator of synoviocytes,
chondrocytes and osteobIasts (Figure 1).
IL-1 is a proinfIammatory cytokine that ampIifies
and perpetuates the disease process in RA
1. arthritis
IinicaI Manifestations
Associated with
Wlow fever
WFatigue
Worning stiffness
WJoint soft, warm to
touch
IinicaI Manifestations
. extra-articular features
. Associated syndromes
(possible complications)
IinicaI Manifestations
(a) Sjögren's syndrome-saIivary gIand
infIammation and keratoconjunctivitis
(b) FeIty's syndrome-profound neutropenia,
thrombocytopenia and splenomegaly
(C) Pulmonary involvement-(pleuritis, interstitial
pneumonitis, alveolitis and intrapulmonary
rheumatoid nodules)
(d) Cardiac involvement-pericarditis
ns
Diagnnostic criteria
1. Morning stiffness Iasting more than
1 hour
2. Arthritis of 3 or more joint areas.
3. Arthritis of the hand joints
4. Symetric arthritis
5. Rheumatoid noduIes over extensor
surface or bony prominences.
6. Serum rheumatoid factor.
7. RadioIogic changes.
W oligoarticular JIA
WPolyarticular JIA
WSystemic JIA
Types of JIA
. Acute Pain r/t inflammation & swelling
2. Fatigue r/t increased metabolic rate
3. Ìmpaired physical mobility r/t decreased
range of motion
4. Disturbed body image r/t physical &
psychological changes
Nursing Diagnosis:
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