RHEUMATOID ARTHRITIS

A. Description 1. Rheumatoid arthritis is a chronic systemic inflammatory disease (immune complex disorder); the cause may be related to a combination of environmental and genetic factors. 2. The name is derived from the Greek rheumatos meaning "flowing," the suffix oid meaning "in the shape of," arthr meaning "joint" and the suffix -itis, a "condition involving inflammation." 3. Rheumatoid arthritis leads to destruction of connective tissue and synovial membrane within the joints. 4. Rheumatoid arthritis weakens the joint, leading to dislocation and permanent deformity of the joint. 5. Pannus forms at the junction of synovial tissue and articular cartilage and projects into the joint cavity, causing necrosis. 6. Exacerbations of disease manifestations occur during periods of physical or emotional stress and fatigue. 7. Risk factors include exposure to infectious agents. 8. Vasculitis can impede blood flow, leading to organ or organ system malfunction and failure caused by tissue ischemia. 9. It is more common in women than in men, the women / men ratio is 3 / 1, and most often is diagnosed between 35 and 50 years.

B. Assessment 1. Inflammation, tenderness, and stiffness of the joints 2. Moderate to severe pain with morning stiffness lasting longer than 30 minutes 3. Joint deformities, muscle atrophy, and decreased range of motion in affected joints 4. Spongy, soft feeling in the joints 5. Low-grade temperature, fatigue, and weakness 6. Anorexia, weight loss, and anemia 7. Elevated ESR and positive rheumatoid factor 8. Radiographic study showing joint deterioration 9. Synovial tissue biopsy reveals inflammation

* * C. Values a. although many patients are treated despite not meeting the criteria. The doctor may order the following tests: * Blood tests. This test may be used early in the course of the disease to help make a diagnosis and separate the condition (rheumatoid arthritis) from other possible problems that affect the bones and joints. If arthritis of any kind is suspected. and a positive test does not necessarily mean rheumatoid arthritis). (Higher levels of these factors are also found in a number of other chronic conditions. and each must be considered and ruled out before a diagnosis can be made. Rheumatoid factor 1. only the swelling of the soft tissues around the joint can be seen. * X-rays. as well as other kinds of arthritis. As the disease condition progresses.* How is Rheumatoid Arthritis Diagnosed? To diagnose rheumatoid arthritis. Blood test used to diagnose rheumatoid arthritis 2. These may show a higher than normal level of antibodies called rheumatoid factors. a specialist who is trained to recognize and treat rheumatoid arthritis. During the first months of the disease. the patient is referred to a rheumatologist. There are a number of forms of arthritis. * MRI. there may be a narrowing of the space in which the joints move and damage to the ends of the bones. * The American College of Rheumatology has defined (1987) the following criteria for the diagnosis of rheumatoid arthritis * Morning stiffness of >1 hour * Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups * Arthritis of hand joints * Symmetric arthritis * Subcutaneous nodules in specific places * Rheumatoid factor at a level above the 95th percentile * Radiological changes suggestive of joint erosion At least four criteria have to be met to establish the diagnosis. Nonreactive: 0 to 39 international units/mL . a doctor will perform a physical examination and discuss the symptoms. * Samples of synovial fluid.

F. and then gold or penicillamine. anti inflammatories. Weakly reactive: 40 to 79 international units/mL c. corticosteroids are reserved for acute inflammation. followed by the addition of NSAIDs.b. as ordered 2. Pathophysiology E. an oral chelating agent. Pain relief: Corticosteroids. Administer analgesics and other medications. if possible. analgesics. Plan/Implementation 1. as ordered and observe for aspirin toxicity (tinnitus. aspirin is the DOC. Reactive: greater than 80 international units/mL D. bleeding) and other adverse effects of the medications . and immunosuppressive drugs. Teach the client to take the medications.

 Instruct the client to use only a small pillow when lying down.  Instruct the client to sit in a chair with a high. removal of the synovial membrane from a joint using an arthroscope to reduce pain. H.  Instruct the client in measures to protect the joints.  Review the prescribed exercise program. straight back. Positive Outcomes  Experiences a reduction in pain  Completes daily activities using supportive devices. Encourage the use of supportive devices to help the client conserve energy and maintain independence 10. 2. vegetables. but incorporate rest periods to prevent fatigue 7. Apply heat and cold. recognizing that some discomfort is always present 6. as needed  Accepts a lifestyle consistent with his/her abilities  Maintains or improves the ROM of his/her involved joints I.  Instruct the client in the correct use of assistive or adaptive devices.  Instruct the client in energy conservation measures. Surgical interventions 1.  Stress the importance of follow-up visits with the health care provider.3. whole grains. Emphasize the need to remain active. Synovectomy: Surgical removal of the synovia to help maintain joint function . Client Education for Rheumatoid Arthritis and Degenerative Joint Disease  Assist the client to identify and correct safety hazards in the home. Encourage the client to verbalize his/her feelings 8. heat paraffin to 52-52 degree Celsius 4. Promote rest and proper position to ease joint pains 5.  Instruct the client regarding the prescribed medications. Provide for ROM exercise up to the point of pain. focusing on the client’s strengths 9. Arthrodesissurgical removal of cartillage from joint surfaces to fuse a joint into a functional position to regain some mobility . as ordered. and legumes to improve and maintain the ideal nutritional status and to compensate for the nutrient interactions of corticosteroid and other treatment medications G. Provide care for the client following joint replacement 11. Encourage a diet rich in nutrient-dense foods such as fruits. Help set realistic goals.

Joint replacement (arthroplasty): Surgical replacement of diseased joints with artificial joints. so that the damaged parts are not moving against each other J. performed to restore motion to a joint and function to the muscles. and other soft tissue structures that control a joint 4.3. ligaments. Nursing dx:  Activity intolerance related to pain and swelling of joints  Chronic pain related to inflammation of joints  Disturbed body image related to arthritic joints  Ineffective health maintenance related to lack of mobility  Altered family process  Fear  Risk for injury  Self care deficit  Sexual dysfunction  Situational low self esteem  Risk for impaired skin integrity . Fusion of joints.

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