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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 physiology Function of JOINTS: To allow articulation between two or more bones and secondarily to permit movement by contraction of opposing muscles.

Etiology

Unknown Genetic Autoimmune

Pathophysiology
Antigen Environmental agent, infectious agent
Genetic Susceptibility
HLA-DR4 HLA-DQ HLA- DP

Activates CD4 helper T cells and probably B lymphocytes Cytokines

T cells stimulates synovial macrophage and fibroblast

Activates B lymphocytes

Pathophysiology
T cells stimulates synovial macrophage and fibroblast
Activates B lymphocytes

RANKL Cytokines Activates osteoclast Proliferation

Formation of rheumatoid factor


Formation of autoimmune complexes and probable deposition in the joint

Fibroblast Chondrocytes Synovial cells


Enzymes release (collagenase, streptomelysin, elactase, PGE2 and matrix metalloproteinases, others)

Joint injury
Pannus formation Joint destruction Cartilage fibrosis Ankylosis

INTERLEUKIN 1
IL-1 is a potent stimulator of synoviocytes, chondrocytes and osteoblasts (Figure 1).

IL-1 is a proinflammatory cytokine that amplifies and perpetuates the disease process in RA

Clinical Manifestations
1. arthritis
Associated with low fever

Fatigue
Morning stiffness Joint soft, warm to touch

Clinical Manifestations

2. extra-articular features

Clinical Manifestations
3. Associated syndromes (possible complications)
(a) Sjgrens syndrome-salivary gland inflammation and keratoconjunctivitis (b) Feltys syndrome-profound neutropenia, thrombocytopenia and splenomegaly (C) Pulmonary involvement-(pleuritis, interstitial pneumonitis, alveolitis and intrapulmonary rheumatoid nodules) (d) Cardiac involvement-pericarditis

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Diagnnostic criteria
1. Morning stiffness lasting more than 1 hour 2. Arthritis of 3 or more joint areas. 3. Arthritis of the hand joints 4. Symetric arthritis 5. Rheumatoid nodules over extensor surface or bony prominences. 6. Serum rheumatoid factor. 7. Radiologic changes.

Types of JIA

oligoarticular JIA Polyarticular JIA Systemic JIA

Nursing Diagnosis:
1. Acute Pain r/t inflammation & swelling 2. Fatigue r/t increased metabolic rate 3. Impaired physical mobility r/t decreased range of motion 4. Disturbed body image r/t physical & psychological changes

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