Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic systemic disease characterized by recurrent inflammation of the diarthrodial joints and other structures. It attacks the lining of your joints (synovium) causing swelling that can result in aching and ankylosis of a joint and eventually deformity. It is severely disabling. The severity of the joint may fluctuate over time, but progressive development of various degrees of joint destruction, deformity and disability are the most common outcomes.

Diagnostic Procedures
• • • • Blood Test Imaging Synovial Membrane Biopsy Synovial Fluid Aspiration and Analysis

Clinical Manifestations

Clinical manifestations of Rheumatoid Arthritis vary not only from one client to another but also in an individual client over the course of the disease. The American Rheumatism Association classified Rheumatoid Arthritis as follows:

Clinical Manifestations


1 2

Morning stiffness in and around joints lasting at least one hour before maximal improvement Soft tissue swelling ( arthritis) of three or more joint areas ( including the right and left proximal PIP, MCP, wrist, elbow, knee, ankle, and MTP joints Swelling of at least one wrist, MCP or PIP joint
Simultaneously symmetric swelling in joints listed in criterion 2

4 5 6 7

Subcutaneous rheumatoid nodules Presence of rheumatoid factor Radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints

The causes of rheumatoid arthritis are unknown. Infectious agents such as viruses, bacteria, and fungi have long been suspected. The cause of rheumatoid arthritis is a very active area of worldwide research. Some scientists believe that the tendency to develop rheumatoid arthritis may be genetically inherited. It is suspected that certain infections or factors in the environment might trigger the immune system to attack the body’s own tissue, resulting to inflammations of the various organs of the body such as the lungs or eyes.

Antigenic Stimulus to any joint of the body
Presence of genetic factor that increases the person’s susceptibility to RA

Immune Responses

T-Cell and B-Cell Proliferation T Cells produces enzyme that enhances inflammatory response B Cells produce Rheumatoid Factor

Macrophages and monocytes migrate to the site of antigenic stimulus (joint)

RF and macrophages bind with the antigen forming immune complexes
Tumor Necrosis Factor- alpha produced by monocytes cause joint degradation and synovial tissue damage

Inflammation of the synovial membrane: Localized and Systemic Response to inflammation begins to manifest Formation of rheumatoid nodules

Fibrosis and synovial tissue hypertrophy and hyperplasia

Pannus formation and invasion of a part of the joint cavity


Nursing Interventions for Pt. with RA
1. Administer analgesics and other medications as ordered 2. Teach client to take medication as ordered and observe for aspirin toxicity (tinnitus, bleeding) and other adverse effects of medications 3. Apply heat and cold as ordered; heat paraffin from 125 to 129 oC 4. Promote rest and position to ease joint pains
5. Provide for ROM exercises up to the point of pain, recognizing that some discomfort is always present

Nursing Interventions for Pt. with RA
1. Emphasize the need to remain active but incorporate rest periods to avoid fatigue 2. Encourage the clients to verbalize feeling 3. Help set realistic goals focusing on strengths 4. Encourage the use of supportive devices to help client to conserve energy and maintain independence 5. Provide care for the client following joint replacement 6. Encourage diet rich in nutrient-dense food such as fruits, vegetables, whole grains and legumes to improve and maintain nutritional status and compensate for nutrient interactions of corticosteroids and other treatment medication

Medical Intervention Drugs
• Analgesic/ antipyretic (aspirin) • NSAIDs • Antirheumatic Agents • Immunosuppressive Agents • Anti-Malarial Agents • Anti- neoplastic agents • Corticosteroids agents

Surgical Intervention Arthroplasty
-an operative procedure of orthopedic surgery performed, in which the arthritic or dysfunctional joint surface is replaced with something better or by remodeling or realigning the joint by osteotomy or some other procedure.

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