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Understanding Rheumatoid Arthritis Overview

Mar 19, 2025

Rheumatoid Arthritis (RA)

Overview

  • Chronic, progressive inflammatory disease affecting tissues and organs.
  • Primarily attacks joints leading to swelling and deformity.
  • Commonly affected joints: fingers, hands, wrists, knees, and feet.
  • Joints involved: proximal interphalangeal and metacarpophalangeal joints.

Etiology and Pathophysiology

  • Autoimmune disease where WBCs attack synovial tissue.
  • Inflammation extends to cartilage, bones, ligaments, and tendons.
  • Results in joint deformity and decreased joint function.
  • Systemic effects on connective tissue, blood vessels, and organs.

Expected Findings

  • Early symptoms: fatigue, joint discomfort, morning stiffness.
  • Pain at rest and during movement.
  • Specific deformities: ulnar deviation, swan neck, boutonniere.
  • Systemic features: xerostomia, anorexia, fever, muscle weakness, etc.

Diagnostic Findings

  • No definitive test for RA diagnosis.
  • Blood tests:
    • Erythrocyte Sedimentation Rate (ESR)
    • C-Reactive Protein
    • Complete Blood Count (CBC)
    • Antinuclear Antibody (ANA) titer
    • Rheumatoid Factors and Anti-CCP
  • Joint scans: X-rays, MRIs.
  • Arthrocentesis for synovial fluid analysis.

Treatment and Management

Medical Treatment

  • Plasmapheresis for severe cases.
  • Total Joint Arthroplasty and Synovectomy as surgical interventions.

Pharmacological Treatment

  1. NSAIDs: First-line for analgesic and anti-inflammatory effects.
  2. COX-2 Inhibitors: Less GI distress but increased cardiac risk.
  3. Corticosteroids: For acute exacerbations, not recommended long-term.
  4. DMARDs: Slow progression by suppressing immune response. Types include:
    • Antimalarials (e.g., Hydroxychloroquine)
    • Antibiotics (e.g., Minocycline)
    • Biologic response modifiers (e.g., Etanercept)

Non-Pharmacological Interventions

  • Physical activity to maintain joint mobility.
  • Patient education on lifestyle modifications and nutritional instructions.

Potential Complications

  • Sjogren's Syndrome: dry eyes, mouth, and vagina.
  • Secondary Osteoporosis: encourage weight-bearing exercises.
  • Vasculitis: monitor for ischemia symptoms.
  • Respiratory and cardiac complications.

Pediatric Considerations

  • Juvenile Rheumatoid Arthritis (JRA) with specific risk factors and environmental triggers.

Quiz Questions

  1. Diagnostic Tests for RA: ESR, ANA titer.
  2. Pain Assessment: First ask location of pain.
  3. Prednisone Education: Avoid crowds, monitor blood glucose, report visual changes.
  4. True/False: No definitive test for RA.
  5. Nursing Diagnosis: Related to fatigue and pain management.