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.