Rheumatoid arthritis

 

DEFINITION:

A chronic inflammatory disease that primarily affects the joints and surrounding tissues.                                                                 

 

 

 

 

 

 

RELATED DIAGNOSTIC TESTS:

Joint X-rays may be performed, A rheumatoid factor test is positive in about 75% of people with symptoms, the erythrocyte sedimentation rate is elevated,  CBC may show low hematocrit (anemia).

This disease may also alter the results of the following tests:

WBC count, synovial fluid analysis, synovial biopsy, Schirmer's test, serum globulin electrophoresis, quantitative immunoglobulins (nephelometry), protein electrophoresis - serum, LE cell test

 immunoelectrophoresis - serum, cryoglobulins, complement component 3, complement ceruloplasmin, blood differential,  antithyroid icrosomal antibody, antithyroglobulin antibody, antinuclear antibody panel, antimitochondrial antibody

 

ETIOLOGY:

The cause of rheumatoid arthritis (RA) is unknown, but infectious, genetic, and endocrine factors may play a role.  It is an autoimmune disorder.   The disease can occur at any age, but the peak incidence of disease onset is between the ages of 25 and 55. Women are affected 3 times more often than men. The incidence increases with age. Approximately 3% of the population are affected. The course and the severity of the illness can vary considerably.

 

 

MEDICAL MANAGEMENT:

MEDICATIONS: Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, fenoprofen, indomethacin, naproxen, Corticosteroids, gold compounds, D-penicillamine, antimalarial medications, methotrexate, azathioprine, cyclophosphamide surgery on effected joints. 

 

PATHOPHYSIOLOGY:

 

The onset of the disease is usually slow, with fatigue, loss of appetite, weakness, and vague muscular symptoms. Eventually, joint pain appears, with warmth, swelling, tenderness, and stiffness after inactivity of the joint. The disease usually only involves a couple of joints initially, but slowly progresses into many other joints. At first, rheumatoid arthritis affects the synovium, which becomes inflamed and secretes more fluid. Later, the cartilage becomes involved and becomes rough and pitted.
The joints usually become affected in a symmetrical pattern, affecting both sides of the body equally. The hands, wrists, elbows, shoulders, knees and ankles are the most frequently affected. Characteristic deformities result from cartilage destruction and destruction of the supporting tissues around the bones. Occasionally, the hips, jaw and neck may be affected. Other features of the disease that don't involve the joints may occur. Rheumatoid nodules are painless, hard round or oval masses (aggregations of cells) that appear under the skin, usually on pressure points such as the elbow or Achilles tendon. These are present in about a quarter of cases. On occasion, they appear in the eye where they sometimes cause inflammation. If they occur in the lungs, inflammation of the lining of the lung (pleurisy) may occur as well as a shortness of breath. Anemia may occur due to failure of the bone marrow to produce enough new red cells to make up for the lost ones. Iron supplements will not help this condition. Muscle weakness and atrophy may occur. If the heart becomes weakened, congestive heart failure may result. Rheumatoid vasculitis (inflammation of the blood vessels) is a serious complication of RA and can be life threatening. It can lead to skin ulcerations, bleeding intestinal ulcers and neuropathies. Skin rashes, Raynaud's phenomenon, and massive hemorrhage may also result from vasculitis.

 

 

NURSING MANAGEMENT:

ü        Monitor patient for s/s of infection if taking immunosuppressive therapy drugs.  Even the slightest fever can be the sign of an overwhelming infection.

ü        Monitor patients renal function tests if taking NSAIDS.  Make sure that they are taking plenty of fluids.  Also if renal impairment is found, maintain I&O to make sure fluids are being secreted.

 

 

 

 

 

 

 

SIGNS & SYMPTOMS:

fatigue,general discomfort, uneasiness, or ill feeling (malaise), loss of appetite, low-grade fever, joint pain, joint stiffness and joint swelling

(usually symetrical), may involve wrist pain, knee pain, elbow pain, finger pain, toe pain, ankle pain, or neck pain, limited range of motion, morning stiffness, deformities of hands and feet, round, painless nodules under the skin .

Additional symptoms that may be associated with this disease:

skin redness or inflammation, skin color ( patchy ), paleness, mouth sores,

swollen glands, eye burning, itching and discharge, ear noise/buzzing.

 

HEALTH DEVIATION SELF-CARE REQUISITES:

 

Ø       Patient may need supplemental equipment that can be provided my OT to help with ADL’s, such as knifes, forks, etc.

Ø       Patient will need education on medications that they are taking and S/S of complications of medications.

Ø       Patients will also need information (if taking immunosuppresants or neoplastics) of S/S of infection and to report IMMEDIATLEY to MD due to risk of overwhelming infection.

 

REFERENCE PAGES:

www.healthcentral.com

Pathophysiology, pages 1464-1469