Rheumatoid Arthritis(RA)

Rheumatoid arthritis is Important topic for 1st ,2nd and 4th and final year exam. Every year one question has been asked in final and first year TU,KU,BPKHIS exam.

Rheumatoid Arthritis(RA)

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Autoimmune diseases are illnesses that occur when the by body's tissues are mistakenly attacked by their own immune system.

Etiology

Genetic Factors                                                          Environmental Factors                                                                                                                                                                      Female                                                                          Advanced age

                Anti-citrullinated protein                                         smoking 

antibodies (ACPA)                                                       Silica exposure      

Rheumatoid factor (RF)                                             Comorbidities

Human leukocyte antigen                                            - Diabetes mellitus           (HLA)-DRB1, HLA-DRB4                                                  type 1 and 2                                                                                                             dyslipidemia                                                                                                           inflammatory lung                                                                                                 disease                                                                                                                Lower education level

                                                                                                                                                                                       

                                                                                        

                                                  

       Signs & Symptoms of RA

• Fatigue.
• Stiffness, especially in early morning and after sitting a long period of time.
• Not relieved by pain
  
• Low Grade Fever, Weakness.
• Muscle pain and pain with prolonged sitting.
• Symmetrical, affects joints on both sides of the body.
• Rheumatoid nodules.
• Deformity of your joints over time.Raynauds phenomenon.Pain
• Raynauds phenomenon.
• Pain                                                                     
  
                                        

Complications of RA  

• Total joint replacements
• Myocardial infarction, cerebrovascular thrombosis
• Non-Hodgkin's lymphoma
• Premature death
• Serious infectious events
• Extra-articular manifestations                                                                                      - Felty's syndrome, Sjögren's syndrome, AA amyloidosis
• Osteoporotic fractures
• Upper gastrointestinal bleeding

TREATMENT

Medical Management:

1. NSAIDS

2. Oral Corticosteroids- used to alleviate intractable joint inflammation or vasculitis

3. DMARD

• Methotrexate: anti folate, hepatic and pulmonary toxicity; first choice DMARD
• Antimalarials: stabilize lysosomal membranes and inhibit IL1, hydroxychloroquine sulfate, major side effect is macular degeneration
•  Sulfasalazine (anti folate activity)
• Gold: gold salts (inhibit monocyte function      side effects; thrombocytopenia, neutropenia, or proteinuria
• D-Penicillamine (modulate lymphocyte function)

SURGICAL TREATMENT

Reserved for pts with severely damaged joints

Includes

1. Arthroplasty/Total joint replacement
2. Open/arthroscopic synovectomy
3. Reconstructive hand surgery

                              

         Rheumatoid Arthritis:

                              

                                 Nursing Considerations

• Patient education on how to protect and strengthen joints
• Ensure adequate pain relief 
• Address sleep disturbance, fatigue and altered mood
• Small nutritious meals, vitamins, iron
• Encourage infornmed decisions on self-management
• Counselling/ emotional support forpatient and family

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