Lizardo, Alyzza G.

BSN 3-1 Rheumatoid Arthritis Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in your hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. In addition to causing joint problems, rheumatoid arthritis can also affect your whole body with fevers and fatigue. It affects 1 in 6 Individuals; 2/3 is women. The exact cause is unknown. Risk factors Your sex. Women are more likely to develop rheumatoid arthritis than men are. Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60. Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease. Smoking. Smoking cigarettes increases the risk of rheumatoid arthritis in some people. Quitting can reduce your risk. Signs and Symptoms Tender, warm, swollen joints Morning stiffness that may last for hours Firm bumps of tissue under the skin on your arms (rheumatoid nodules) Fatigue, fever and weight loss

Pathophysiology Risk Factors: Genetics, Infections, Age (40-60 years old), Gender (F), Smoking Autoimmune Reaction Interleukin I attracts netrophils into joints.

Synoviocytes are exposed

Macrophages will be activated

Synoviocytes Proliferate

Stimulates B and T cells proliferation

Production of IL-6 and matrix metalloproteases

Joint Inflammation

Pain Production of MMPs causes proteoglycan degradation Cartilage destruction and Ankylosis Ligaments supporting joints are damage and tendon sheats are affected and ruptures.

Pain and swelling in your joints, aching and stiffness of joints, loss of motion of affected joints, deformity of joints.

RHEUMATOID ARTHRITIS

Bone loss/Eroision

Diagnostic Test During the physical exam: checking of joints for swelling, redness and warmth, checking of reflexes and muscle strength. Blood tests People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation rate (ESR, or sed rate), which indicates the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. X-rays X-rays to help track the progression of rheumatoid arthritis in your joints over time. Medications NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems and liver and kidney damage. Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, cataracts, weight gain and diabetes. . Immunosuppressants. These medications act to tame your immune system, which is out of control in rheumatoid arthritis. Surgery Osteotomy surgical removal of a wedge from the joint. Synovectomy - removal of synovial Athroplasty - replacement of joints with prosthesis Tendon repair - Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.

Nursing Interventions Assess joints carefully. Look for deformities, contractures, inability to perform ADL, and immobility. Monitor vital signs. Monitor changes of weight. Assess level of pain. Monitor duration of stiffness and not the intensity to determine when to perform ROM. Observe for pressure ulcers with traction and wearing splints. Encourage patient to perform ADL at the level of activity.. Teach patient how to stand, walk, or sit correctly upright and erect. collaborative: a) Bed rest during acute pain b) Passive ROM exercises of joints c) Splint painful joints d) Heat and cold application cold application during acute pain; 20 minutes at a time.