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SUDIARTO, MN
 DEFINITION
 Arthritis is term used to refer to joint
inflammation
 More frequently attack diarthrosis joints
 Often classified as inflammatory and
noninflammatory.
 Inflammatory arthritis include: Rheumatoid
arthritis (RA) and Systemic Lupus
Erythematosus (SLE)
 Non inflammatory (degenerative arthritis) 
osteoarthritis
 ETIOLOGY / EPIDEMIOLOGY
 RA affect approximately 6.5 million people in the
US.
 RA is polyarticular inflammatory arthritis
 Two to three time more prevalent in women
 Has familiar tendency, manifest between the age
of 25 and 55 years.
 The cause is still unknown
 Two possible causes being investigated 
autoimmune and infectious agents.
 PATHOPHISIOLOGY
 RA initially as a response to the inflammatory by an
external agent with its accompanying increase blood flow
to the inflamed joint.
 Cardinal signs of inflammation are loss of function and
pain
 The inflammatory process results in increased synovium
and inflammatory granulation tissue (Pannus) formation.
 Pannus is the result of the inflammatory process and the
proliferation of the synovium.
 Pannus destroys cartilage and cause joint subluxation
(partial dislocation) and bony ankylosis (stiffness or
fixated joints) or abnormal immobility and consolidation
of joints
 CLINICAL MANIFESTATION
 Joint pain
 Warmth
 Edema
 Limitation of motion
 Morning stiffness in multiple joints  commonly symmetrical
 Most common affected areas: small joints of the hand and wrist –
the proximal interphalangeal and metacarpophalangeal joints)
 Subcutaneous nodules  occur over bony prominence, present
approxmtly 25 % of RA
 The nodules include: olecrannon and Bouchard’s node
 Deformities of the hand include: SWAN NECK deformity or
hyperextension of the proximal interphalangeal joints:
BOUTONNAIRE deformity. Or flexion deformity of the proximal
proximal interphalangeal joints; and ULNAR DRIFT  the fingers
drift forward the ulna
 CLINICAL MANIFESTATION
(Cont..)
 Synovial cyst
 Episcleritis (inflammation of the loose
connective tissue between the sclera and
the conjunctive
 Elevated erythrocyte sedimentation rate
 Normocitic, Normochromic and
hypochromic anemia
 Positive RA factor
 X-ray  joint space narrowing
 THERAPEUTIC MANAGEMENT
 Therapeutic management aimed to relief pain, minimize
joints destruction and promote joint function. These
goals will met with hot and cold application, weight
control, limited joint mobility and exercise and
medication.
Medication include:
 Salycilate
 NSAID’s (Indomethacin, ibuprofen, sulindac, keptrofen)
 side effect: GI irritation and fluid retention
hypertension, impaired immune response
 Antimalarial drug  Hydroxychloroquine is the most
common, side effect: GI distress, retinopathy, extra
ocular muscle movement.
 Other medications??? See table 58-1 (attached)
 NURSING MANAGEMENT
 ASSESSMENT
 Evaluate joint inflammation
 When inflammation indicated  limitation of
motion, pain, edema, warmth and erythrema.
 Assess systemic symptoms of fever, malaise,
weight loss and subcutaneous nodules
 Assess psychosocial issues: body image,
vocational and recreational limitations, family
and social roles, and sexual adjustment
 NURSING DIAGNOSES
1. Chronic pain r/t joint inflammation
2. Impaired physical mobility r/t limited joint mobility
3. Sleep pattern disturbances r/t pain
4. Activity intolerance r/t pain, fatigue, and impaired joint
mobility
5. Total self care deficite r/t fatigue and decreased joint
mobility
6. Body image disturbance r/t visible joint deformity
7. Knowledge deficit regarding condition and treatment
8. Impaired home maintenance management r/t impaired
joint mobility.
 PLANNING
Depend on the intensity of symptoms and impaired joint
mobility.
Expected patient outcome include:
1. Achievement of optimal management of pain
2. Demonstration of increased mobility
3. Attainment of and maintenance of optimal sleep
pattern
4. Attainment of tolerance of activities within physical
restrictions
5. Engagement in self-care activities and activities of
daily living
6. Explanation of the disease process, applicability of
treatment measures to his condition and plans for
follow up
7. Maintenance of optimal level of independence
 IMPLEMENTATION
 Addressed to pain control and maintenance of
joint mobility
 Administer prescribed medication
 Employ cold and warmth application
approximately 30 minutes before activities
 Whirlpool bath or ultrasound and frequent
position changes  prevent muscle spasm and
contractures and minimize joint stress
 Control pain with Diversionary activities, the use
of imagery and relaxation techniques, humor,
xercise and Transcutaneous Electric Nerve
Stimulation (TENS).