RHEUMATOID ARTHRITIS RHEUMATOID ARTHRITIS A chronic systemic inflammatory
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RHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITIS • A chronic, systemic inflammatory disorder characterised by recurrent inflammation of multiple joints and related structures. • It is a disorder that principally affects synovial tissues and frequently accompanied by extraarticular manifestations. • Although the cause of rheumatoid arthritis is unknown, autoimmunity is thought to play a pivotal role in its chronicity and progression. • Most clients exhibit a pattern of symmetric involvement of multiple peripheral joints and periods of remission
INCIDENCE It affects three times as many women as men. The onset is mostly between the ages of 30 and 50.
AETIOLOGY • • The actual cause is unknown Hereditary or genetic factors Smoking Autoimmunity Infections e. g. EBV Metabolic or biochemical abnormalities, Nutritional factors e. g. vit D deficiency,
DIAGNOSTIC INVESTIGATIONS • • • Rheumatoid factors FBC ESR Synovial fluid analysis X-ray of the joints
PATHOPHYSIOLOGY RA begins when T lymphocytes infiltrate the synovial membrane, following the invasion of the body by antigens. They proliferate in the synovium and initiate an immune response. B cells are also stimulated to produce auto antibodies [rheumatoid factors] to Ig. G. The antigenantibody interaction leads to the formation of immune complexes which initiates synovitis, with swelling of the synovial lining membrane and production of excess synovial fluid. Pannus [granulation inflammatory tissue] is formed at the juncture of synovium and cartilage. This extends over the surface of the articular cartilage and eventually invades joint capsule and subchondral bone.
PATHOPHYSIOLOGY Tough fibrous connective tissue replaces the pannus, occluding the joint space. Fibrous ankylosis results in decreased joint motion, mal-alignment and deformity. Finally, as the fibrous tissue calcifies, bony ankylosis may result in total joint immobilisation.
SWAN NECK DEFORMITY AND ULNAR DEVIATION
CLINICAL MANIFESTATIONS Musculoskeletal General • Symmetric polyarticular joint swelling • Joint redness, warmth, pain, tenderness • Morning stiffness • Limitation of motion Spine • Cervical pain • Neurologic manifestations Wrists • Limited range of motion • Deformity • Carpal tunnel syndrome
CLINICAL MANIFESTATIONS CONT’D Hands • Ulnar deviation Ankles • Limited range of motion • Swan-neck deformity [DIP • Pain on ambulation hyperflexion with PIP Feet • Subluxation hyperextension] • Boutonnière deformity [PIP flexion with DIP hyperextension] Knees • Joint effusion • Instability • Hallux valgus [deviation of the great toe towards other digits of the foot] • Lateral toe deviation • Cock-up toe
CLINICAL MANIFESTATIONS CONT’D Respiratory • Pleural disease • Pneumonitis Integumentary • Rheumatoid nodules Exocrine glands Sjögren’s syndrome • Dry eyes • Dry mouth Cardiovascular • Vasculitis • Pericarditis Hematologic Felty's syndrome • Splenomegaly • Neutropenia • Anemia
CLINICAL MANIFESTATIONS CONT’D Metabolic Processes • Fatigue • Weakness • Anorexia • Weight loss • Low-grade fever
MANAGEMENT Pharmacologic • NSAIDs: especially Aspirin: • Corticosteroids e. g. prednisolone • Immunosuppressive or cytotoxic drugs e. g. methotrexate, cyclophosphamide Disease modifying anti-rheumatic drugs: e. g. methotrexate, gold salts, antimalarial agents e. g. hydroxychoroquine, sulfasalazine and Dpenicillamine, leflunomide
MANAGEMENT Rest and sleep • Complete bed rest is unnecessary and should be avoided to prevent stiffness and immobility • Regularly scheduled rest periods alternated throughout the day help relieve pain and fatigue and minimise excessive weight bearing • Encourage client to sit instead of standing • Teach client good body alignment while resting • Provide a firm mattress or bed board • Encourage position of extension and avoid position of flexion • Never place pillows under client’s knees
MANAGEMENT Joint protection • Help client to identify ways to modify tasks • Encourage periods of rest in-between activity to avoid fatigue • Encourage client to use assistive devices to conserve the joints Exercise: • ROM exercise, • isometric exercise, • Lying prone and allowing the legs to hang over the end
MANAGEMENT Pain management: • Assess the level of pain and duration of morning stiffness • Encourage client to relate pain to activity level and adjust activity accordingly • Application of cold or warm compress to relieve pain • Serve prescribed analgesics Psychological support: • Self image disturbance • Body image disturbance
- Nursing diagnosis for rheumatoid arthritis
- Polyarticular arthritis
- Rheumatoid arthritis
- Boutonniere and swan neck deformity
- Pictures of rheumatoid arthritis vs osteoarthritis
- Deformities in rheumatoid arthritis
- Soft tissue rheumatoid arthritis
- Pathology of rheumatoid arthritis
- Steinbrocker stage rheumatoid arthritis
- Nail pitting
- Fibula fractire
- Haart side effects
- Rheumatoid arthritis nursing management
- Rheumatoid arthritis
- Rheumatoid arthritis extra-articular manifestations
- Dr adria rusli
- Desquamative inflammatory vaginitis
- Inflammatory cells