Rheumatoid ArthritisGroup 1

Linda Akioyame, Laura Dunwell, Crystal Johnson, Kathlyn, Millare, Christina Porter, Whitney Slater, Trung Tu, Daryl Yann

Pathophysiology

An autoimmune disorder that occurs when the immune system mistakenly attacks its own body tissues

Inflammation occurs in the lining of the joints, causing painful swelling that can eventually result in joint breakdown and deformity

Typically affects the small joints in the hands and the feet

Clinical Manifestations Red, swollen, painful, and tender joints in a

symmetrical pattern Rheumatoid nodules Low-grade fever Fatigue/Loss of energy Lack of appetite Sjogren’s syndrome (dry mouth and eyes) Chest pain upon coughing or deep breathing d/t

inflammation of lung lining Decreased white and red blood cells Felty’s syndrome (enlarged spleen) Vasculitis (blood vessel inflammation)

Blood Tests – Rheumatoid Factor Normal adult results should be negative positive or increase can indicate a possible RA or

other connective tissue diseases.› measures the presence of unusual antibodies of

immunoglobulins G (IgG) and M (IgM)› Not all positive titers are specific of RA especially in

adults   A positive in this test can also be elevated in

leukemia, liver disease, and renal disease Recent blood transfusion may affect result High lipid levels may cause a false-positive on test Nursing Interventions – explain procedure, monitor

site for bleeding, report abnormal findings

Blood Tests – Erythrocyte sedimentation rate (ESR)

This test shows the presence of inflammation in the body and the activity of the disease

Indications: Inflammation, rheumatoid arthritis, acute and chronic infection, rheumatoid/auto-immune infections

Normal range for males is up to 15mm/hr, and females up to 25mm/hr

Nursing Interventions: explain procedure, monitor site for bleeding, andreport abnormal readings

Drug Therapy:DMARD (Disease-modifying anti-rheumatic drug)ex. Methotrexate (Rheumatrex)

Interrupts the immune system that promotes inflammation

Can slow or stop the progression sending RA into remission

Not only does it decrease pain and swelling, but also reduces damage to joints and can prevent long-term disability

Do not use methotrexate if the person has a liver disease, bone marrow disorder, blood cell disorder, pregnant, alcoholism, or active infection or hepatitis

SIDE EFFECTS• Abdominal pain• Chills or fever• Dizziness• Hair loss• Headache

• Light sensitivity• Itching• Liver problems• Low blood counts

Drug Therapy:Nonsteroidal anti-inflammatory drugs (NSAIDS)

Help manage chronic pain, inflammation, and swelling› Prostaglandins are released by damaged tissues

which trigger imflammation that results in pain and swelling

› NSIADS b lock prostaglandins by blocking COX enzymes specifically, COX-1 & COX-2 do not slow RA progression

Ex. Ibuprofen (Advil, Motrin) SIDE EFFECTS• GI Bleeding• Hepatitis• Constipation• Dyspepsia

• Nausea/Vomiting• Abdominal

Discomfort• Headache

Nursing Interventions

Scheduling NSAIDs at equal intervals throughout the day

Taking morning NSAID dose with milk and crackers approximately 30 minutes before rising

Performing ROM exercises in shower or bathtub

Applying local heat with paraffin dip or compress; using cold packs as needed

Teach techniques to minimize joint stress while performing ADLs

Provide Arthritis Foundation literature and information

Discuss ways to delegate household tasks to other family members

Teach techniques for relieving pain and morning stiffness including:

Education Regular, moderate exercise reduces joint pain and

stiffness, builds strong muscle around the joints, and increases flexibility and endurance.

Dealing with pain can be the hardest part of having arthritis, but pain can be managed by learning more about RA, treatments, preventative measures, and alternative remedies.

Optimal treatment for the disease involves a combination of medications, rest, joint-strengthening exercises, joint protection, and patient (and family) education. 

Early treatment of rheumatoid arthritis results in better outcomes.

Quiz Time!!!!!

What is the normal ESR range present in males and females with Rheumatoid Arthritis?

Quiz Time!!!!!There is no known cure for RA, but individuals canreduce symptoms of the disease by:1. Medications2. Rest3. Oral Hygiene4. Joint-strengthening exercises5. Joint protection6. Patient and Family Teaching

a) 1,2,3,4,5,6b) 2,3,5,6c) 1,2,4,5,6d) 4,5,6

ResourcesCarey, RC. (2006, Semptember 30). Rheumatoid arthritis. Retrieved

from http://www.labtestsonline.org/understanding/conditions/rheumatoid-2.html

Mayo Clinic. (2009, November 3). Rheumatoid arthritis. Retrieved from http://www.mayoclinic.com/health/rheumatoid-arthritis/DS00020

Shiel, W. C. (2009, April 08). Rheumatoid arthritis. Retrieved from http://www.medicinenet.com/rheumatoid_arthritis/article.htm

Van Leeuween, AV. (2006). Laboratory and diagnostic tests with nursing implication. PHILADELPHIA: F.A Davis Company.

(2009, November 30). Rheumatoid arthritis guide. Retrieved from http://www.webmd.com/rheumatoid-arthritis/guide/rheumatoid-arthritis-medications

(2009). Rheumatoid arthritis. Retrieved from http://www.medicinenet.com/rheumatoid_arthritis_pictures_slideshow/article.htm

(2009). Rheumatoid arthritis. Retrieved from http://www.arthritis.org/disease-center.php?disease_id=31