Rheumatoid arthritis with nursing management

1. Baljinder singh
M. Sc (MSN)
Assistant Professor
PIMS , Panipat

2.  Rheumatoid arthritis is
autoimmune disorder in
which Immune system
identifies the synovial
membrane as "foreign"
and begins attacking it.
 Synovial membrane shown in
picture

3.  Rheumatoid Arthritis (RA) is a chronic
inflammatory disorder that may affect many
tissues and organs, but mainly attacks the
joints producing an inflammatory synovitis.

6.  Idiopathic
 Positive family history
 Inherited tissue type major
histocompatibility complex (MHC) antigen
 Smoking
 Bacterial and Fungal Infection
 Herpes simplex virus infections
 Epstein-Barr virus (EBV)
 Vitamin D deficiency

7.  RA affects 0.5-1.0% of population in USA
 Females > males 3:1
 but people of any age can be affected
 Peak age 45-65 but onset early from age 20-45
yrs
 About 75% of these are women.
 The disease strikes women three times more
often than men

8.  Presentation of antigen to T cells
 T- and B-cell Proliferation Angiogenesis in
synovial lining
 Neutrophil accumulation in synovial fluid.
 Synovitis.
 Early pannus Formation(The pannus is a
sheet of inflammatory granulation tissue that
spreads from the synovial membrane and
invades the joint)

9.  Subchondral bone erosion.
 Pannus invasion of cartilage Chondrocyte
proliferation.
 Laxity of ligaments
 Joint instability, contractures, decreased
ROM, systemic complications

10. Sign and Symptoms

11.  The joints of the
hands are often the
very first joints
affected by
rheumatoid arthritis.
These joints are
swollen red and
tender when
squeezed.
 Swelling due to synovitis

14.  The deformity arises
from hyperextension
of the proximal
interphalangeal joint,
while the distal
interphalangeal joint
is flexed.

16.  Mallet finger is a
simple flexion
deformity of the
distal
interphalangeal
joint preventing
extension.

17.  Severe
hyperextension of
the interphalangeal
joint of the thumb

18.  Fatigue
 Joint pain
 Joint tenderness
 Joint swelling
 Joint redness
 Joint warmth

19.  Joint stiffness
 Loss of joint range of motion
 Many joints affected (polyarthritis)
 Limping
 Joint deformity
 Both sides of the body affected (symmetric)

20. Diagnosis

21.  X Rays
 X rays of hands and feet are generally performed in
people with RA.
 Magnetic Resonance Imaging (MRI)
 Ultrasounds

22.  Blood Tests
 Rheumatoid Factor (RF)
 RF is a specific antibody in the blood.
 A negative RF does not rule out RA. The arthritis is then called
seronegative, most common during the first year of illness and
converting to seropositive status over time.
 Anti-citrullinated Protein Antibodies (ACPAs)
 Like RF, this testing is only positive in a proportion of all RA
cases.
 Unlike RF, this test is rarely found positive if RA is NOT present,
giving it a specificity of about 95%.

23.  Other blood tests performed when RA is suspected:
 Erythrocyte Sedimentation Rate (ESR)
 The rate at which red blood cells precipitate in a 1
hour period.
 C-Reactive Protein
 A protein found in the blood in response to
inflammation.
 Full Blood Count
 Gives information about all blood cells.
 Renal Function
 Kidney Function
 Liver Enzymes
 Gives information on the state of a patient’s liver

24.  Salicylates
 Acetylated
 aspirin
 Nonacetylated
 choline magnesium
 trisalicylate (Trilisate)
 choline salicylate (Arthropan)

25.  Nonsteroidal Anti-inflammatory Drugs
(NSAIDs)
 diclofenac (Voveran)
 etodolac (Lodine)
 flurbiprofen (Ansaid)
 ibuprofen
 meclofenamate (Meclomen)
 meloxicam
 nabumatone (Relafen)

26.  Disease-Modifying Antirheumatic Drugs (DMARDs)
 Antimalarials
 Action: Anti-inflammatory, inhibits lysosomal enzymes
 hydroxychloroquine
 chloroquine

27.  Gold-containing compounds
 Action: Inhibits T- and B-cell activity, suppresses
synovitis during active stage of rheumatoid
 aurothioglucose (Solganol)
 gold sodium thiomalate
 auranofin (Ridaura)
 sulfasalazine (Azulfidine)
 penicillamine (Cuprimine)

28.  Immunosuppressives
 Action: Immune suppression, effects DNA
synthesis and other cellular effects
 methotrexate (Rheumatrex)
 azathioprine (Imuran)
 cyclophosphamide (Cytoxan)

29.  Corticosteroids
 Action: Anti-inflammatory, analgesic Used
for shortest duration and at lowest dose
possible to minimize adverse effects
 prednisone
 prednisolone
 hydrocortisone
 intra-articular injections

30.  Topical Analgesics
 capsaicin (Zostrix)

31. Surgeries considered for people who
have severe rheumatoid
arthritis include:
 Arthroplasty, to replace part or all of a joint, such
as the hip or knee.
 Arthroscopy, which uses a small lighted instrument
to remove debris or inflamed tissue from a joint.
 Carpal tunnel release, to relieve pressure on the
median nerve in the wrist.

32.  Cervical spinal fusion, to treat severe neck
pain and nerve problems.
 Finger and hand surgeries, to correct joint
problems in the hand.
 Foot surgery such as phalangeal head
resection.
 Synovectomy, to remove inflamed joint
tissue.

33.  NURSING DIAGNOSES
• Acute and chronic pain related to inflammation
and increased disease activity, tissue damage,
fatigue, or lowered tolerance level
• Fatigue related to increased disease activity,
pain, inadequate sleep/rest, deconditioning,
inadequate nutrition, emotional
stress/depression
• Disturbed sleep pattern related to pain,
depression, and medications
•
• Self-care deficits related to contractures,
fatigue, or loss of motion

34.  Impaired physical mobility related to
decreased range of motion, muscle
weakness, pain on movement, limited
endurance, lack of or improper use of
ambulatory devices
 Disturbed body image related to physical and
psychological changes and dependency
imposed by chronic illness
• Ineffective coping related to actual or
perceived lifestyle or role changes