Ch 89 Rheumatoid Arthritis Flashcards Preview

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Flashcards in Ch 89 Rheumatoid Arthritis Deck (18):

What is rheumatoid arthritis

A CHRONIC, progressive inflammatory disease that can affect tissues and organs but, principally affects the joints producing an inflammatory synovitis. It involves joints bilaterally and symmetrically, & it typically involves several joints at one time. RA typically affects upper joints first.


What is RA precipitated by

It is an auto immune disease precipitated by WBCs attacking synovial tissue. The WBCs cause the synovial tissue to become inflamed and thickened. The inflammation can extend to the cartilage, bone, tendons, and ligaments that surround the joint. Joint deformity and bone erosion may result, decreasing the joints ROM and function.


What does the phrase RA is also a systemic disease mean

It can affect any connective tissue in the body. Common structures that are affected are the blood vessels, pleura surrounding the lungs, and pericardium. Iritis and scleritis can also develop on the eyes...
The natural course of the disease a exacerbations and remissions


What are risk factors of rheumatoid arthritis

Female gender
Age 20-50 years
Genetic predisposition
Epstein Barr virus
Enviromental factors


What are early signs of rheumatoid arthritis

Joint discomfort


What is subjective signs of RA

Pain at rest and with movement
Am stiffness
Pleuritic pain ( pain upon inspiration)
Xerostomia ( dry mouth) Subcutaneous nodules
Anorexia/ weight loss Low grade fever
Fatigue Muscle weakness/ atrophy
Paraesthesias Reddened sclera and abnormal pupil shape
Recent illness/ stress Lymph node enlargement
Joint pain/ lack of function


What is objective assessment data of RA

Joint swelling, warmth and erythema
Ulnar deviation, swan neck, and boutonnière deformities are common in the fingers


What joints are generally affected by RA

Finger, hands, wrists, knees, foot joints


What are lab tests to diagnose RA

1. Anti- CCP will be positive ( this test detects antibodies to cyclic citrullinated peptide.... The test will test + long before symptoms appear.... Very sensitive test to RA

2. RF antibody. High tigers correlate with severe disease
3. ESR
4. C reactive protein
5. ANA titer
6. Elevated WBC


What is the erythrocyte sedimentation rate

Elevation is associated with inflammation or infection in the body

20-40 indicates mild inflammation
40-70 indicates moderate inflammation
70-150 indicates severe inflammation
* other autoimmune diseases can increase ESR


What is ANA

Anti nuclear antibody
( antibody produced against ones own DNA)


What are diagnostic procedures for RA

Arthrocentesis ( synovial fluid aspiration by needle, with RA, increased WBC and RF are present in fluid


What is recommended teaching for morning stiffness related to RA

Hot shower


What is recommended teaching for edema

Cold therapy


What are medications for RA

Treatment begins with NSAIDS which provides analgesic, antipyretic, and anti inflammatory effects...NSAIDS can cause considerable GI distress.


If NSAIDS cause considerable GI distress, what can be done

Request a concurrent prescription for a GI lowering agent ( antihistamine 2 receptor antagonist,PPI) ...... Monitor for fluid retention,HTN, and renal dysfunction


What are other meds for RA

COX-2 enzyme blockers
Disease modifying anti rheumatic drugs ( DMARDS)
Anti malarial agent ( hydroxychloroquine { Plaquenil})
Antibiotic ( minocylcine { Minocin}
Sulfonamide ( sulfasalazine { Azulfidine}
Biologic response modifiers
Cytotoxic medications... Methotrexate, leflunomide, cyclophosphamide,and azathioprine.


How do DMARDS work

They work In a variety of ways to slow the progression of RA and suppress the systems reaction to RA that causes pain and inflammation.....relief of symptoms may not occur for several weeks