Rheumatoid Arthritis Flashcards
(35 cards)
Rheumatoid Arthritis (RA)
Chronic, systemic autoimmune disease
Inflammation of connective tissue in synovial joints
Periods of remission and exacerbation
Extraarticular manifestations- Rheumatoid nodules, Sjogren’s syndrome, felty syndrome , depression
Etiology and Pathophysiology of RA
Autoimmune etiology
Combination of genetics and environmental triggers
Antigen triggers formation of abnormal immunoglobulin G (IgG)
Autoantibodies develop against the abnormal IgG
Rheumatoid factor (RF)
Rheumatoid factor combines with IgG immune complexes → deposit on synovial membranes or cartilage in joints → activates complement → inflammatory response
Neutrophils → proteolytic enzymes → damage cartilage and thicken synovial lining
Pathologic Changes in Rheumatoid Arthritis Picture
Clinical Manifestations Joints
Onset typically insidious
Fatigue, anorexia, weight loss, generalized stiffness
May report history of precipitating event
Infection, stress, exertion, childbirth, surgery
Specific articular involvement
Pain, stiffness, limitation of motion, and signs of inflammation
Symptoms occur symmetrically
Most often affects small joints
Larger joints and cervical spine may be involved
Other Clinical Manifestations Joints
Joint stiffness after inactivity
Morning stiffness 60 minutes to several hours or longer
MCP and PIP joints typically swollen-metacarpal and peripheral
Fingers spindle shaped
Joints tender, painful, warm to touch
Pain ↑ with motion, intensity varies
Tenosynovitis
Deformity and disability
Subluxation
Walking disability
What is Tenosynovitis
inflammation of the tendon sheath, flexor and extender and cartlidge. Similar to carpal tunnel
What is Subluxation
Dislocation and they over lap
Typical Deformities of Rheumatoid Arthritis
A. Ulnar drift
B. Boutonnière deformity
C. Hallux valgus
D. Swan neck deformity
Clinical Manifestations Extraarticular-outside joints Manifestations
Rheumatoid nodules can be in both eyes
Sjögren’s syndrome
Felty syndrome
Flexion contractures
Nodular myositis
Cataracts- Can cause blindeness with these patients
Depression
What is Sjögren’s syndrome
decrease secretion of the salivary glands and eye gland- give over the counter eye drops
Diagnostic Studies in RA
Laboratory studies
Rheumatoid factor (RF)
Erythrocyte sedimentation rate (ESR)
C-reactive protein (CRP)
Antinuclear antibody (ANA)
Anti-citrullinated protein antibody (ACPA)-
Synovial fluid analysis
X-rays of involved joints
Bone scan
Why is Anti-citrullinated protein antibody (ACPA) important
Very important in Dx of RA most definitive
What does Synovial fluid analysis show
It would be cloudy and increased WBC’s
Collaborative Care
Patient teaching
Drug therapy
Disease process
Home management strategies
NSAIDs
Physical therapy
Occupational therapy
Individualized treatment plan
What is DMARDS
Disease Mofifying Antirheumatic Drugs
Drug Therapy: DMARDs
↓ Permanent effects of RA- Why we give these meds
Methotrexate (Rheumatrex)
Sulfasalazine (Azulfidine)
Hydroxychloroquine (Plaquenil)- Can cause retinopathy-teach regular eye exams- also a antimalarial drug
Leflunomide (Arava)
Monitor for bone marrow suppression and hepatotoxicity
Teratogenic-Can be harmful to babies, careful in women of childbearing age
Drug Therapy: Biologic/Targeted Therapies
Tumor necrosis factor (TNF) inhibitors-Prevent inflammation, at high risk for infection due topreventing S/S of inflammation-Do not give live vaccinations
Etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), certolizumab (Cimzia), and golimumab (Simponi)
Bind with TNF, inhibiting inflammation
Tumor necrosis factor (TNF) inhibitors
TB test and chest x-ray before start of therapy
Monitor for infection
Avoid live vaccinations
Drug Therapy
Antibiotics (minocycline [Minocin])
Immunosuppressants (azathioprine [Imuran])
Penicillamine (Cuprimine)
Gold preparations (auranofin [Ridaura])-injections used
Drug Therapy CorticosteroidsHow would you know therapy was affective?
Look at CRP and ESR. Must be tapered off
Intraarticular injections
Low-dose oral for limited time
Drug Therapy NSAIDS
Anti-inflammatory, analgesic, and antipyretic
May take 2 to 3 weeks for full effectiveness
Nutritional Therapy
Balanced nutrition important
Loss of appetite or inability to shop for and prepare food → weight loss
Corticosteroid therapy → weight gain
Surgical Therapy
Relieve severe pain
Improve function
Synovectomy-Removal of joint lining to improve movement
Total joint replacement (arthroplasty)-Common in elderly. How to prevent infection. Aseptic technique
Nursing Assessment Subjective Data
Recent infections, presence of precipitating factors, pattern of remissions and exacerbations
Use of aspirin, NSAIDs, corticosteroids, DMARDs
Any joint surgery
Family history
Malaise
Ability to participate in therapeutic regimen
Impact on functional ability
Anorexia, weight loss
Dry mucous membranes of mouth and pharynx
Stiffness and joint swelling, muscle weakness, difficulty walking, fatigue
Paresthesia of hands and feet
Loss of sensation
Symmetric joint pain and aching that ↑ with motion or stress on joint
