Rheumatoid arthritis Flashcards
What is rheumatoid arthritis?
A connective tissue disease that can be the most destructive to the joints. It is chronic, progressive, systemic inflammatory autoimmune disease that affects primarily the synovial joints.
What are some manifestations of RA?
EARLY: Inflammation in joints (usually upper extremities) Symmetrical (both-sided) Low-grade fever Fatigue Weakness Anorexia LATE: Deformities Moderate to severe pain & morning stiffness Osteoporosis Severe fatigue Weight loss
What are some manifestations of RA?
EARLY: Inflammation in joints (usually upper extremities) Symmetrical (both-sided) Low-grade fever Fatigue Weakness Anorexia LATE: Deformities Moderate to severe pain & morning stiffness Osteoporosis Severe fatigue Weight loss
What is the most commonly associated syndrome with RA?
Sjogren’s syndrome (dry eyes, dry mouth, dry vagina).
What is an atrthrocentesis?
Invasive procedure where a large-gauge needle is inserted into the joint and synovial fluid is aspirated for analysis and to relieve pressure on the joint.
Which assessment findings will the nurse expect for client with late-stage RA?
High ESR values (erythrocyte sedimentation rate)
Positive antinuclear antibody (ANA) titer
Subcutaneous nodules
Anemia
Red, swollen joints
What is methotrexate (Rheumatrex)?
A disease-modifying anti rheumatic drug (DMARD), which is an immunosuppressive medication given once a week. It takes 4-6 weeks to control inflammatory joint symptoms. It puts patients at high risk for infection so tell them to avoid crowds, do not drink alcohol as it is nephrotoxic. Teach to notify doc STAT if dyspnea. It is given with folic acid to help decrease some of the drug side effects. Pregnancy is not recommended because birth defects are possible. If patient becomes pregnant, instruct to stop taking immediately and notify physician of pregnancy.
What is leuflunomide (Arava)?
Another DMARD that helps diminish inflammatory arthritis symptoms of joint swelling and stiffness and improves mobility.It puts patients at high risk for infection so tell them to avoid crowds, do not drink alcohol as it is nephrotoxic. Teach to notify doc STAT if dyspnea. Side effects include hair loss, diarrhea, decreased WBC and platelets. Pregnancy is not recommended because birth defects are possible. If patient becomes pregnant, instruct to stop taking immediately and notify physician of pregnancy.
What is hydroxychloroquine (Plaquenil)?
An antimalarial drug that slows progression of mild rheumatoid disease before it worsens. It helps decrease joint and muscle pain. Side effects include mild stomach discomfort, light-headedness, or headache. (sounds like a commercial).
What are biological response modifiers?
Newest class of DMARDs. They neutralize the biologic activity of tumor necrosis factor alpha and are only available via injection/IV. Named: Enbrel, Humira, Orencia, Kineret, Remicade. They are very expensive and not widely used at this time. Page 340 goes into detail about these.
What kind of complications are caused by chronic steroid use?
Diabetes mellitus infection fluid and electrolyte imbalances hypertension osteoporosis glaucoma
Patients who take chronic steroids should take what vitamin supplements and why?
Calcium and Vitamin D
to help prevent osteoporosis
Patients who take chronic steroids should take what vitamin supplements and why?
Calcium and Vitamin D
to help prevent osteoporosis
What kinds of nonpharmalogic interventions for RA patients?
Adequate rest
proper positioning
ice and heat applications
Heated paraffin (wax) dips with finger exercises done immediately afterward
