Rheumatoid Arthritis (Exam 3) Flashcards by Isaiah Smith

Rheumatoid Arthritis

Autoimmune symmetrical progressive insidious

HIGHLY inflammatory connective disorder

Remissions and Exacerbations

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RA: Early Symptoms

Systemic (unlike OA)
-anorexia
-weight loss
-stiffness

Progresses to

Pain and worsening stiffness
Limited motion
Deformity and disability

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Rheumatoid Arthritis: Morning Stiffness

Last longer than 60 min

More prolonged vs OA

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RA: Extra-articular systemic changes

Rheumatoid nodules

Sjogren’s syndrome

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Sjogren’s Syndrome

Incidence 10-15%

Diminished lacrimal secretion
-Burning-Gritty Eyes
-Decreased tearing

Diminished salivary gland secretion
-Dry - Erythematous
-Depapillation

Photosensitivity

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Sjogren’s Syndrome is associated with other rheumatoid disorders like

SLE for example

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Rheumatoid Nodules

Incidence - 20/30%

Subcutaneous non tender firm nodules

Located fingers and elbows

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Hand Deformities in RA vs OA

Ulnar deviation (Side out toward ulna)

Knuckle subluxation (partial dislocation)

Wrist subluxation (partial dislocation)

Finger Swan Neck

Finger boutonniere

Z-shaped thumb

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Hand Deformities in OA vs RA

Heberden’s nodes

Bouchard’s nodes

Squaring of thumb joint

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Primary Joints OA vs RA

OA:
-Distal Interphalangeal
-Carpometacarpal

RA:
-Metacarpophalangeal
-Proximal Interphalangeal

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Lab Finding: OA vs RA

OA
-Negative RF
-Negative Anti-CCP
-Normal ESR and CRP

RA
-Postive RF
-Postive anti-CCP
-Elevated ESR and CRP

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How do we diagnose RA?

Inflammatory arthritis involving 3 or more joints:
-Metacarpophalangeal and proximal interphalangeal
-Wrist and Feet

Rheumatoid Factor
-80% time positive but poor specificity

ACPA (Anti-CCP)
-Levels are more specific than RF and may be positive very early in the course of the disease

ESR and CRP
-Elevated

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RA Diagnostic: RF

-80% time positive but poor specificity

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RA Diagnostic: ESR and CRP

Elevated

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RA Diagnostic: ACPA (Anti-CCP)

-Levels are more specific than RF and may be positive very early in the course of the disease

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RA duration of symptoms

Typically greater than 6 weeks

RA: Nursing Problems

-Chronic Pain

-Impaired physical mobility

-Fatigue

-Self-care deficit

-Disturbed body image

-Depression / Ineffective coping

-Deficient Knowledge

-Ineffective role preformance

RA: Collaborative Care

Rest
-inflamed joints should be retested but physical fitness should be maintained
-8-10 hrs of sleep + nap

Exercise
-pain/stiffness often prompt to become inactive — bad idea
-regular exercise can prevent reverse effects

Hand Finger Splinting

Physical and Occupational Therapy

Heat / Cold therapy
-limit to 20 min or less
-alternate

Nutrition

RA: Heat / Cold Therapy

Limit to 20 min or less

Alternating fashion

RA Collaborative Care: Rest

-inflamed joints should be retested but physical fitness should be maintained

-8-10 hrs of sleep + nap

RA Collaborative Care: Exercise

-pain/stiffness often prompt to become inactive — bad idea

-regular exercise can prevent adverse effects

What is the cornerstone treatment for active RA?

Drug therapy

Goal of Treatment for RA

Achieve REMISSION and PREVENT further joint damage without causing unacceptable side effects

Need regular medical care and blood test to monitor for complications

Drug Therapy For RA

Disease-modifying anti-rheumatic drugs (DMARDS)

RA drug therapy: DMARDS (moa)

-substantially reduce inflammation of RA -reduce/prevent joint damage -preserve joint structure and function -enable a person to continue his/her activities

DMARDS

Methotrexate and Hydroxychloroquine

Methotrexate: Improvement in symptoms

4-6 weeks Often used in early RA = start ASAP / within 3 months of diagnosis / can lessen permanent effects of RA

What is the key to DMARDS and Drug Therapy for RA

Start as early as you can because after a certain period the drugs are not nearly effective

Hydroxychloroquine: Improvement of symptoms

2-3 months

RA: NSAIDS

Provided more immediate relief from pain and minor inflammation Do not reduce long-term damage Must be taken continuously at specific dose to have anti-inflammatory effect (SEVERAL WEEKS)

How must NSAIDS be taken for anti-inflammatory effect?

Must be taken continuously at specific dose to have anti-inflammatory effect (SEVERAL WEEKS)

DMARDS and NSAIDS

Once DMARDS take effect and begin to work we d/c the NSAIDS

RA: Glucocorticoids (Steriods)

Prednisone Rapid inflammation suppression Short term use only GOAL = lowest possible dose for shortest period of time MANY STEROID SIDE EFFECTS

OA vs RA: Compare and Contrast Chart in Lewis