Rheumatoid Arthritis ( RA) Flashcards
OAvsRA
OA- weight bearing joints (asymmetrical) , over age of 40
RA - small joints such as the hand, foot, wrist, elbow , shoulder or ankle (bilateral) , over age of 50
How long can morning joint stiffness be in rheumatoid arthritis
Last for at least 60 minutes and can persist for hours
How long does morning joint stiffness last in OA?
Last only a few minutes
Symptoms besides joint pain of RA
Fatigue, weight loss, and fever (usually systemic)
Overall health of OA is affected during
False
Why is it important for someone with RA to stay active?
Stiffness will decrease
disease progression with RA
Symptoms worsen over a period of weeks , months
RA pain
May get worse doing yard work in back or knees
RA
Chronic
Extraarticular manifestations
Periods of remission and exacerbation
Genetic link*
What are some factors that may cause RA
Enviromental factors and genetic link
What antibody can SOME not all rehrumatoid arthritis pt test positive for
rheumatoid factor
Clinical manifestations of RA
Sneaks up on you,
Fatigue, anorexia, weight loss, generalized stiffness
History of precipitating factors
What are examples of precipitating events that can happen
Infection, stress , childbirth, surgery, emotional upset
(Physical exertion or environmental)
JOINTZ N RA
Symmetrical
Morning stiffness 60 minutes or longer
Tender, painful warm to touch
Increase pain with motion
Intensify varies
What joints of the hand l\get affected
MCP joint and PIP joint
What is the appearance of the skin on hand look like in RA
Wrinkled part wi be smooth
More common in wrist than ankles and toes
Things that can happen if RA left untreated
Tenosynovitis
Deformity and disability
Subluxation
Walking disability
Deformities in the hands
Boutonnière deformity
Button hole
Middle joint stays in flexed position
Developed problems with tendons that straighten out that joint
If you want to straighten it out you’ll have it do it manually
Bunion
Joint in toe leans outward
Swan neck
Finger in a zig zag
Rheumatoid nodules
Will show up if someone has not had a lot of access to treatment
Hardened, inflamed tissue
Teaching pt about pressure ulcers
(Skin break down biggest concern )
Sjögren’s syndrome
Can be on its own or part of RA
Dry mouth and dry eyes , hard to swallow
( dry eyes prone to infection and dry mouth more prone to dental carries)
Targets silvery glands and tear glands
Flexion contractures
Decrease mobility and decrease strength in the hand
Effects how thy live their life
People with chronic pain typically deal with
Depression
RA are prone to
Anemia problems
Neuropathy issues
lung stiff ness **(pleural, pericardium)
Kidneys ( amyloidosis)
What do we want to teach our pt with RA with respiratory issues
Turn cough deep breath
If pt on ventilator they can be hard to get off but just have to work a bit harder
Higher the inflammation in body
Higher chance of systemic impact
Certain drugs will help prevent systemic damage
Subjective data
Precipitating factors
Pattern of remissions & exacerbations
Use of meds
Family history
Impact on functional ability
Anorexia, weight loss, malaise
Stiffness ad joint swelling, muscle weakness, difficulty walking
Parasthesia of hands and feet
Symmetric joint pain
What subjective data will nurse gather with join pain
Which joints
Is it singular or bilateral
Is there swelling, tenderness or tempature changes
Nursing assessment objective data
lymphadenopathy , fever
Rheumatoid nodules
Skin ulcers
Shiny, taut skin over joints
Cardiovascular involvement
Respiratory
And gi issues
Cardiovascular issues in RA
Raynaud’s phenomenon
Dysrhythmias
Raynaud’s phenomenon
Exacerbated or extreme vasoconstriction when pt is exposed to cold
Some pt use gloves
How is Raynaud’s phenomenon treated **
Beta blocker to help vasoconstriction
Dysrhythmias
Inflammation from RA causes scarring on SA node or AV node
Makes pt prone to dysrhythmias
Respiratory issues that in RA are more prone to
Chronic bronchitis
Tuberculosis
GI issues in RA
Splenomegaly (felty syndrome)
splenomegaly felty syndrome
An enlarged spleen
Decrease WBC count
(At risk for infections)
SANTA
Splenomegaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis RA
Musculoskeletal RA
Symmetric joint involvement
Swelling erythema
Heat tenderness
Deformities
Joint enlargement
Lab findings RA
Rheumatoid factor (85% of ppl)
increase ESR (erythrocyte sedimentation rate)
Increase WBCs in synovial fluid
X-ray findings
RA
Joint space narrowing
Bony erosion
Deformity
Osteoporosis
Thin
People who dont have rheumatoid factor positive but have other s/s
Usually s/s aren’t as bad compared to ppl who do test positive
C reactive protien
Not specific to RA but tell us that people have inflammation somewhere , but people with RA will usually have elevated CRP
If we start someone on a treatment what wold we expect in the labs
Decreased numbers
If we did an aspiration of the joint space what would you expect to see?
WBCs
What muscles do PT work with
Larger muscle groups and mobility
Knees hips and back
Occupational therapies
Fine muscle movement, adls, adaptive devices
Also deal with splints
Goals of drug therapy
Relieve symptoms
Maintain joint function and ROM
Manage systemic involvement
Delay disease progression
(No cure or prevention)
For every 5 pounds of weight
Puts an extra pressure 20 pounds on hips knees and ankles
Corticosteroids stimulate
Apetite = weight gain
What do we assess when it comes to nutritional therapy
Balanced nutrition
Loss of appetite, weight loss weight gain
What’s the purpose of surgery therapy
Relieve severe pain
Improve function
Synnovectomy
Removal of synovial of the joints 
Total joint replacement (arthroplasty)
It’s not as effected in larger joint in hip and knee because of the atrophy so ROM may not be restored
Acute intervention
Plan care around morning stiffness
To relieve joint stiffness and increase ability to perform ADLS
Sit or stand in warm shower
Sit in tub with warm towels around shoulders
Soak hands in warm water
What is a good thing to contribute to ambulatory care
Remain active but rest!
Body alignment practice RA
Firm mattress or bed board
Encourage. Position of extension
Avoid flexion positons(no pillow under knees
Small flat pillow under head and shoulders
Ice during exacerbation
Beneficial
Helps with swelling
10-15 minutes at a time
Towel in between the skin
Moist heat
Warm baths, showers, moist hot packs , paraffin
Relieves stiffness
20 minutes at a time
Be alert for potential burns
Excercise
Need recreational and therapeutic
Gentle ROM done daily
Weights limit to one or two reps urine acute inflammation
(Moderate to light)
Psychological support
Pt constantly challenged by issues
Limited function and fatigue
Loss of self esteem
Altered body image
Fear of disability or deformity
Why are RA so immunosuppressed
a lot of the the drugs they take are immunosuppressive
