RHMTIC DS

Question 1

What are the common sites of RHEUMATIC DISEASE?

Answer 1

● Skeletal muscles,
● Bones,
● Cartilage,
● Ligaments,
● Tendons, and
● Joints

Question 2

What are the classifications of RHEUMATIC DISEASE?

Answer 2

-MONOARTICULAR
-POLYARTICULAR

Question 3

CLASSIFICATION OF RHEUMATIC DISEASE:

• only one joint is affected

Answer 3

MONOARTICULAR

Question 4

CLASSIFICATION OF RHEUMATIC DISEASE:

• multiple joints are affected

Answer 4

POLYARTICULAR

Question 5

WHAT ARE THE FURTHER CLASSIFICATION OF RHEUMATIC DISEASE?

Answer 5

-INFLAMMATORY
-NONINFLAMMATORY

Question 6

FURTHER CLASSIFICATION OF RHEUMATIC DISEASE:

• there is a formation of
  pannus.

Answer 6

-INFLAMMATORY

Additional Notes:
● Deformity is caused by the
pannus - destructive granulation
tissue that extends from
synovium to synovial cavity.

Question 7

● ____________ is the most common rheumatic disease
● Autoimmune; real cause is unknown
● Chronic systemic inflammatory disease

Answer 7

RHEUMATOID ARTHRITIS

Question 8

T OR F: Women affected 2x to 3x than men,

Answer 8

TRUE

○ Peak: 40 to 60
○ Onset: 30 to 50

Question 9

Destructive granulation tissue that extends from synovium to synovial cavity

Answer 9

PANNUS

Question 10

MANIFESTATIONS OF RHEUMATOID ARTHRITIS:

Answer 10

● Fatigue
● Anorexia
● Weight loss
● Generalized aching and stiffness
● Subluxation of joints - a condition that occurs when
a joint begins to dislocate
● Swan neck deformity - hyperextension of PIP joint
and partial flexion of DIP
● Boutonniere deformity
● Bulge skin
● Genus valgus
● Joints contractures
● Baker’s cyst
● Increase ESR or Erythrocytes Sedimentation Rate -
matagal mag settle meaning there is inflammatory
response happening to the patient
● Rheumatoid nodules: ulna
● Ulcerations of lower extremities

Question 11

MANIFESTATIONS OF RHEUMATOID ARTHRITIS:

-a condition that occurs when
a joint begins to dislocate

Answer 11

SUBLUXATION OF JOINTS

Question 12

MANIFESTATIONS OF RHEUMATOID ARTHRITIS:

-hyperextension of PIP joint
and partial flexion of DIP

Answer 12

SWAN NECK DEFORMITY

Question 13

CRITERIA FOR CLASSIFICATION OF RHEUMATOID ARTHRITIS

Answer 13

Four or more of the following conditions must be present to
establish a diagnosis of rheumatoid arthritis:
1. Morning stiffness for at least 1 hour and present for
at least 6 weeks
2. Simultaneous swelling of three or more joints for at
least 6 weeks
3. Swelling of wrist, metacarpophalangeal, or proximal
interphalangeal joints for 6 or more weeks
4. Symmetric joint swelling for 6 or more weeks
5. Rheumatoid nodules
6. Serum rheumatoid factor identified by a method that
is positive in less than 5% of normal subjects
7. Radiographic changes typical or rheumatoid arthritis
on hand or wrist radiographs

Question 14

DIAGNOSTICS OF RHEUMATOID ARTHRITIS:

Answer 14

● Physical examination
● Rf test
● Presence of 4 major criteria
● Anti-cyclic citrullinated peptide (CCP)
● Antibodies - antibodies attacking normal antibody
● Synovial fluid analysis - done to check if there is
problem in the synovial fluid of the patient

Question 15

STAGES OF RHEUMATOID ARTHRITIS:

-● There is inflammation of the joint but no bone
damage.

Answer 15

STAGE 1/ Early Stage

Question 16

STAGES OF RHEUMATOID ARTHRITIS:

● Synovium’s inflammation causes damage to the
joint cartilage.
● Limited ROM or Range of Movement

Answer 16

STAGE 2/ Moderate Stage

Question 17

STAGES OF RHEUMATOID ARTHRITIS:

● Damage extends from the joint to the
bones
● Joint to the bones

Answer 17

STAGE 3/ Severe Stage

Question 18

STAGES OF RHEUMATOID ARTHRITIS:

● Joints become destroyed and the bones fused
together (ankylosis)

Answer 18

STAGE 4/ End stage

Question 19

TREATMENT OF RHEUMATOID ARTHRITIS:

○ Regulating activity by pacing, establishing
priorities, and setting realistic goals - since
there is limitations in the EDM of the
patient or the ROM or Range of motion
○ Long-term adherence to the prescribed
treatment modalities - if there is an
available therapy, encourage the patient to
adhere or have the said therapy
○ Proper posture, positioning, body
mechanics, and the use of supportive
shoes

Answer 19

1. SYMPTOM CONTROL

Question 20

TREATMENT OF RHEUMATOID ARTHRITIS:

■ range of motion exercises

Answer 20

2. ROM

Question 21

TREATMENT OF RHEUMATOID ARTHRITIS:

○ Reduce pain, decrease inflammation,
maintain or restore joint function, and
prevent bone and cartilage destruction.

Answer 21

3. GOALS OF PHARMACOLOGICAL THERAPY

Question 22

TREATMENT OF RHEUMATOID ARTHRITIS:

○ Coxib,
○ Ibuprofen
○ Naproxen
○ Celecoxib, rofecoxib, and valdecoxib

Answer 22

● NSAID and ASA (nonsteroidal pain medication)

Additional Notes:
● Coxib is very common (once na mag
aggressive, automatic mag order na si
doctor)

Question 23

TREATMENT OF RHEUMATOID ARTHRITIS:

○ Gold salts, hydroxychloroquine,
sulfasalazine, methotrexate, and azathioprine

Answer 23

5. DISEASE MODIFYING ANTIRHEUMATIC DRUGS (DMARD’s)

Question 24

TREATMENT OF RHEUMATOID ARTHRITIS:

○ Interfere with purine metabolism, leading
to the release of adenosine, a potent anti-inflammatory compound

Answer 24

METHOTREXATE

Question 25

TREATMENT OF RHEUMATOID ARTHRITIS:

○ Dexamethasone, hydrocortisone,
methylprednisolone, prednisone

Answer 25

CORTICOSTEROIDS

Question 26

TREATMENT OF RHEUMATOID ARTHRITIS:

○ Leflunomide
○ etanercept infliximab, and adalimumab

Answer 26

ANTIRHEUMATIC DRUGS

○ Leflunomide
■ Pyrimidine synthesis inhibitor that
blocks the expansion of T cells

○ etanercept infliximab, and adalimumab
■ Are biologic response - modifying
agent that blocks tumor necrosis
factor-α (TFN-α)

Question 27

What are the SURGICAL TREATMENT of RHEUMATOID ARTHRITIS?

Answer 27

-SYNOVECTOMY
-TENOSYNOVECTOMY
-ARTHROPLASTY
-ARTHRODESIS

Question 28

SURGICAL TREATMENT OF RHEUMATOID ARTHRITIS:

○ Removal or partial removal of the synovial membrane

Answer 28

SYNOVECTOMY

Question 29

SURGICAL TREATMENT OF RHEUMATOID ARTHRITIS:

○ Is the excision of the tendon sheath

Answer 29

TENOSYNOVECTOMY

Question 30

SURGICAL TREATMENT OF RHEUMATOID ARTHRITIS:

○ Construction or replacement of joint

Answer 30

ARTHROPLASTY

Question 31

SURGICAL TREATMENT OF RHEUMATOID ARTHRITIS:

○ Immobilization of joint by fusion
○ To not let the joints move to avoid (kaskas)
inside, which can cause pain to the patient

Answer 31

ARTHRODESIS

Question 32

NURSING INTERVENTION FOR RHEUMATOID ARTHRITIS:

Answer 32

● ASSESSMENT
○ For us to know what is the extent of the RA
(Rheumatoid Arthritis) of the patient
○ To help us plan our nursing management
○ For us to know what are the activities that
we can let the patient do
○ For us to know what the patient can or
can’t do

● MAINTENANCE OF JOINT MOBILITY

● CHANGE POSITION FREQUENTLY

● COMFORT AND RELIEF OF PAIN

● BED REST FOR ACUTE EXACERBATION
○ If worst na ang situation ng patient

● PROVIDE HEAT AND COLD TREATMENTS
○ Hot and cold compress will help in
managing the pain of the patient
○ When can you apply warm and cold
compress?
■ Generally, if inflammatory with
infection, we can apply warm
compress, and at the same time,
if you only want to prevent the
inflammatory response or the
inflammatory process, then we
can apply cold compress because
we will minimize the blood flow on
that area
■ In surgeries, especially in ortho
operations, the doctor will order
cold compress
■ Initially after surgeries, our goal is
to prevent the pain post-surgery
of the patient
■ Cold compress can help the
patient once the anesthesia
subsides
■ 20 minutes i apply, pwede i
alternate with warm compress but
depende pa rin sa order ng doctor
■ Cold compress and hot compress
- 20 minutes with 1 hour interval
■ Warm compress - we need to
take note if the temperature is
right for the patient