Topic 10: Rheumatoid Arthritis

Question 1

Rheumatoid arthritis (RA):

Answer 1

chronic, systemic auto-immune disease characterized by inflammation of connective tissue in the diarthrodial (synovial) joints. RA is typically marked by periods of remission and exacerbation

Question 2

RA is marked by

Answer 2

thepresence of autoantibodies nd those that target IgG (leads to inflamm & joint dmg)

Question 3

autoantibodies IgG are known as…

Answer 3

rheumatoid factor (RF)

Question 4

what do some patients say bring on RA onset

Answer 4

stressful events

Question 5

clinical manifestation of RA

Answer 5

-early signs:fatigue, anorexia(weight loss) MORNING JOINT STIFFNESS
-symmetrical pain and swelling of small joints in the hand
-joint pain RELIEF WITH ACTIVITY

Question 6

joint pain relief with

Answer 6

ACTIVITY

Question 7

finger deformities in RA

Answer 7

-swan neck
-ulnar drift
-boutonniere deformity

Question 8

Sjogren’s syndrome

Answer 8

inflammation of RA can damage the tear-producing (lacrimal) glands, making the eyes feel dry and gritty, patient may have photosensitivity

Question 9

Felty syndrome

Answer 9

rare but can occur with long-standing RA, characterized by enlarged spleen and low WBC count

Question 10

diagnostic assessment

Answer 10

· RF positive in 70-90% of patients
· ESR and CRP are increased as general indicators of active inflammation
· Increase in antinuclear antibody (ANA) titers is an indicator of autoimmune reaction
· CBC
· X-ray of involved joint
Synovial fluid analysis: slightly cloudy, straw-colored fluid with many fibrin flecks

Question 11

management for RA

Answer 11

· Nutritional and weight management counseling
· Therapeutic exercise
· Psychologic support
· Rest
· Maintain good body alignment during rest through use of firm mattress or bed board
· Encourage positions of extension, and avoid positions of flexion, never place pillow under knees
· Joint protection
· Use of assistive devices
· Moist heat
· CAMS: herbal and nutritional supplements, acupuncture
· Reconstructive surgery
· Synovectomy
Arthroplasty

Question 12

moist heat application

Answer 12

do not exceed 20 minutes at a time

Question 13

cold application

Answer 13

do not exceed 10-15 minutes at a time

Question 14

joint protection

Answer 14

using devices such as electric can opener, Velcro

Question 15

Synovectomy

Answer 15

removal of joint lining

Question 16

Arthroplasty

Answer 16

total joint replacement

Question 17

patient teaching: protection of small joints

Answer 17

· Maintain joint in neutral position to minimize deformity
· Use strongest joint available for any task
· Distribute weight over many joints instead of stressing a few
· Change positions often, do not grip anything for too long without rest period
· Avoid repetitious movement
· Modify chores to avoid stress points

Question 18

Disease-modifying antirheumatic drugs (DMARDs)

Answer 18

o May slow disease progression and decrease risk for joint erosion and deformity

Question 19

what drug is preferred in early treatment of RA

Answer 19

Methotrexate

Question 20

what lab monitoring is needed for methotrexate

Answer 20

requires frequent CBC and blood chemistry monitoring