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Jenna J
Mrs. Caplan
Pathology Paper
April 17, 2010
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a disease that “affects 1.3 million Americans” (Arthritis
Foundation 2010). American patients dealing with rheumatoid arthritis usually have to cope with
“varying degrees of disease activity requiring a spectrum of treatments ranging from oral
corticosteroids to disease-modifying antirheumatic drugs (DMARDs) or biological agents, which
typically consist of injections or intravenous therapy” (Barker, et. al. 2010). DMARDs are
usually the first drug given to RA patients when treatment starts (Oliver 2007). Rheumatoid
arthritis generally affects women between the ages of twenty and fifty but this disease can
develop at any age (Burton, et. al. 2006). RA in men is rare and develops around the age of
thirty, but is more common in the ages between sixty and seventy (Burton, et. al. 2006). Women
are more affect by rheumatoid arthritis than men, around a three to one ratio (Oliver 2007).
Women who have RA and become pregnant do not experience their symptoms during pregnancy
but start experiencing their symptoms again after the birth of the baby (Arthritis Foundation
2010).
Rheumatoid arthritis is a chronic or long lasting disease, affecting the lining, or the
synovium of the joints, causing inflammation and can lead to long term damage of the joints, and
patients may experience loss of function in the affected parts and RA can become a disability
(Barker, et. al. 2010). Currently, there are no known causes of RA (Arthritis Foundation 2010).
A doctor must take a complete medical history on the patient and the patient must have a full
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musculoskeletal exam to diagnose RA (Oliver 2007). Assessment of the synovial joints in the
clinical setting must take place to see if there is tenderness and swelling around the area and
what the patient’s range of movement is with the affected joints (Oliver 2007). The presence of
the rheumatoid factor in blood tests can also help to diagnose RA but the presence of the
rheumatoid factor does not always mean the patient has RA (Oliver 2007).
Rheumatoid arthritis develops in three stages. Stage one consists of inflammation and
swelling of the synovial joint which causes pain, inability to move the joint, redness and
puffiness is also around the joint (Arthritis Foundation 2010). Stage two consists of the rapid
growth of cells in the synovium which makes the synovium become thick (Arthritis Foundation
2010). Stage three consists of the inflamed cells releasing enzymes that eat bone and cartilage,
causing the joint to come out of its alignment and to lose its shape (Arthritis Foundation 2010).
Patients with stage three of RA suffers through pain, and loss of movement in the joint that is
affected (Arthritis Foundation 2010).
The effects of RA are basically the end of the joint because the body’s immune system
will attack the joints and eventually erode the joint into nothing (Oliver 2007). The symptom that
is most notable with patients is pain, affecting the joints of the hands, fingers, and the smaller
bones of the feet (Oliver 2007). If RA is allowed to go untreated, a person’s joint will be
eliminated, because of the destruction of the disease and the person’s number of years to live will
also be diminished (Oliver 2007).
There are many skeletal joints that are affected by rheumatoid arthritis. RA affects the
wrist, articulating hand bones, (metacarpophalangeal bones), and the finger bones
(interphalangeal bones), which are the most commonly affected joints (Burton, et. al. 2006). The
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wrist, shoulder, feet, knees, elbows, hips, any joints in the lumbar area and the top of the spine,
(the cervical spine), can also be affected by RA (Burton, et. al. 2006).
RA has several but common physical symptoms: fatigue, stiffness, weakness, flu-like
symptoms including a low grade fever, pain with long periods of sitting, periods of disease
activity and disease inactivity, muscle pain, loss of appetite, depression, weight loss, anemia,
cold/sweaty hands, decreased production of tears and saliva, and rheumatoid nodules which are
bulges of tissue under the skin (Arthritis Foundation 2010). Nodules are a sign the disease is
becoming severe and cause the joints where the nodules are located to swell, which means RA is
active at that point (Burton, et. al. 2006) Also, cardiovascular disease is a risk factor to patients
with RA because of the inflammatory component of this disease (Oliver 2007).
To be considered a RA patient, four types of symptoms must be present for six weeks:
patients experience stiffness in the morning hours that lasts at least one hour before any
improvement begins to appear, soft tissue swelling must appear and be noted by a doctor in three
or more joints, swelling in the wrist and finger joints, and the patient must already have arthritis
affecting symmetric joints (Burton, et. al. 2006).
Doctors give treatments with the goal of preventing the progression of RA, keep the
joints as healthy as they are at the point of diagnosis, and prevent the patient from suffering an
early death (Oliver 2007). There are four criteria that doctors use to achieve the best treatment
for RA patients: give patients the earliest diagnosis possible, making patients even out their
treatment plan to gain control of RA, help the patient enter remission or gain a strong disease
control, and help the patient succeed in agreement between the patient and the doctor, ability
manage their own care and produce the patients desired result in battling RA (Oliver 2007).
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RA treatments are many in number and each are different involving prevention,
monitoring and continuous management (Barker, et. al. 2010). A rheumatologist is suggested for
patients with RA because these doctors are specially trained in arthritis and other diseases of the
bones, muscles and joints (Arthritis Foundation 2010).Treatment involves medications combined
with physical therapy to help with pain but to also strengthen the patient to help keep the disease
from progressing further (Barker, et. al. 2010). Doctors, who prescribe medications to RA
patients, tend to use biological or nonbiological drugs to help prevent further damage (Barker, et.
al. 2010). Drugs, like corticosteroids, can be used as a type of therapy in patients with RA, that
help prevent more damage in the affected joints and also prevent more progression of RA
(Burton, et. al. 2006). Biological drugs are used when other therapies are tried but do not help
(Barker, et. al.2010). For pain, doctors prescribe extra-strength medications, such as naproxen or
Motrin (Barker, et. al. 2010).
Surgery is also an option. Some patients receive a synovectomy, which is the surgical
removal of the diseased lining in the synovium (Arthritis Foundation 2010). Arthroscopic
surgery is an exploratory surgery in which the doctor can see the progression of RA, or take
samples to evaluate how far RA has progressed, and remove diseased tissue (Arthritis
Foundation 2010). Joint replacement surgery is also an option for patients with RA because this
surgery replaces the disease joint with a man made piece and is used in patients with a severe
progression of RA (Arthritis Foundation 2010).
Many modern technologies have helped in the diagnosis of rheumatoid arthritis. Doctors
look at the hands and feet, and X-rays are usually taken to look for loss of bone mass (Oliver
2007). Ultrasound is used for looking into patients and determining if signs of inflammatory joint
disease are present (Oliver 2007). Magnetic Resonance Imaging (MRI) can also find swelling in
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the joints before and X-ray will show damage, this alternative is expensive (Arthritis Foundation
2010). A bone densitometry (DEXA) is also used for diagnosing RA because it measures bone
density which is a test for osteoporosis, but in people with RA, osteoporosis can be severe
because of joint immobilization (Arthritis Foundation 2010). Ultrasounds and X-rays combined
can detect the early signs of synovitis, which is found to be the beginning of joint loss (Oliver
2007). A patient’s medical history is examined, physical exams, and lab tests may be ordered so
the doctor can check for abnormalities (Arthritis Foundation 2010).
Patients with RA usually have a pre-existing factor that triggers this disease. Factors like
the type of background a person has, what kind of choices the person has made for their
lifestyles, and factors that are already biologically affecting the person (Barker, et. al. 2010). RA
is now believed to have a genetic factor, but also has environmental factors as well that
contributes to the disease (Burton, et. al. 2006). The main theory of what causes RA is that a type
of infection causes inflammation and attacks the joints (Burton, et. al. 2006).
RA is a very modern disease. This disease has only been around for the last two hundred
years and is not known before that time (Burton, et. al. 2006). RA was distinguished only fifty
years ago from other rheumatic diseases, such as reactive arthritis (Burton, et. al. 2006). In the
1960s, rheumatology became popular as immunological research and treatment were advancing
(Burton, et. al. 2006).
RA is a very complex disease. This disease can physically make a person unable to move
and lead a normal daily life because RA gives patients days with no symptoms or days with the
most intolerable, painful symptoms. Good nursing care helps to promote the mental well being of
a patient dealing with RA (Burton, et. al. 2006). Rheumatoid arthritis is a disease that is affecting
people in the western world at a rate of one percent (Oliver 2007). Patients dealing with RA must
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also deal with a chronic and destructive disease and learn how to supervise and control this
disease (Oliver 2007). Good communication between the doctor and nurse providing the care,
and the patient will keep RA manageable and under control (Oliver 2007). With medication and
good management, RA can be prevented from taking control of an affected person’s life.
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References
Arthritis Foundation. (2010). Rheumatoid arthritis. Retrieved from
http://www.arthritis.org/disease-center.php?disease_id=31&df=definition
Barker, T., & Puckett, T. (2010). Rheumatoid arthritis: coping with disability. Rehabilitation
Nursing, 35(2), Retrieved from http://ezproxy.octc.kctcs.edu:2068/pqdweb?index=1...
Burton , S., & Lloyd, M. (2006). An Overview of rheumatoid arthritis. Nursing Standard,
20(24), Retrieved from Ebsco on April 17, 2010.
Oliver, S. (2007). Best practice in the treatment of patients with rheumatoid arthritis. Nursing
Standard, 21(42), Retrieved from Ebsco on April 17, 2010.
Oliver, S. (2007). Painful joints: is this osteo- or rheumatoid arthritis?. Practice Nurse, 34(4),
Retrieved from http://ezproxy.octc.kctcs.edu:2068/pqweb...
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