Download Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA)
 Rheumatoid arthritis (RA)
is a chronic, systemic inflammatory disorder that may
affect many tissues and organs, but principally
attacks synovial joints.
RA is considerd autoimune disease of unknown origin
that affect 1% of the population worldwide with a
female to a male ratio between 2:1 and 4:1.
 The process produces an inflammatory response of the
synovium (synovitis) secondary to hyperplasia of synovial
cells, excess synovial fluid, and the development of
pannus in the synovium.
 The pathology of the disease process often leads to the
destruction of articular cartilage and ankylosis of the
joints. Rheumatoid arthritis can also produce diffuse
inflammation in the lungs, pericardium, pleura, and
sclera, and also nodular lesions, most common in
subcutaneous tissue
- Joint pain, swelling , warmth, erythema and lack of
function .
- Palpation reveal spongy or boggy tissue.
- The classic sign is joint stiffness in the morning .
- Fever, fatiuqe, anemia.
- lymph node enlargment and Raynaud’s phenomena
 The history and physical examination
The erythrocyte sedimentation rate (ESR) is significantly
elevated with RA..
 C-reactive protein and antinuclear antibody test
results may also be positive.
CONT…
 Arthrocentesis shows synovial fluid that is cloudy, milky
or dark yellow and contain numerous amount of
leukocyte and complement.
 X-ray studies, performed to help diagnose and monitor
the progression of disease, show characteristic bony
erosions and narrowed joint spaces occurring later in the
disease
 Early-Stage RA :
1 ) In patients with early RA, treatment begins with
education, a balance of rest and exercise, and referral to
community agencies for support
2 ) Medical management begins with therapeutic doses of
NSAIDs.
CONT….
3 ) Several COX-2 inhibitors, another class of NSAIDs,
have been approved for treatment of RA.
4 ) biologic response modifiers that are currently available
infliximab (Remicade). These agents inhibit the function
of tumor necrosis factor-alpha, a key cytokine known to
play a role in the disease process in RA.
CONT….
 MODERATE, EROSIVE RA :
For moderate, erosive RA, a formal program with
occupational and physical therapy is prescribed to
educate the patient about principles of joint protection,
pacing activities, work simplification, range of motion,
and muscle-strengthening exercises. The patient is
encouraged to participate actively in the management
program.
CONT….
 PERSISTENT, EROSIVE RA :
1 ) Reconstructive surgery is indicated when
pain cannot be relieved by conservative measures.
2 ) Systemic corticosteroids are used when the patient
has unremitting Inflammation.
CONT….
 ADVANCED, UNREMITTING RA :
1 ) Advanced , Unremitting RA : For advanced,
unremitting RA, immunosuppressive agents are
prescribed.
 These include high-dose methotrexate (Rheumatrex),
cyclophosphamide (Cytoxan), and azathioprine
(Imuran). These medications, however, are highly toxic
and can produce bone marrow suppression, anemia,
gastrointestinal disturbances,
and rashes.
The device, a protein A
Immunoadsorption
column (Prosorba.
The Prosorba Column is a
Plasma filtering device used to
treat severe cases of
Rheumatoid Arthritis

The effect of the Protein A is to
remove circulating immune
complexes
1 ) Food selection should include the daily requirements
from the basic food groups, with emphasis on foods high
in vitamins, protein, and iron for tissue building and
repair.
2 ) Some medications (ie, oral corticosteroids) used in RA
treatment stimulate the appetite and, when combined
with decreased activity, may lead to weight gain.
CONT…
3 ) The most common issues for the patient with RA
include pain, sleep disturbance, fatigue. altered mood,
and limited mobility.
4 ) The patient with newly diagnosed RA needs
information about the disease to make daily self
management decisions and to cope with having a chronic
disease.