Musculo Skeletal Disorders For Nursing Student Under Medical Surgical Nursing For G.N.M & B.Sc. Nursing.

1. RHEUMATOID ARTHRITIS
Mr. Kush JOshi

2. Femur

3. DEFINATION
Rheumatoid arthritis is a chronic systematic
autoimmune connective tissue disorder which causes
symmetrical inflammation of the synovial tissue of joints and
surrounding tissues, characterized by destruction and
Proliferation of synovial membrane resulting in joint
destruction, ankylosis ( abnormal stiffening and immobility of a
joint due to fusion of the bones) and deformity.
An autoimmune disorder, rheumatoid arthritis occurs
when immune system mistakenly attacks own body’s tissues.

5. Etiology and risk factors
■ Exact cause is unknown
■ Genetic factors may be involved in determining whether
they will develop rheumatoid arthritis
■ Gender- women are more likely to develop rheumatoid
arthritis than men
■ Age- can occur at any age, but mostly begins between age
30- 60
■ Family history of arthritis increases the risk

6. ■ Hormonal factors:- changes or deficiencies in certain
hormone may be involved
■ Heavy long term smoking is a very strong risk factor
■ Infection such as bacteria, fungi, viruses esp. Epstein
barr virus
■ An immunological response
■ Metabolic and biochemical abnormalities

7. Clinical manifestations
■ Most of the time, rheumatoid arthritis affects joints on
both sides of the body equally. Fingers, wrists, knees, feet,
elbows, ankles, hips and shoulders are the most commonly
affected.
■ The disease often begins slowly. Early symptoms may
include:
1. minor joint pain
2. stiffness
3. fatigue

10. ■ Joint symptoms may include:
1. Morning stiffness, which lasts more than 1 hour, is common
2. Joint may feel warm, tender and stiff when not used for an
hour.
3. Joint pain is often felt in the same joint on both sides of the
body
4. Joints are often swollen
5. Over time, joints may lose their range of motion and may
become deformed.

11. ■ Other symptoms include:-
1. Chest pain when taking a breath ( pleurisy)
2. Dry eyes and mouth ( sjogren syndrome)
3. Eyes burning , itching and discharge
4. Nodules under the skin ( most often a sign of more
severe disease)
5. Numbness, tingling, or burning in the hands and feet
6. Sleep difficulties

12. Diagnostic evaluation
■ History collection and physical examination
■ Two laboratory tests that are positive in most people and
often help in the diagnosis are:-
1. Rheumatoid factor
2. Anti- CCP antibody
■ These tests are positive in most patients with RA .The
anti-CCP antibody test is more specific for RA.

13. ■ Rheumatoid factor test
RF is a blood test that measures the amount of the
rheumatoid factor ( RF) antibody in the blood.
■ Anti- CCP antibody tests
It is a type of blood test that looks for anti-CCP
antibody ( also called anti-citrullinated protein antibodies or
ACPAs) in the blood.
■ Other tests include:-
- complete blood count
- joint X- ray, ultrasound and MRI scan
- joint fluid analysis

14. Management
■ Medical management
1. Disease modifying antirheumatic drugs (DMARDs)-
Commonly used to treat moderate to severe rheumatoid
arthritis.Types of medications include those used to suppress
immune system ( Imuran) , antimalarial medications
(plaquenil), gold preparations ( Auranofin), Penicillamine and
some medications normally used to treat cancer (
Methotrexate).

15. ■ Nonsteroidal anti inflammatory drugs
Relieve pain and reduce inflammation. Ex., ibuprofen
and naproxen sodium (Aleve).
■ Corticosteroids-Ex.,Triamcinolone hexacetonide
■ Immunosuppressive drugs- Ex., azathioprine and
cyclosporine

16. ■ Surgical management
1. Total joint replacement :- during joint replacement surgery,
surgeon removes the damaged parts of joint and inserts a
prosthesis made of metal and plastic
2. Synovectomy:- Removal of joint lining. It is used to remove
inflamed tissue that causes pain, it can help to reduce
swelling.
3. Tendon repair:- Inflammation and joint damage may cause
tendons around joints to loosen or rupture. Surgeon may be
able to repair the tendons around joints.

17. Nursing management
■ Check vital signs
■ Administration of medications
■ Monitor level of pain and duration of morning stiffness
■ Position the patient comfortably
■ Teach the use of hot and cold application
■ Encourage to do yoga, relaxation techniques, breathing
exercises etc..
■ Advice the patient to balance period of activity with rest.

18. Thank you…