Nursing College

2. eumatoid Arthritis-RA
disease characterized by acute and chronic inflammation
e synovium, which is associated with a proliferative and
structive process in joint tissues
•
e immune system is not able to
ferentiate self from non-self tissues
d attacks the synovial and other
nnective tissues (Autoimmune disease)
ost common
mall joints of the hands, wrists, feet
)
etatarsophalangeal joints
her joints
-
bows, shoulders, hips, knees, and
erglage

3. A disease characterized by acute and chronic inflammatio
the synovium, which is associated with a proliferative and
destructive process in joint tissues
Rheumatoid Arthritis-RA
•
The immune system is not able to
differentiate self from non-self tissues
and attacks the synovial and other
connective tissues (Autoimmune disease)
Most common
-
Small joints of the hands, wrists, feet
)
metatarsophalangeal joints
(
Other joints

4. Extra-articular Involvement
Rheumatoid nodules
:
o firm lumps under the skin
can occur around the elbows and fingers where there is
frequent pressure
o asymptomatic and do not require any intervention
Sjögren's syndrome: inflammation of the glands of the
eyes and mouth
can cause dryness of these areas (xerostomia)
Felty's Syndrome: an enlarged spleen, which
can increase risk of infections
Bjogrens Byndrome Bynptoms

5. Vasculitis
:
-
impaired blood supply to tissues and lead to
necrosis
-
most often initially visible as tiny black areas
around the nail beds or as leg ulcers
Peri-carditis: may occur and results in the
accumulation of fluid
Pulmonary complications: such as pleural effusions,
pulmonary fibrosis
rery
Pleurisy
Lng

6. Consequences of RA
•
Consequent chronic inflammatory changes results
in
:
-
Loss of cartilage
-
Loss of joint space
-
Loss of joint motion
-
Loss of support to the affected joint
-
Chronic deformity
RHEUMAToiD ARTHRTIS

7. Risk Factors to develop RA
•
Occur at any age but peak onset at
35
-
50
years of
age
Gender
-
3
times more common in females vs males
Genetic predisposition
First-degree relatives of patients with RA develop RA
at
4
-
6
times the standard population rate
Environmental factors such as smoking
Infectious agent e.g. Epstein-Barr virus, Escherichia
coli

8. Signs
-
Tenderness with warmth and swelling
Clinical Presentation
over affected joints (signs of inflammation)
-
Joint involvement is frequently symmetrical
?
Symptoms
-
Joint pain
-
Prolonged morning stiffness of more than
6
weeks
•
Joint stiffness typically is worse in the morning
•
Can last for
1
hour or longer
-
Non-specific symptoms such as fatigue, weakness, low-
grade fever, loss of
appetite, muscle pain

9. Laboratory Tests in RA
Positive Rheumatoid Factor (RF) present in
60
-
70
%
of patients
•
Anti-Cyclic Citrullinated Peptide Antibodies (ACCPA)
present in
50
-
85
esaesid eht ni reilrae dna stneitap fo %
Elevated Erythrocyte Sedimentation Rate ((ESR) and C-Reactive
Protein (CRP
•
Complete blood count
Slight elevation inwBC count
Slight thrombocytosis (Platelets)
Slight normocytic normochromic anaemia (anaemia of chronic
disease) (RBC
)

10. Anaemia of Chronic Disease
Laboratory tests useful to differentiate this anaemia
from iron
-
deficiency anaemia are
:
"
iron
Stool guaiac (or other stool tests for occult
blood/FOBT) +ve deficiency
Serum iron-to-iron-binding capacity ratio (TIBC)
-
Ferritin
-
Mean corpuscular volume (MCV)
anaemia
•
Anaemia of chronic disease do not respond to iron-
supplement

11. Diagnostic Tests for RA
•
Joint fluid aspiration may show increased WBC counts
without infection
•
Joint radiographs may show
-
Soft tissue swelling
-
Osteoporosis near the joint
)
peri-articular osteoporosis
(
-
Joint space narrowing
-
Erosions occurring later in the course of the disease

12. Treatment of RA
•
Non-pharmacological therapy
•
Pharmacological therapy
>
Treatment [Non-biologics; Biologics; Guideline
;
Therapy duration; Outcome evaluation
[
>
Symptom control
•
Prophylactic measures

13. •
Rest
Non-pharmacological Therapy for RA
V Relieves stress on inflamed joints and prevents
further joint destruction
✔
Aid in alleviation of pain
/
Too much rest and immobility may lead to muscle atrophy
and contractures
Occupational and physical therapy
✔
Provides patients with skills and exercises necessary
to increase or maintain mobility that help in their daily
tioc

14. Non-pharmacological Therapy for RA
Use of assistive devices
canes, walkers, splints
✔
To compensate for reduced grip strength
and joint mobility & reduce stress on painful joints
Weight reduction
✔
Helps to alleviate stress on inflamed joints
•
Psychological interventions
✔
Stress management, relaxation
✔
If not treated may lead to depression
Belire

15. Use of assistive devices
V canes, walkers, splints
V To compensate for reduced grip strength
and joint mobility & reduce stress on painful joints
Neight reduction
Helps to alleviate stress on inflamed joints
Psychological interventions
Stress management, relaxation
If not treated may lead to depressio
Surgery
✔
Patients with severe disease with extensive
joint erosions, to replace or reconstruct the
joint

16. Pharmacological Treatment for RA
Disease-Modifying Anti-rheumatic Drugs (DMARDS)
Methotrexate
,
Leflunomide
,
Sulfasalazine
,
Hydroxychloroquine
Non-biologics/csDMARD
more favourable outcomes
Anti-TNF agents
)
Tumor Necrosis
reduce mortality rate
Factor-alpha
antagonists
(

17. Gastrointestinal effects
Painful/painless stomatitis
Nausea
Vomiting
Haematological effects
Myelosupression
Methotrexate- Side effects
T with: Age, renal impairment and
concomitant use with anti-folate drug
)
eg. trimethoprim
(
Liver toxicity
Hepatic fibrosis
Cirrhosis

18. Pulmonary toxicity
Pulmonary infiltration
Fibrosis
Acute/chronic interstitial
Pneumonitis
Methotre
Skin reactions
Rashes
Toxic epidermal necrolysis
Steven-Johnson syndrome
Exfoliative dermatitis
Skin necrosis
Erythema multiforme
Opportunistic infections