Monday, July 30, 2012

Pathophysiology - Rheumatoid Arthritis

Rheumatoid Arthritis - systemic inflammatory disease affecting the joints
  • More common in women 40-60 years old
  • Genetics, remissions and exacerbations
  • Fingers, hands, wrists, knees, feet
  • Rheumatoid Factor – antibody that reacts with fragments of IgG

Signs and Symptoms
  • Fatigue
  • Anorexia
  • Weight loss
  • Crepitus
  • Morning stiffness
  • Increased ESR
  • Pain
  • Malaise
  • Fever
  • Increased capillary permeability

Pathophysiology

Viruses

Alteration of IgG (foreign)

Lymphocytes

Rheumatoid factor

Binding of rheumatoid factor to IgG

Inflammatory response

Leukocytes, monocytes, macrophages and lymphocytes congregate

Phagocytosis

Release of lysosomal enzymes

Destruction of joint cartilage

Dislocation

Fibrous formation

Misalignment

Diagnostic Tests:
  • x-ray showing bone demineralization and soft tissue selling
  • Positive RF test
  • Elevated serum globulins
  • Elevated ESR
  • Complete blood count shows moderate anemia and slight leukocytosis
Medical Management

1. Medications such as salicylates to decrease inflammation and relieve joint pain
2. Cold therapy – if acute
3. Heat therapy – if chronic
4. Physical therapy, passive ROM, weight control, rest

Nursing Management

1. Assess joints and look for any deformities.
2.  Monitor vital signs.
3. Monitor weight.
4. Heat therapy to help relieve pain. Ice packs are effective during acute episodes.
5. Administer due medications.
6. Encourage to take adequate sleep and rest.

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