⦿ Rheumatoid arthritis is
autoimmune disorder in
which Immune system
identifies the synovial
membrane as "foreign"
and begins attacking it.
⦿ Synovial membrane shown in
⦿ Rheumatoid Arthritis (RA) is a chronic
inflammatory disorder that may affect many
tissues and organs, but mainly attacks the
joints producing an inflammatory synovitis.
⦿ Positive family history
⦿ Inherited tissue type major
histocompatibility complex (MHC) antigen
⦿ Bacterial and Fungal Infection
⦿ Herpes simplex virus infections
⦿ Epstein-Barr virus (EBV)
⦿ Vitamin D deficiency
⦿ RA affects 0.5-1.0% of population in USA
⦿ Females > males 3:1
⦿ but people of any age can be affected
⦿ Peak age 45-65 but onset early from age 20-45
⦿ About 75% of these are women.
⦿ The disease strikes women three times more
often than men
⦿ Presentation of antigen to T cells
⦿T- and B-cell Proliferation Angiogenesis in
⦿ Neutrophil accumulation in synovial fluid.
⦿ Early pannus Formation(The pannus is a
sheet of inflammatory granulation tissue that
spreads from the synovial membrane and
invades the joint)
⦿ Subchondral bone erosion.
⦿ Pannus invasion of cartilage Chondrocyte
⦿ Laxity of ligaments
⦿ Joint instability
, contractures, decreased
ROM, systemic complications
⦿ X Rays
◾X rays of hands and feet are generally performed in
people with RA.
⦿ Magnetic Resonance Imaging (MRI)
⦿ Blood Tests
◾Rheumatoid Factor (RF)
RF is a specific antibody in the blood.
A negative RF does not rule out RA. The arthritis is then called
seronegative, most common during the first year of illness and
converting to seropositive status over time.
◾Anti-citrullinated Protein Antibodies (ACPAs)
, this testing is only positive in a proportion of all RA
, this test is rarely found positive if RA is NOT present,
giving it a specificity of about 95%.
◾Other blood tests performed when RA is suspected:
Erythrocyte Sedimentation Rate (ESR)
⚫The rate at which red blood cells precipitate in a 1
⚫A protein found in the blood in response to
Full Blood Count
⚫Gives information about all blood cells.
⚫Gives information on the state of a patient’s liver
⦿ Action: Immune suppression, effects DNA
synthesis and other cellular effects
⦿ Action: Anti-inflammatory, analgesic Used for shortest
duration and at lowest dose possible to minimize adverse
⦿ Topical Analgesics
Surgeries considered for people who
have severe rheumatoid
, to replace part or all of a joint, such
as the hip or knee.
⦿Arthroscopy, which uses a small lighted instrument
to remove debris or inflamed tissue from a joint.
⦿ Carpal tunnel release, to relieve pressure on the
median nerve in the wrist.
⦿ Cervical spinal fusion, to treat severe neck
pain and nerve problems.
⦿ Finger and hand surgeries, to correct joint
problems in the hand.
⦿ Foot surgery such as phalangeal head
, to remove inflamed joint
⦿ NURSING DIAGNOSES
• Acute and chronic pain related to inflammation
and increased disease activity, tissue damage,
fatigue, or lowered tolerance level
• Fatigue related to increased disease activity,
pain, inadequate sleep/rest, deconditioning,
inadequate nutrition, emotional
• Disturbed sleep pattern related to pain,
depression, and medications
• Self-care deficits related to contractures,
fatigue, or loss of motion
⦿ Impaired physical mobility related to
decreased range of motion, muscle
weakness, pain on movement, limited
endurance, lack of or improper use of
⦿ Disturbed body image related to physical and
psychological changes and dependency
imposed by chronic illness
• Ineffective coping related to actual or
perceived lifestyle or role changes
• Nursing Considerations
Patient education on how to protect and
Ensure adequate pain relief
Address sleep disturbance, fatigue and
Small nutritious meals, vitamins, iron
Encourage informed decisions on self-
Counselling/ emotional support for patient