This is an autoimmune disorder notes.

1. RHEUMATOID
ARTHRITIS
SUBMITTED BY,
MS. GAUTAMI TIRPUDE
F.Y.M.SC NURSING,
B.V.C.O.N, PUNE.

2.  Introduction
 Definition
 Review of anatomy and physiology of joint
 Epidemiology
 Etiology
 Risk Factors
 Pathophysiology
 Clinical Manifestation

3.  Diagnostic Findings
 Management
Medical management
Surgical management
Nursing management
Complications
Summary
Conclusion
Bibliography

4.  Rheumatoid arthritis is an autoimmune
disorder in which immune system identifies
the synovial membrane as”foreign” and
begins attacking it.

5. 1. Rheumatoid arthritis(RA) is a systemic
inflammatory disorder of connective tissue
characterized by chronicity, remissions, and
exacerbations.
2. Rheumatoid arthritis is a chronic
inflammatory disorder that may affect many
tissues and organs, but mainly attacks the
joints producing an inflammatory synovitis.

6. JOINTS

7. FIBROUS JOINTS

8. CARTILAGINOUS JOINTS

9. SYNOVIAL JOINTS

11.  Consist of epithelial layer lines the capsule
 Secretes synovial fluid
SYNOVIAL FLUID
 Thick sticky fluid, of egg-white consistency
 Fills the synovial cavity
 Nourishes the structures within the joint
cavity
 Contains phagocytes, which removes
microbes and cellular debris

12.  Acts as a lubricant
 Maintains joint stability
 Prevents the end of the bones from being
separated

13.  RA affects 0.5-1% of the population world-
wide with a peak prevalence between the
ages of 30 and 50 years.
 The ratio of female to male with RA is
between 2:1 and 4:1.

14. ETIOLOGY:
 Unknown

15.  Positive family history
 Infectious agents

16.  Gender
 Environmental factors
 Smoking
 Vitamin D deficiency
 Occupational exposures

17. Immune system produces antibodies, called
as rheumatoid factor (RF),
RF Attack and destroy joint structures
Affects synovium of the joint
Resulting in synovitis and excess synovial fluid

18. Causes edema(swelling)
Surrounding articular cartilage and tendons
and ligaments are affected
Chronic congestion and thickening of the
synovium produce pannus or granulation
tissue
Pannus causes further erosion of the articular
cartilage and invades the joint capsule

19. Destruction continues, affecting bone and
connective tissue
Pannus is replaced by fibrous connective
tissue
Fills the joint cavity(fibrous ankylosis)
Fibrous tissue calcifies, causing osseous(bony)
ankylosis(fusion) of the joint

20. Fusion results in pain, deformity, and limited
mobility or immobility

22.  onset of symptoms is acute
 Fatigue
 Joint pain
 Joint tenderness
 Joint swelling
 Erythema

23. CONT.
 Joint stiffness
 Joint warmth
 Loss of joint range of motion
 Joint deformity
 Both sides of the body affected(symmetric)
 Anorexia

24. CONT.
 Weight loss
 Persistant Anaemia
 Rheumatoid nodules(subcutaneous nodules)

27. a simple flexion deformity of the distal
interphalangeal joint preventing extension.

28. Persistant flexion of the proximal
interphalangeal joint with hyperextension of
the distal interphalangeal joint.

29.  Bone Marrow Suppression
 Anaemia
 Gastrointestinal disturbances

30.  X-RAY
-X-rays of hands and feet are generally
performed in people with RA.
-Reveals soft-tissue swelling, erosion of joints,
and osteoporosis of adjacent bone (early
changes) progressing to bone-cyst formation,
narrowing of joint space

31.  Magnetic Resonance Imaging

32.  BLOOD TEST:
Rhematoid Factor(Rose-Waaler test)
 RF is a specific antibody in the blood.
 Seropositive
Erythrocyte Sedimentation Rate(ESR) –the
rate at which red blood cells precipitate in a 1
hour period.
ESR may be elevated.
 C-reactive protein
A protein found in the blood in response to
inflammation.

33.  Complete Blood Count
Usually reveals moderate anemia. WBC is
elevated when inflammatory processes are
present.
 Immunoglobulin (Ig) (IgM and
IgG): Elevation strongly suggests
autoimmune process as cause for RA.
 Synovial membrane biopsy: Reveals
inflammatory changes and development of
pannus (inflamed synovial granulation
tissue).

34.  Synovial/fluid aspirate: May reveal volume
greater than normal; opaque, cloudy, yellow
appearance
- Elevated levels of WBCs and leukocytes
Synovial membrane biopsy: Reveals
inflammatory changes and development of
pannus (inflamed synovial granulation tissue).

35.  Direct arthroscopy: Visualization of area
reveals bone irregularities/degeneration of
joint.

36.  Goal: Decreasing inflammation of the joint
before bony ankylosis occurs, relieving
discomfort, preventing or correcting
deformities, and maintaining or restoring
function of affected structures.

37.  Pharmacological management
1.Salicylates (aspirin) or NSAIDs (Diclofenac-
voveran, etodolac, ibuprofen)
2.Corticosteroids,
Action- Anti-inflammatory, analgesic used for
shortest duration and at lowest dose possible
to minimize adverse effeCts
 -Prednisone
 -Prednisolone

38. 3.Topical Analgesics
 -Capsaicin (Zostrix)
 4.Immunosuppressives
 Action- Immune suppression, effects DNA
synthesis and other cellular effects
 -Azathioprine(Imuran)
 -Methotrexate(Rheumatrex)

39.  THERAPEUTIC MANAGEMENT:
Heat and cold application with drug therapy to
relieve swelling and pain.
 DIETARY MANAGEMENT:
Although there is no RA diet that treats the
condition , some foods can lower inflammation
in your body.
-Fruits
-Vegetables
-Whole grains
-Olive oil
-Fish

40.  History and physical exam. The history and
physical examination address manifestations
such as bilateral and symmetric stiffness,
tenderness, swelling, and temperature
changes in the joints.
 Extra-articular changes. The patient is also
assessed for extra-articular changes and
these include weight loss, sensory
changes, lymph node enlargement,
and fatigue.

41.  Acute and chronic pain related to
inflammation and increased disease activity,
tissue damage, fatigue, or lowered tolerance
level.

42. NURSING INTERVENTIONS
 Comfort measures
 Administer anti-inflammatory, analgesic, and
slow-acting antirheumatic medications
 Encourage verbalization of feelings about
pain
 Teach pathophysiology of pain and rheumatic
disease
 Assess for subjective changes in pain

43.  Fatigue related to increased disease activity,
pain, inadequate sleep/rest, deconditioning,
inadequate nutrition, and
emotional stress/depression
 NURSING INTERVENTIONS
-Describe comfort measures while providing
them
-Develop and encourage a sleep routine
-Explain importance of rest for relieving
EMOTIONAL stress
-Identify physical and emotional factors

44.  Facilitate development of appropriate
activity/rest schedule
 Encourage adherence to the treatment
program
 Encourage adequate nutrition

45.  Impaired physical mobility related to
decreased range of motion, muscle
weakness, pain on movement, limited
endurance, lack or improper use of
ambulatory devices.
 NURSING INTERVENTIONS
-Encourage verbalization regarding limitations
in mobility
-Assess need for occupational or physical
therapy consultation
-Encourage independence in mobility and
assist as needed

46.  Self-care deficit related to contractures,
fatigue, or loss of motion.
NURSING INTERVENTIONS
-Assist patient to identify self-care deficits
-Identify factors that interfere with ability to
perform self-care activities.
-Develop a plan based on the
patient’s priorities on how to establish and
achieve goals to meet self-care needs

47.  Provide appropriate assistive devices
 Explore with the patient different ways to
perform difficult tasks

48.  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 INTERVENTIONS:
-Help patient identify elements of control over
disease symptoms and treatment
-Encourage patient’s verbalization of feelings,
perceptions, and fears

49.  Identify areas of life affected by disease
 Develop plan for managing symptoms and
enlisting support of family and friends to
promote daily function.

50.  Today we have seen about the Rheumatoid
arthritis, its definition, causes, risk factors,
pathophysiology, sign and symptoms,
complications, management –medical,
surgical and nursing.

51.  Write down three nursing care plans
Submission Date:29/03/19

53.  Introductory Medical-Surgical Nursing,
Barbara K. Timby, Jeanne C. Scherer, Nancy
E. Smith,7th edition,LIPPINCOTT, pg no-1029
to 1031.
 Lewis’ Medical-Surgical
Nursing,Lewis,Dirksen,Heitkemper,
Bucher,Second South Asia Edition,pg no.-
1631-1636
 Medical surgical nursing clinical
management for positive outcome jayce M.
Black Jane Hokanson Hawks, published by
Elsevier, a division of reed Elsevier India

54.  Medical surgical nursing, Brunner and
suddarths published by Wolters Kluwer
(India) PVT LTD 2010 fifth edition,pg no.-
1067
 SITES:
 https://nurseslabs.com/rheumatoid-arthritis/
 https://www.healthline.com/health/rheumatoi
d-arthritis
 https://www.slideshare.net/BaljinderSingh33/r
heumatoid-arthritis-67614655
 https://www.slideshare.net/VLokeesan/rheum
atoid-arthritis-44210913