RHEUMATOID ARTHRITIS

What is RA?A Chronic,

systemic inflammatory disease, characterised by symmetrical joint involvement which is typically erosive/destructive. hallmark feature: persistent symmetric polyarthritis (synovitis)

RHEUMATOID ARTHRITIS

Recap on the anatomy and physiology

Function of JOINTS:

• To allow articulation between two or more bones and• secondarily to permit movement by contraction of opposing muscles.

•Unknown

• Genetic

• Autoimmune

Etiology

Pathophysiology

Antigen –Environmental agent, infectious agent

Activates CD4 helper T cells and probably

B lymphocytes

T cells stimulatessynovial macrophage

and fibroblast

Activates B lymphocytes

Genetic Susceptibility HLA-DR4 HLA-DQ HLA- DP

Cytokines

Pathophysiology

Pannus formationJoint destruction Cartilage fibrosis

Ankylosis

Joint injury

RANKL

Activates osteoclast

Formation of rheumatoid

factor

Formation of autoimmune complexes and probable deposition

in the joint

Cytokines

Fibroblast Chondrocytes Synovial cells

Enzymes release (collagenase, streptomelysin, elactase, PGE2 and matrix metalloproteinases, others)

T cells stimulatessynovial macrophage

and fibroblast

Activates B lymphocytes

Proliferation

INTERLEUKIN 1

IL-1 is a potent stimulator of synoviocytes, chondrocytes and osteoblasts (Figure 1).

IL-1 is a proinflammatory cytokine that amplifies and perpetuates the disease process in RA

1. arthritis

Clinical Manifestations

Associated with

•low fever

•Fatigue

•Morning stiffness

•Joint soft, warm to touch

Clinical Manifestations

2. extra-articular features

3. Associated syndromes (possible complications)

Clinical Manifestations

(a) Sjögren’s syndrome-salivary glandinflammation and keratoconjunctivitis(b) Felty’s syndrome-profound neutropenia,thrombocytopenia and splenomegaly(C) Pulmonary involvement-(pleuritis, interstitialpneumonitis, alveolitis and intrapulmonaryrheumatoid nodules)(d) Cardiac involvement-pericarditis

ns

Diagnnostic criteria 1. Morning stiffness lasting more than 1 hour2. Arthritis of 3 or more joint areas. 3. Arthritis of the hand joints 4. Symetric arthritis 5. Rheumatoid nodules over extensor surface or bony prominences. 6. Serum rheumatoid factor. 7. Radiologic changes.

• oligoarticular JIA

•Polyarticular JIA

•Systemic JIA  

Types of JIA

1. Acute Pain r/t inflammation & swelling

2. Fatigue r/t increased metabolic rate

3. Impaired physical mobility r/t decreased range of motion

4. Disturbed body image r/t physical & psychological changes

Nursing Diagnosis:

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