UNIT 6: ADVANCE NURSING MANAGEMENT OF
Musculoskeletal
DISEASESES
Rehumatoid Arthritis
By
Dr Briya Hameed
DPT, MS-PT*
Super College of Nursing BWP
post RN semester 1 1
Rehumatoid Arthritis
RA
• RA is a chronic autoimmune disorder where
the body attacks the joints causing major
inflammation & deformity.
• Mainly seen in the hand joints, but can also
involve other organs (skin, eyes, & lungs)
with collateral damage as the body attacks
itself.
Cont..
• Rheumatoid arthritis weakens the joint,
leading to dislocation and permanent
deformity of the joint.
• Exacerbations of disease manifestations
occur during periods of physical or emotional
stress and fatigue.
Pathophysiology of RA
1. Immune System Problem: In RA, the immune
system gets confused and mistakenly attacks
the lining of the joints called the synovium.
• Many parts of the body, including joints,
tendons are surrounded by a delicate membrane
lining called synovial tissue (synovium).
Rheumatoid arthritis causes the synovial lining
surrounding a joint to become inflamed. This
condition is called synovitis, and it can cause
joint pain, stiffness, and swelling.
Cont..
2. Pannus tissue forms
Inflammation causes the synovial tissue cells to
divide and multiply, which causes the tissue to
thicken, resulting in more pain and swelling. As
cells continue to multiply, the tissue expands
into the joint space—the space between the
joint’s two bones—where it does not belong.
The invading tissue is called pannus or
rheumatoid pannus.
Cont..
• 3. Cartilage and other joint tissues are
damaged
• The pannus cells release molecules called
enzymes that damage cartilage and underlying
bone. Over time, this damage can alter the
alignment of the joints, lead to further pain
and, in some cases, cause joint deformities.
Signs and Symptoms
• Signs and symptoms of RA include:
1. Pain or aching in more than one joint
2. Stiffness in more than one joint
3. Tenderness and swelling in more than one joint
4. The same symptoms on both sides of the body
(such as in both hands or both knees)
5. Weight loss
6. Fever
7. Fatigue or tiredness
8. Weakness
Complications
• Rheumatoid arthritis increases your risk of developing:
• Osteoporosis. Rheumatoid arthritis itself, along with some
medications used for treating rheumatoid arthritis, can
increase your risk of osteoporosis — a condition that
weakens your bones and makes them more prone to fracture.
• Rheumatoid nodules. These firm bumps of tissue most
commonly form around pressure points, such as the elbows.
However, these nodules can form anywhere in the body,
including the heart and lungs.
• Dry eyes and mouth. People who have rheumatoid arthritis
are much more likely to develop Sjogren's syndrome, a
disorder that decreases the amount of moisture in the eyes
and mouth.
Cont..
Carpal tunnel syndrome. If rheumatoid arthritis
affects your wrists, the inflammation can compress
the nerve that serves most of your hand and fingers.
Infections. Rheumatoid arthritis itself and many of
the medications used to combat it can impair the
immune system, leading to increased infections.
Cont..
• Heart problems. Rheumatoid arthritis can
increase your risk of hardened and blocked
arteries, as well as inflammation of the sac
that encloses your heart.
• Lung disease. People with rheumatoid
arthritis have an increased risk of
inflammation and scarring of the lung tissues,
which can lead to progressive shortness of
breath.
• Lymphoma. Rheumatoid arthritis increases
the risk of lymphoma, a group of blood
cancers that develop in the lymph system
Physical mobility
• 1. Preserve joint function.
• 2. Provide range-of-motion exercises to maintain joint
motion and muscle strengthening.
• 3. Balance rest and activity.
• 4. Splints may be used during acute inflammation to
prevent deformity.
• 5. Prevent flexion contractures.
• 6. Apply heat or cold therapy as prescribed to joints.
• 7. Apply paraffin baths and massage as prescribed.
• 8. Encourage consistency with exercise program.
• 9. Use joint-protecting devices.
• 10. Avoid weight bearing on inflamed joints.
Client Education for Rheumatoid Arthritis
• ■ Assist the client to identify and correct safety hazards in
the home.
• ■ Instruct the client in the correct use of assistive or
adaptive devices.
• ■ Instruct the client in energy conservation measures.
• ■ Review the prescribed exercise program.
• ■ Instruct the client to sit in a chair with a high, straight back.
• ■ Instruct the client to use only a small pillow when lying
down.
• ■ Instruct the client in measures to protect the joints.
• ■ Instruct the client regarding the prescribed medications.
• ■ Stress the importance of follow-up visits with the primary
health care provider.
Nursing Diagnosis
1. Acute/chronic pain r/t joint
damage/inflamation
2. Fatigue r/t chronic inflamation, limited
mobility
3. Disturbed sleep pattern r/t pain, discomfort
4. Impaired physical mobility r/t stiffness
5. Self care deficits r/t decrease ability to do
ADLS
6. Disturbed body image r/t joint deformities
7. Ineffective coping r/t persistent pain
