Rheumatoid Arthritis
Original Editors -Amanda Fetz & Katie Robertson from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
Rheumatoid arthritis (RA) is an autoimmune disease and a form of inflammatory arthritis that affects five or more joints. Autoimmune conditions occur when the body fights its own immune system. Instead of the immune system protecting the body, it attacks itself. In RA, the immune system attacks the lining of the joints, called the synovium. RA is a long-term disease that leads to inflammation of the joints and surrounding tissues and can also affect other organs. Symptoms may present as inflammation of joints, pain and fatigue.
The disease course typically follows three possible paths:
a. Monocyclic: Having one episode that does not reoccur. This usually ends within 2-5 years of initial diagnosis.
b. Polycyclic: The disease severity varies over the course of the progression of the condition.
c. Progressive: Condition continues to become more severe and non-remitting.
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Prevalence[edit | edit source]
The prevalence of Rheumatoid Arthritis is estimated between 1.5- 2.1 million US adults or 10 cases per every 1000 people. There are nearly three times as many women then men with the disease. RA is found all around the world, but does tend to be more prevalent in the Native American and white population.
The risk of RA increases with age. RA most commonly begins in women between the ages of 30 and 60. It often occurs later in life for men, but can happen at any age. When RA affects the pediatric population, it is called Juvenile Idiopathic Arthritis (JIA) and usually begins before the age of 16.
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Characteristics/Clinical Presentation[edit | edit source]
Signs and Symptoms of RA:
1. Joint Pain: The most common symptom of Rheumatoid Arthritis
a. Warmth
b. Redness
c. Tenderness
d. Swelling
2. Joint Stiffness- Increased in the mornings.
3. Fatigue throughout the body
4. Fever
5. Weight Loss
6. Rheumatoid Nodules: Small lumps of tissue that can be felt under the skin.
7. Symmetrical Patterns of affected joints
a. Wrist, Hand, and Fingers: the most affected in the body
b. Cervical Spine
c. Shoulder
d. Elbow
e. Knee
f. Hip
g. Foot and Ankle
8. Prolong symptoms
9. Symptoms varies with patients.
10. Anemia
11. Neck Pain
12. Dry Eyes
13. Dry Mouth
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| Class 1 | Completely able to perform usual activities of daily living (Self care, vocational and avocational) |
| Class 2 | Able to perform usual self care and vocational activates by limited in avocational |
| Class 3 | Able to perform usual self care activities but limited in vocational and avocational activities |
| Class 4 | Limited ability to perform usual self care, vocational, and avocational activities |
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Associated Co-morbidities[edit | edit source]
RA has many effects on individuals including mortality, hospitalization, work disability, increase in medical cost/expenses, decreases of quality of life, and chronic pain. On average, the chronic RA patient has two or more comorbid conditions. This is significant because of the comorbidities effects on quality of life, functional status, prognosis and outcome.
Associated Co-morbidities:
a) Myocardial Infarction and Cardiovascular disease
b) Stroke
c) Peripheral Vascular Disease
d) Cancer (All)
e) Infection
f) Osteoporosis
g) GI disease
h) Psoriasis and other skin conditions
i) Cataract
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Complications of RA:
Rheumatoid arthritis can affect nearly every part of the body. Even though the joints are most commonly affected, RA can also have effects on organs.
a) Damage to the lung tissue (rheumatoid lung)
b) Increased risk of hardening of the arteries
c) Spinal injury when the neck bones become damaged
d) Inflammation of the blood vessels (rheumatoid vasculitis), which can lead to skin, nerve, heart, and brain problems
e) Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis), which can lead to congestive heart failure
f) Side effects from treatment and medication.
g) General deconditioning
h) Rhematoid nodules
i) Vascular complications
j) Neurological complications
k) Cardiopulmonaryc complications
l) Ocular complications
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Medications[edit | edit source]
| Medication | Uses/ Effects | Side Effects |
| NSAIDs | ||
| Acetaminophen | ||
| Asprin Buffered Plain | ||
| Corticosteriods | ||
| Methylprednisolone Prednisone |
||
| Disease-modifying antirheumatic drugs (DMARDs) | ||
| Azathioprine | ||
| Hydroxychloroquine | ||
| Gold sodium thiomalate | ||
| Leflunomide | ||
| Methotrexate | ||
| Sulfasalazine | ||
| Biologic response modifiers | ||
| Tumor necrosis factor inhibitors | ||
| Interleukin-1 inhibitor | ||
| Selective costimulation modulator | ||
| CD20 antibody |
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Etiology/Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
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1. Fischman A, Abeles M, Zanetti M, Weinstein A, Rothfield N. The coexistence of rheumatoid arthritis and systemic lupus erythematosus: a case report and review of the literature. The Journal Of Rheumatology [serial on the Internet]. (1981, May), [cited March 3, 2013]; 8(3): 405-415. Available from: MEDLINE.
2. McKendry R, Huebsch L, Leclair B. Progression of rheumatoid arthritis following bone marrow transplantation. A case report with a 13-year followup. Arthritis And Rheumatism [serial on the Internet]. (1996, July), [cited March 3, 2013]; 39(7): 1246-1253. Available from: MEDLINE.
3. Krishnadas R, Krishnadas R, Cavanagh J. Sustained remission of rheumatoid arthritis with a specific serotonin reuptake inhibitor antidepressant: a case report and review of the literature. Journal Of Medical Case Reports [serial on the Internet]. (2011, Mar 19), [cited March 3, 2013]; 5112. Available from: MEDLINE.
4. Stolt P, Bengtsson C, Nordmark B, Lindblad S, Lundberg I, Alfredsson L, et al. Quantification of the influence of cigarette smoking on rheumatoid arthritis: results from a population based case-control study, using incident cases. Annals Of The Rheumatic Diseases [serial on the Internet]. (2003, Sep), [cited March 3, 2013]; 62(9): 835-841. Available from: MEDLINE.
5. Ben Dhaou B, Boussema F, Aydi Z, Baili L, Kochbati S, Rokbani L. [Rheumatoid arthritis in the elderly: ten cases report]. La Tunisie Médicale [serial on the Internet]. (2012, June), [cited March 3, 2013]; 90(6): 442-445. Available from: MEDLINE.
6. Källberg H, Jacobsen S, Bengtsson C, Pedersen M, Padyukov L, Alfredsson L, et al. Alcohol consumption is associated with decreased risk of rheumatoid arthritis: results from two Scandinavian case-control studies. Annals Of The Rheumatic Diseases [serial on the Internet]. (2009, Feb), [cited March 3, 2013]; 68(2): 222-227. Available from: MEDLINE.
Resources
[edit | edit source]
1. Rheumatoid Arthritis: Help to understand Rheumatoid Arthritis:
http://www.rheumatoidarthritis.com/ra/diagnosing-ra/default.htm
2. Rheumatoid Arthritis: Frequently asked Questions:
http://www.rheumatoidarthritis.com/ra/additional-resources/faq.htm
4. Rheumatology Check List Visit
http://www.rheumatoidarthritis.com/ra/WebResources/pdf/VisitChecklist.pdf
5. The RA Symptom Tracker Sheet
http://www.rheumatoidarthritis.com/ra/WebResources/pdf/SymptomTracker.pdf
6. The Arthritis Organization
http://www.arthritis.org
7. American College of Rheumatology Patient Education
http://www.rheumatology.org/
8.Self-help
http://www.aidsforarthritis.com/
9. RA Treatment
http://www.ra.com/ra-treatment.aspx
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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