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Rheumatoid Arthritis

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VOL: 98, ISSUE: 46, PAGE NO: 30

EPIDEMIOLOGY
EPIDEMIOLOGY
Rheumatoid arthritis is the most common form of chronic inflammatory joint disease. It is a systemic disease but with most notable effect on synovial joints. The prevalence of RA is 1.16% in women and 0.44% in men in the UK. The disease starts most commonly in the age range 30-60 years.


AETIOLOGY
There is no known cause for RA but it is thought to be an autoimmune disease in which the body's immune system mistakenly attacks its own tissue. Development of this autoimmunity is thought to be initiated by microbial infection, possibly viruses in genetically susceptible people. There are no specific risk factors for RA.


SIGNS AND SYMPTOMS
- In the majority of patients the onset is insidious, with joint pain, stiffness and symmetrical swelling of peripheral joints.


- Morning stiffness lasting at least one hour is a feature of RA.


- Other symptoms include weakness, fatigue, fever and weight loss.


DIAGNOSIS
- A full health history should be taken and a physical examination performed.


- Laboratory tests - levels of C-reactive protein level and erythrocyte sedimentation rate (ESR) are usually elevated. White blood cell count can be raised in RA. Rheumatoid factors (RF) are usually found in the blood and in synovial fluid.


- Radiographic findings - to detect RA changes in order to determine potential usefulness of drugs or surgery. These may show soft tissue swelling, bone demineralisation, cartilage erosion, joint space narrowing and bony cysts.


- Synovial fluid analysis - to measure viscosity which is usually lowered in RA. White blood cells are present in RA, and a mucin clot test is performed.


TREATMENT
- Drug therapy - non-steroidal anti-inflammatory drugs (NSAIDS) and disease modifying anti-rheumatic drugs (DMARDS).


- Supportive - rest, splinting of affected joints and use of orthotic devices.


- Surgical - total joint replacements.


NURSING IMPLICATIONS
Assessment of pain, swelling, tenderness, limitation of movement, fatigue and joint deformities.


Consider and discuss the patients' ability to perform activities of daily living and coping with physical and functional losses.


WEBSITES




FURTHER READING
Linton A, et al (2000)
Introductory Nursing Care of Adults. Philadelphia: WB Saunders Company.
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