Rheumatic Arthtitis

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RHEUMATIC ARTHRITIS
* Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in your hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

STAGES OF CLASSIFICATION
* Stage 1: disease present but no disability
* Stage 2: disease beginning to interfere with ADLs
* Stage 3: major compromise in function
* Stage 4: incapacitation

CAUSE
* Unknown, the most widely held theory is that an autoimmune response initiates inflammation.

SIGNS and SYMPTOMS
* Tender, warm, swollen joints
* Morning stiffness that may last for hours
* Firm bumps of tissue under the skin on your arms (rheumatoid nodules) * Fatigue, fever and weight loss

DIAGNOSTIC AND LABORATORY TEST FINDINGS

* Positive rheumatoid factor (RF) is seen in a majority of clients who have this disease process but it is also seen in a majority of the normal population, making it a specific finding. * Elevated ESR, C- reactive protein, and serum complement are often seen in this disease process. * CBC is differential may reveal anemia as well as leukocytosis. * X- ray reveal a narrowing of joint spaces and erosive changes at bone margins as the disease process * Aspiration of synovial fluid reveals characteristic findings such as turbidity, elevated cell counts, and formation of a poor mucin clot.

COMPLICATIONS

* Osteoporosis. Rheumatoid arthritis itself, along with some medications used for rheumatoid arthritis, can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture. * Carpal tunnel syndrome. If rheumatoid arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers. * 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.

TREATMENT
* NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems and liver and kidney damage. * Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, cataracts, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication. * Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine) and minocycline (Dynacin, Minocin, others). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections. * Immunosuppressants. These medications act to tame your immune system, which is out of control in rheumatoid arthritis. Examples include azathioprine (Imuran, Azasan), cyclosporine (Neoral, Sandimmune, Gengraf) and cyclophosphamide (Cytoxan). These medications can increase your susceptibility to infection. * TNF-alpha inhibitors. Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints. Examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira),...
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