Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s own immune system attacks the joints on both sides of the body including the hands, wrist and knees. Early stages of RA include:
- Joint pain, tenderness, swelling or stiffness for 6 weeks or longer
- Morning stiffness for 30 minutes or longer
- More than one joint is affected
- Small joints ( wrists, certain joints of the hands and feet) are affected
- The same joints on both side of the body are affected
The history would include complaints of the above systems along with deformities of the affected areas depending on the severity. Rheumatoid nodules are commonly observed over the olecranon process or other extensor surfaces of the limbs and may be tender (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The patient may present with a low grade fever. A thorough history of other systems is elicited because of the involvement of other extra-articular organ systems. Physical exam would include inspection and palpation of the joints on both sides of the body. Passive and active range of motion may be limited due to the swelling and tenderness to the affected area. The initial diagnostic test is the presence of Rheumatoid factor (RF) in the blood. This test alone is not diagnostic and specific test such as circulating anti-CCP autoantibodies. Other test include a ESR, CRP, CBC, platelet count and joint fluid analysis. Studies for a more progressive diagnosis include ANA and comprehensive autoantibody panel. Management of RA progresses from conservative interventions to aggressive symptom management. Initial management would include heat/cold applications, exercise, rest, OT/PT, assistive devices, splints, and weight loss. Subsequent management for a more progressive version of the disease include drug therapies such as NSAIDs, analgesics, corticosteroids and DMARDs.Patient education focuses on medication therapy and control of pain and inflammation. Both primary and secondary medication nonadherence may be affected by low levels of health literacy and patient education (Joplin, Zwan, Joshua, & Wong, 2015). Emotional, spiritual and social education is advised due to disability and pain.
Joplin, S., Zwan, R., Joshua, F., & Wong, P. (2015). Medication adherence in patients with rheumatoid
arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound. BioMed
Research International, 2015, 10.
Dunphy, L., Brown, J., Porter, B., & Thomas, D. (2015). Primary Care: The Art and Science of
Advanced Practice Nursing. Philadelphia: F.A. Davis Company.
Rheumatoid arthritis is a condition that is chronic and consists of inflammation to different joints. RA in the hands is very common. This condition is related to an autoimmune response where the patient’s immune system ends up attacking its own body tissues. This condition can be very painful and requires certain testing for diagnoses and treatment (Mayo Clinic, 2018).
I would get a health history on this patient to determine if she has RA and what she has done for treatment of it. If this patient has a “flare up” then this patient most likely is educated and familiar with her condition. Risk factors for this condition include being female, age 40-60, having a family history of RA, smoking or other environment exposures like asbestos, and being obese (Mayo Clinic, 2018).
Some testing for this patient would include a blood test looking for elevated erythrocyte sedimentation rate or C-reactive protein. Imaging could be helpful to see how this condition is progressing for the patient. Medication to help include NSAIDs, steroids, antirheumatic drugs, and biological agents. The goal is to decrease inflammation and slow the progression of the disease. Physical therapy is also an option to help the patient maintain joint flexibility (Mayo Clinic, 2018).
For patient education, it could be helpful to make sure the patient has signs to be aware of a flare up starting. It can be easier to prevent flare ups than treat them. Some signs of a flare up include an increased stiffness to the joints, entire body pain, swelling that may cause shoes not to fit, a change in fatigue that is intense, and even flu-like symptoms. Some foods or medications could be the cause of a flare up and this is something for the patient to be aware of (Healthline, 2019).
Healthline. (2019). Signs of rheumatoid arthritis exacerbations and how to prevent them. Retrieved from https://www.healthline.com/health/rheumatoid-arthritis-exacerbations
Mayo Clinic. (2018). Rheumatoid arthritis. Retrieved from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648 (Links to an external site.)Links to an external site.