Podcast
Questions and Answers
What is the primary benefit of using methotrexate in the treatment of rheumatoid arthritis (RA)?
What is the primary benefit of using methotrexate in the treatment of rheumatoid arthritis (RA)?
What is a common side effect associated with leflunomide?
What is a common side effect associated with leflunomide?
Which nonpharmacologic intervention is NOT mentioned for managing rheumatoid arthritis?
Which nonpharmacologic intervention is NOT mentioned for managing rheumatoid arthritis?
How long can it typically take for leflunomide to show maximum benefits?
How long can it typically take for leflunomide to show maximum benefits?
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What serious complication is a risk factor associated with the use of steroids?
What serious complication is a risk factor associated with the use of steroids?
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Which cell type is primarily responsible for stimulating cytokine release in rheumatoid arthritis?
Which cell type is primarily responsible for stimulating cytokine release in rheumatoid arthritis?
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What is a common early sign and symptom of rheumatoid arthritis?
What is a common early sign and symptom of rheumatoid arthritis?
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Which late sign of rheumatoid arthritis involves the appearance of nodules on the surface of the arms or fingers?
Which late sign of rheumatoid arthritis involves the appearance of nodules on the surface of the arms or fingers?
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Which diagnostic test can assess the extent of joint involvement in rheumatoid arthritis?
Which diagnostic test can assess the extent of joint involvement in rheumatoid arthritis?
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Which laboratory assessment is NOT typically associated with rheumatoid arthritis diagnosis?
Which laboratory assessment is NOT typically associated with rheumatoid arthritis diagnosis?
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Which symptom is least likely to be associated with rheumatoid arthritis?
Which symptom is least likely to be associated with rheumatoid arthritis?
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What is a common psychosocial effect of living with rheumatoid arthritis?
What is a common psychosocial effect of living with rheumatoid arthritis?
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What type of drug therapy is considered first-line treatment for rheumatoid arthritis?
What type of drug therapy is considered first-line treatment for rheumatoid arthritis?
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What is a significant risk when prescribing leflunomide to women of childbearing age?
What is a significant risk when prescribing leflunomide to women of childbearing age?
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Which of the following is a common side effect of long-term steroid use?
Which of the following is a common side effect of long-term steroid use?
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What is the main action of methotrexate in treating rheumatoid arthritis?
What is the main action of methotrexate in treating rheumatoid arthritis?
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Which nonpharmacologic intervention can help manage symptoms of rheumatoid arthritis?
Which nonpharmacologic intervention can help manage symptoms of rheumatoid arthritis?
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How long does it typically take for methotrexate to start controlling joint inflammation in rheumatoid arthritis patients?
How long does it typically take for methotrexate to start controlling joint inflammation in rheumatoid arthritis patients?
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Which of the following symptoms is an early sign of rheumatoid arthritis?
Which of the following symptoms is an early sign of rheumatoid arthritis?
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What is a primary component of the psychosocial assessment for rheumatoid arthritis patients?
What is a primary component of the psychosocial assessment for rheumatoid arthritis patients?
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What late symptom of rheumatoid arthritis is characterized by the weakening and swelling of joints?
What late symptom of rheumatoid arthritis is characterized by the weakening and swelling of joints?
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Which laboratory assessment is commonly used to aid in diagnosing rheumatoid arthritis?
Which laboratory assessment is commonly used to aid in diagnosing rheumatoid arthritis?
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Which imaging technique can confirm joint involvement in rheumatoid arthritis?
Which imaging technique can confirm joint involvement in rheumatoid arthritis?
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Which of the following is a common physical assessment finding in rheumatoid arthritis?
Which of the following is a common physical assessment finding in rheumatoid arthritis?
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What serious complication can occur due to advanced rheumatoid arthritis?
What serious complication can occur due to advanced rheumatoid arthritis?
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Which type of joint involvement is typical in rheumatoid arthritis?
Which type of joint involvement is typical in rheumatoid arthritis?
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Study Notes
Rheumatoid Arthritis (RA)
- Inflammatory autoimmune disease impacting synovial joints
- CD4+ helper cells trigger cytokine release, inflaming joints via neutrophils and other inflammatory cells, leading to cartilage breakdown.
- B and T lymphocytes also stimulated, amplifying inflammation.
Physical Assessment
- Presentation varies: acute/severe vs. slow/progressive
- Early signs/symptoms: joint inflammation, generalized weakness, fatigue, anorexia, weight loss, low-grade fever.
- Upper extremity involvement: redness, tenderness, swelling (esp. interphalangeal joints), usually bilateral. Hot, swollen joint warrants immediate assessment for infection.
- Late signs/symptoms: increasing pain, morning stiffness, soft/puffy joints, spindle-shaped fingers, muscle atrophy, tendon rupture, weight loss, fever, fatigue, subcutaneous nodules (ulnar aspect of arm/fingers, Achilles tendon), vasculitis, peripheral neuropathy (foot drop, paresthesia), pleurisy, pericarditis/myocarditis, Sjogren's syndrome (dry eyes/mouth/vagina).
Laboratory Assessment
- Tests used to diagnose and monitor RA:
- Rheumatoid factor
- Antinuclear antibody (ANA)
- Serum complement
- Erythrocyte sedimentation rate (ESR)
- Serum protein electrophoresis (SPEP)
- Globulin levels (alpha1, alpha2, beta, gamma)
- HLA testing
Diagnostic Tests
- Standard X-rays: reveal joint damage
- CT scans: 3D imaging for diagnostic clarity
- Arthrocentesis: joint aspiration to evaluate synovial fluid for inflammatory cells, immune complexes, increased WBCs, cloudiness, and large volume. Monitor site for bleeding/fluid leakage.
- Bone/joint scans: determine the extent of joint involvement
Nursing Diagnosis
- Chronic pain related to RA and inflammation
- Risk for impaired mobility due to pain and inflammation
- Risk for impaired body image due to physical changes
Managing Pain (RA)
Drug Therapy
-
First-line Disease-Modifying Anti-Rheumatic Drugs (DMARDs):
- Methotrexate (MTX): immunosuppressive, slow-acting (4-6 weeks to see effect), cost-effective.
- Leflunomide: immune-modulating, slow-acting (4-6 weeks to 3 months for max benefit), may cause hair loss, diarrhea, decreased WBCs/platelets, liver enzyme changes. Avoid alcohol, strict birth control for women of childbearing age. Urgent contact if pregnancy occurs.
- Steroids: quick-acting anti-inflammatory/immunosuppressive but potential side effects: hyperglycemia, osteoporosis, decreased immunity, glaucoma, hypertension.
Nonpharmacologic Interventions
- Emphasize adequate rest, quiet environment, warm drinks, positioning
- Use modalities like ice and heat applications, hypnosis, imagery, and music therapy
- Promote proper nutrition.
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Description
This quiz explores the key aspects of Rheumatoid Arthritis (RA), an inflammatory autoimmune disease affecting the synovial joints. It covers the role of immune cells in inflammation, the varied clinical presentations, and the early and late signs and symptoms. Test your understanding of this complex condition!
