Rheumatoid Arthritis Overview
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Questions and Answers

What is the primary benefit of using methotrexate in the treatment of rheumatoid arthritis (RA)?

  • It is a potent drug that causes minimal side effects.
  • It is effective and relatively inexpensive. (correct)
  • It is fast-acting and provides immediate relief.
  • It requires frequent monitoring of blood levels.

What is a common side effect associated with leflunomide?

  • Immediate relief from joint swelling
  • Rapid weight gain
  • Increased blood sugar levels
  • Decreased white blood cells and platelets (correct)

Which nonpharmacologic intervention is NOT mentioned for managing rheumatoid arthritis?

  • Adequate rest
  • Regular exercise (correct)
  • Ice and heat applications
  • Proper positioning

How long can it typically take for leflunomide to show maximum benefits?

<p>4 to 6 weeks to 3 months (D)</p> Signup and view all the answers

What serious complication is a risk factor associated with the use of steroids?

<p>Osteoporosis and decreased immunity (D)</p> Signup and view all the answers

Which cell type is primarily responsible for stimulating cytokine release in rheumatoid arthritis?

<p>CD4+ helper cells (C)</p> Signup and view all the answers

What is a common early sign and symptom of rheumatoid arthritis?

<p>Extreme fatigue (D)</p> Signup and view all the answers

Which late sign of rheumatoid arthritis involves the appearance of nodules on the surface of the arms or fingers?

<p>Subcutaneous nodules (D)</p> Signup and view all the answers

Which diagnostic test can assess the extent of joint involvement in rheumatoid arthritis?

<p>Bone scan or joint scan (C)</p> Signup and view all the answers

Which laboratory assessment is NOT typically associated with rheumatoid arthritis diagnosis?

<p>Liver function tests (B)</p> Signup and view all the answers

Which symptom is least likely to be associated with rheumatoid arthritis?

<p>Weight gain (D)</p> Signup and view all the answers

What is a common psychosocial effect of living with rheumatoid arthritis?

<p>Altered body image (C)</p> Signup and view all the answers

What type of drug therapy is considered first-line treatment for rheumatoid arthritis?

<p>Disease-modifying antirheumatic drugs (DMARDs) (D)</p> Signup and view all the answers

What is a significant risk when prescribing leflunomide to women of childbearing age?

<p>Potential for birth defects (B)</p> Signup and view all the answers

Which of the following is a common side effect of long-term steroid use?

<p>Decreased immunity (C)</p> Signup and view all the answers

What is the main action of methotrexate in treating rheumatoid arthritis?

<p>Immunosuppressive therapy (B)</p> Signup and view all the answers

Which nonpharmacologic intervention can help manage symptoms of rheumatoid arthritis?

<p>Adequate rest and quiet environment (D)</p> Signup and view all the answers

How long does it typically take for methotrexate to start controlling joint inflammation in rheumatoid arthritis patients?

<p>4 to 6 weeks (A)</p> Signup and view all the answers

Which of the following symptoms is an early sign of rheumatoid arthritis?

<p>Joint inflammation (D)</p> Signup and view all the answers

What is a primary component of the psychosocial assessment for rheumatoid arthritis patients?

<p>Altered body image (B)</p> Signup and view all the answers

What late symptom of rheumatoid arthritis is characterized by the weakening and swelling of joints?

<p>Joint softening (C)</p> Signup and view all the answers

Which laboratory assessment is commonly used to aid in diagnosing rheumatoid arthritis?

<p>Rheumatoid factor (B)</p> Signup and view all the answers

Which imaging technique can confirm joint involvement in rheumatoid arthritis?

<p>Standard X-Ray (B)</p> Signup and view all the answers

Which of the following is a common physical assessment finding in rheumatoid arthritis?

<p>Tenderness in the interphalangeal joint (D)</p> Signup and view all the answers

What serious complication can occur due to advanced rheumatoid arthritis?

<p>Pleurisy (D)</p> Signup and view all the answers

Which type of joint involvement is typical in rheumatoid arthritis?

<p>Bilateral hand joints (A)</p> Signup and view all the answers

Flashcards

Rheumatoid Arthritis

An autoimmune disease causing joint inflammation.

Inflammatory Cells

Cells like neutrophils that contribute to joint damage in RA.

Physical Assessment (RA)

Evaluate joint inflammation, weakness, and other symptoms.

Late RA Symptoms

Progressive pain, stiffness, and joint deformities.

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Rheumatoid Factor (RF)

A blood test used to diagnose RA.

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Arthrocentesis

A procedure to remove synovial fluid from a joint.

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Disease-modifying antirheumatic drugs (DMARDs)

First-line medications to treat RA.

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Joint Inflammation

Swelling and tenderness in a joint due to damage or infection.

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Methotrexate (MTX) for RA

A slow-acting immunosuppressant used to treat rheumatoid arthritis (RA).

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Leflunomide side effects

Possible side effects include hair loss, diarrhea, low blood cell counts, and liver problems; strict birth control is crucial for women of childbearing age.

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Steroid side effects

Steroids quickly reduce inflammation but have significant complications like high blood sugar, bone loss, weakened immunity, glaucoma, and high blood pressure.

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Nonpharmacologic RA treatment

Includes rest, proper positioning, applying ice/heat, therapies like hypnosis/music, and nutrition.

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Leflunomide onset

It typically takes 4-6 weeks or sometimes up to 3 months for maximum benefit from leflunomide.

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What is Rheumatoid Arthritis?

An autoimmune disease where the body's immune system attacks the joints, causing inflammation and damage.

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How does RA damage joints?

Immune cells, like neutrophils, are triggered by CD4+ helper cells to attack the cartilage in the joints, leading to pain and swelling.

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Early RA Signs

Early signs include joint inflammation, fatigue, weakness, and persistent low-grade temperature.

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Late RA Signs

Late signs include progressive pain, morning stiffness, joint deformities, muscle atrophy, and potential complications.

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What are the potential complications of RA?

Complications include tendon rupture, weight loss, anemia, heart problems, and Sjogren's syndrome (dry eyes and mouth).

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What is a key lab test for RA Diagnosis?

Rheumatoid Factor (RF) is a blood test that detects antibodies that are often found in RA patients.

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DMARDs

Disease-modifying antirheumatic drugs are the first-line treatment for RA. They slow down the progression of the disease.

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Leflunomide for RA

Another drug for RA that works on the immune system to reduce swelling and stiffness. It takes time for the full benefits to be seen, up to 3 months. It can cause side effects like hair loss and lowered blood cell counts.

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RA: Rest and positioning

To manage RA, getting enough sleep, staying in comfortable postures, and using ice and heat are important. These help ease pain and inflammation.

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RA: Non-pharmacologic treatments

Beyond medications, RA management involves rest, position, ice/heat, mind-body therapies like hypnosis, and healthy eating plans.

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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!

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