NURS 6501 Wk2 Discussion – Arthritis

NURS 6501 Wk2 Discussion – Arthritis

NURS 6501 Wk2 Discussion – Arthritis

Discussion 2: Arthritis

While arthritis impacts nearly 50 million adults in the United States, it is not a disease that is limited to adulthood. Consider the case of Ashley Russell. At the age of 14 months, Ashley was diagnosed with juvenile rheumatoid arthritis. As a baby, her parents noticed that her knee was always swollen and that she often wanted to be carried instead of walking on her own (Cyr, 2012). After seeking medical care, Ashley’s underlying disorder was discovered. Arthritis in children is not uncommon. According to the CDC (2011), an estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition. Due to the prevalence of the disorder in both children and adults, you must understand the pathophysiology and symptoms of arthritis in order to properly diagnose and prescribe treatment.

To Prepare

• Review Chapter 37 in the Huether and McCance text and Chapter 24 in the McPhee and Hammer text. Identify the pathophysiology of osteoarthritis and rheumatoid arthritis. Consider the similarities and differences of the disorders.
• Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the pathophysiology of the disorders, as well as the diagnosis of and treatment for the disorders.

NURS 6501 Wk2 Discussion – Arthritis

By Day 4

Post a description of the pathophysiology of osteoarthritis and rheumatoid arthritis, including the similarities and differences between the disorders. Then explain how the factors you selected might impact the pathophysiology of the disorders, as well as the diagnosis of treatment for the disorders.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different factors than you, in one or more of the following ways:

INITIAL POST

NURS 6501 Week Two Discussion #2

NURS 6501 Wk2 Discussion – Arthritis Sample solution 

Arthritis

Arthritis is a condition affecting millions of individuals affecting people of all ages and races and is foremost the number one cause of disability (Arthritis Foundation, n.d.).

Rheumatoid Arthritis Pathophysiology

Rheumatoid arthritis (RA) is a systemic polyarthritis and a progressively debilitating disease that affects the synovium of multiple joints, favoring the small joints of the hands and feet (Hammer, and McPhee, 2014).  Periods of exacerbation and remissions plague RA, this characteristic is also true in other autoimmune disorders. In RA inflammation of the synovium, or the synovial membrane surrounding a joint, and the destruction of articular cartilage is what causes leukocytosis, pain and swelling, fever, malaise, anorexia, loss of function, and hyperfibrinogenemia (Huether, and McCance, 2017).

The cause of RA is unknown however the pathogenesis is well understood, and fibroblast-like synoviocytes (FLS) are an important part of RA pathogenesis.  The cycle begins in the synovial fluid from a triggering of an immune response on the FLS.  Then macrophages, CD4 T cells, plasma or B cells, and other cells secrete cytokines, such as tumor necrosis factor-alpha, interlukin-1, and interlukin-6, interlukin-17 and granulocyte-macrophage colony-stimulating factors (GM-CSF, Hammer, and McPhee, 2014).  Cytokines assist in the immune response stimulating the angiogenesis process allowing for increased migration of immune cells to the joints.  Cytokines also potentiate inflammation trough abnormal FLS proliferation releasing protease leading to cartilage degradation, which in turn produces more protease (Huether, and McCance, 2017).  The abnormal proliferation of the FLS presents as an RA synovial tissue called pannus (Hammer, and McPhee, 2014).  The location of pannus tissue is at sites where synovium and articular cartilage are contiguous (Hammer, and McPhee, 2014).  The Pannus then invades and destroys adjacent cartilage and bone by secretion of RANKL which encourages more FLS secretion (Hammer, and McPhee, 2014).

The pannus cells promote proliferation of more macrophages and motivate osteoclast activity causing bone erosion via RANKL and protease expression.  Another characteristic of the FLS cells is that they migrate from joint to joint and this is what causes the symmetrical joint presentation in RA (Bingham, 2013).  Also in the synovial fluid are plasma or B cells which assist with the inflammatory process through the release of cytokines and antibodies.  Another leucocyte present is the neutrophil producing proteases and reactive nitric oxide causing bone and cartilage degradation contributing to inflammation (Bingham, 2013).  Cytokines play a significant role in the many complex processes of the RA immune response producing inflammation and bone destruction.

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