NURS 6501 Wk2 DP – Rheumatoid Arthritis

NURS 6501 Wk2 DP – Rheumatoid Arthritis

NURS 6501 Wk2 DP – Rheumatoid Arthritis (RA) is a chronic, progressive, and systemic autoimmune disease that affects the synovial tissue in the joints.  (Hammer & McPhee, 2019)   RA usually presents in middle-aged women; who are three times as likely as men to suffer from RA. (Stark, 2019)    Its symptoms include not only pain, stiffness, and swelling of the joints, but also fatigue, weakness, weight loss, and a low-grade temperature. (Stark, 2019) Eventually, it can affect other organs.  Factors that influence the RA are gender, genetics, and environment.  Environmental factors such as stress, illness, and tobacco use contribute to the autoimmune activation. (Hammer & McPhee, 2019)

For example, a 42-year-old female who has smoked one pack of cigarettes per day for 24 years (tobacco use) with a family history of RA (gene presence) and who recently divorced after 20 years of marriage (stressful event) develops painful, swollen joints, unexplained weight loss, and a low-grade fever.  The stressful event triggered the autoimmune response because the environment was favorable for the onset of disease, and a gene was present.

Pathogenesis of RA involves the synovium of the joints, which is abnormally thick and inflamed with T and B cells. Instead of lubricating the joints as normal synovium does, RA activated synovium attacks the cartilage and joints. (Hammer & McPhee, 2019)

Diagnosis would include physical examination revealing painful, swollen joints.  Followed by an x-ray of the affected joints.  Then laboratory tests:  CRP, ESR, ACPA, RA factor.  (Hammer & McPhee, 2019)

Treatment is the use of non-steroidal anti-inflammatory drugs (NSAIDS), disease-modifying antirheumatic drugs (DMRDs) like methotrexate, corticosteroids, biologic DMRDs called tumor necrosis factor (TNF) inhibitors such as etanercept, and eventually, surgery may be necessary. (Stark, 2019)

Osteoarthritis (OA)

OA is a chronic, progressive, degenerative joint disease caused by age, obesity, joint overuse, congenital bone deformity, joint injury, and metabolic or genetic disease.  OA is not autoimmune.  Its cause is cartilage deterioration that causes swelling, inflammation, pain, stiffness, limited range of motion (ROM), bone spurs, and misalignment. (Stark & Price, 2019)

Age and gender are factors in OA.  OA is more common in older women than men.  “According to the Arthritis Foundation, approximately twenty-seven million people in the United States have OA, and it is the most common form of arthritis. OA is three times more common among women, although before forty-five years of age, it is more common in men.” (Stark & Price, 2019, p. 1)

Pathogenesis of OA stems from the aging process.  With age, cartilage deteriorates, becoming more fragile and rigid because of the decreased concentration of glycosaminoglycan. The aging of muscles and ligaments decrease the joint ROM.  Bone density decreases and “tendons shrink and harden.” (Huether and McCance, 2018, p. 987)

Diagnosis would begin with a physical exam revealing limited ROM, tenderness with pressure, swelling, X-ray, and possibly CT or MRI.  (Stark & Price, 2019) Lab tests would be CRP, ESR, ACPA, and RA factor.

Treatment includes physical and occupational therapy to strengthen the surrounding muscles. Heat, exercise, NSAIDS, COX-2 inhibitors, injection of cortisone or hyaluronic acid into joint spaces, surgical trimming of torn cartilage, and may eventually require joint replacement surgery. (Stark & Price, 2019)

Comparison of OA and RA

RA is an autoimmune disease, but OA is a disease of aging.  Lab tests would reveal elevated levels of ESR, CRP, ACPA, and RA factor with RA, but in OA, they would not be elevated.  Weight loss and low-grade fever is common in RA, but not with OA. Patients with OA are more likely to be obese. (Stark & Price, 2019) Heat and COX-2 inhibitors may alleviate discomfort in OA due to their inhibition of prostaglandins but would have little or no benefit for RA symptoms. (Stark & Price, 2019)   Biologic DMRDs would be helpful for RA but not OA. (Stark, 2019)

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NURS 6501 Wk2 DP – Rheumatoid Arthritis  References

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Stark, S. W., (2019). Rheumatoid arthritis. Magill’s Medical Guide (Online Edition). Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=86196150&site=eds-live&scope=site

Stark, S. W., & Price, V., Ph.D. (2019). Osteoarthritis. Magill’s Medical Guide (Online Edition). Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=86194360&site=eds-live&scope=site