Rheumatoid Arthritis : A Progressive Inflammatory Autoimmune Disease

A. The blood and synovial tissues of RA patients contain an autoantibody directed against the patient’s own gamma globulin.

20 patients with active RA in 1992 were first to be treated with infliximab. There was a dramatic drop in C-reactive protein (CRP and ethrocyte sedimentation rate. However patients relaped with 3-8 week demonstrating that they require another dose of

Rheumatoid arthritis is a chronic syndrome that is characterized by inflammation of the peripheral joints, but it may also involve the lungs, heart, blood vessels, and eyes. The prevalence of this autoimmune disease is between 0.3% to 1.5% of the population in the United States (Feinberg, pp 815). It affects women two to three times more often than men, and the onset of RA is usually between 25 and 50 years of age, but it can occur at any age (Reed, pp 584). RA can be diagnosed by establishing the presence of persistent joint pain, swelling in a symmetric distribution, and prolonged morning stiffness. RA usually affects multiple joints, such as the hands, wrists, knees, elbows, feet, shoulders, hips, and small hand joints. RA is

Huston states,” Joints are extremely damaged and the only thing that will help the pain at this point is replacing the joints.” She applies cold therapy to reduce pain in the joints and does range of motion three times. RA treatment includes disease modifying anti-rheumatic drugs (DMARDs), non-steroidal anti-inflammation drugs, and biologic therapy (Walker, 2012). Physician uses DMARDs as a common treatment for patient who just got diagnosis of RA, and the drugs have side effect that nurses need to educate patient about (Firth, 2012). Biologic drugs are another RA treatment available for patient. Biologic drugs are very expensive and their main target are cells, molecules, B-cell, and tumor necrosis that start the disease process. Hot and cold packs are common treatment used to reduce inflammation and allow client to complete their task, and move around (Walker,

As an autoimmune disease, the synovial cells are affected and causes synovial membrane and joint damage because synovial fibroblast and the immune response initiates the release of cytokines, enzymes, prostaglandins that cause synovial tissue to thicken and loss of bone due to an abnormality in the immune response that causes a condition called synovitis (Huether & McCance, 2017). Because the signaling immune pathway is altered in the processes it causes additional inflammation, enzymes migration to the area, and ingrowth of blood vessels that allow more fibroblast to be able to travel to ligaments, tendon, other fibrous joint located throughout the body that contributes to its systemic effect (Huether & McCance, 2017). As a result of this process, inflammation spreads to surrounding ligaments, tendons, and affected joints and people experience joint pain, decrease mobility, and deformity (Huether & McCance,

There are 5 types of RA progression measured by imaging radiography. Type 1 is identified as a rare type, with no radiographic progression, type 2 is a slow or moderate onset with increasing progression, type 3 is a moderate-to-fast onset with stable progression, type 4 is a fast onset with a decreased progression rate, and type 5 is a slow onset with acceleration in progression, then deceleration (Graudal et al, 2004). Having any of the five types of RA can cause disability as a result of joint damage, lowers quality of life, and can lead to other comorbidities such as cardiovascular disease, tuberculosis, malignancies, and mental health conditions such anxiety and depression (Scott et al,

Rheumatoid Arthritis known as RA is an autoimmune disease which the body’s immune system mistakenly attacks the joints. In a healthy individual the immune system protects by attacking foreign substances like bacteria and viruses. When this happens the body will create inflammation that causes the tissue that lines the inside of the joints known as the synovium to thicken, which creates swelling and pain around the joints. If the individual is to go a prolong period without treatment for RA it can damage the cartilage and over time the loss of cartilage the joint can then become loose, unstable, painful and most lose their mobility. Joint deformation can occur and the damage to the joint cannot be reversed.

Today in the United States there is an estimated 1.3 million people living and dealing with rheumatoid arthritis (Arthritis Foundation). One might ask, what exactly is rheumatoid arthritis? Well, rheumatoid arthritis, also commonly known as RA, is a form of inflammatory disease and an autoimmune disease. If the person is a minor, or below the age of six-teen, then the chronic disease can also go by the name of juvenile arthritis. The juvenile arthritis is, “Defined as chronic inflammation of the synovial joints, with unknown etiology, which starts before the age of sixteen and persists for at least six weeks” (Hink et al 1). This disease can affect anyone with a functioning immune system. Out of the 1.3 million people in the United States that have rheumatoid arthritis, 70% of that number is women (RA.com). Once again there are no certain reasons as to who receives this disease whether its children, elders, Caucasians, African Americans, etc. But once they do receive the illness, then it affects them immensely. “The disease is systemic, meaning it can occur throughout the whole body. It’s a chronic disease, so it can’t be cured” (Arthritis Foundation). The pain, stiffness and fatigue can affect the entire body. “RA occurs when your immune system, the system that protects your body from outside harm, mistakenly starts attacking healthy tissue” (RA.com). Rheumatoid arthritis is an incurable disease that is affecting

RA is a mediated inflammatory process that triggers an autoimmune response. The result is in the production of antibodies and inflammatory cytokines that over time destroys bone, cartilage, tendons, ligaments and blood vessels (Dewing, Setter, & Slusher, 2012). Although joints are the primary areas of destruction, the inflammatory process can also affect various organs, such as heart tissue including the heart values, visceral layers of the lung and brain, spleen, sclera and larynx (Dunphy, Windland-Brown, Porter, & Thomas 2011). If RA is not treated promptly or if the patient does not respond to treatment, irrevocable bone deformity, bone erosion and immobility is often the sequelae.

Rheumatoid Arthritis, what is it? The word Rheumatoid comes from the greek word referring to rheumatism, which means any painful disorder from the joints. Arthritis means inflammation of the joint. (William Collins Sons & Co. Ltd. 1979). Putting these two words together Rheumatoid Arthritis creates a disorder. The pathophysiology of RA is that it is a chronic, systemic, inflammatory autoimmune disease which means that this disorder is attacking your own body (Silvestri, 2013, p. 851 ). This usually happens at the joints where two bones meet that create movement of body parts. This disorder is systemic and usually if it happens one side,

Most commonly affected are in fingers, feet, wrists, elbows, ankles, and knees, but shoulders, hips, and spine may be involved. RA affected 1% to 2% of adults and develops most often in women with a female/male ratio of 3:1. The frequency of RA increases from

The increase of macrophages and fibroblast synoviocytes results in hyperplasia of the lining. Enzymes that destroy and digest the extracellular matrix and articular structures such as metalloproteinase, serine proteases, and aggrecanase will be present in the joints. According to the American rheumatism association there are criteria for the classification of rheumatoid arthritis, these are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints (Arnett et al. 1988). As for treatment there is no cure but only reduction of symptoms. Analgesic drugs reduce pain, and non-steroidal anti-inflammatory drugs (NSAIDs) lessen pain and

The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (hyperplasia) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium (Gerd et al.,2014). RA is more prevalent among women than men, and usually develops in the fourth and fifth decades of life, with 80% of the total cases occurring between ages 35 and 50 (Kavanaugh and Lipsky 1996).RA reduces lifespan on average from three to twelve years. RA is associated with decreased physical function, disability, under employment, and overall diminished quality of life. (Maclean C H et al., 2000). When it occurs in children it is called Juvenile Rheumatoid Arthritis. The incidence and prevalence of RA differs significantly over time and between continents. The prevalence in developing countries ranges between 0.1 and 0.5% (Akar et al., 2004). Rheumatoid arthritis (RA) is a chronic systemic inflammatory illness with prevalence of approximately 0.75% in India (Ausaf et al.,

Rheumatoid Arthritis (RA) is a chronic inflammatory disease that primarily attacks all synovial joints. RA is the second most common form of arthritis, with osteoarthritis being the most common (Clements, 2011). It can occur at any age, however it generally affects those between the age of 30 and 50 (Marieb and Hoehn, 2013). If left untreated, active rheumatoid arthritis can cause joint damage, frailty, a decrease in quality of life, cardiovascular disorders along with other dire consequences (Scott, Wolfe, & Huizinga, 2010).

RA is associated with inflammation of the synovium, autoantibody production, progressive cartilage and bone destruction, early morbidity, and other systemic consequences in which many include cardiovascular events. Although structural changes can be visualized by conventional imaging techniques, joint damage is rarely apparent in early stages of disease, but rather accumulates over time (4). Various immune modulators and signalling pathways are involved in the pathophysiology of RA. The influx of mononuclear cells, including T and B cells results in synovitis, which is inflammation of the synovial joint. The synovial lining becomes hyperplastic and the membrane expands and destroys bone, due to osteoclast-rich regions. Cartilage is also degraded by enzymes secreted from synoviocytes and chondrocytes (4).