1. Rheumatoid arthritis (RA)

2.  Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. RA is considerd autoimune disease of unknown origin that affect 1% of the population worldwide with a female to a male ratio between 2:1 and 4:1.

3.  The process produces an inflammatory response of the synovium (synovitis) secondary to hyperplasia of synovial cells, excess synovial fluid, and the development of pannus in the synovium.  The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura, and sclera, and also nodular lesions, most common in subcutaneous tissue

6. - Joint pain, swelling, warmth, erythema and lack of function. - Palpation reveal spongy or boggy tissue. - The classic sign is joint stiffness in the morning. - Fever, fatiuqe, anemia. - lymph node enlargment and Raynaud’s phenomena

7.  The history and physical examination  The erythrocyte sedimentation rate (ESR) is significantly elevated with RA..   C-reactive protein and antinuclear antibody test results may also be positive.

8. CONT…  Arthrocentesis shows synovial fluid that is cloudy, milky or dark yellow and contain numerous amount of leukocyte and complement.  X-ray studies, performed to help diagnose and monitor the progression of disease, show characteristic bony erosions and narrowed joint spaces occurring later in the disease

10.  Early-Stage RA : 1 ) In patients with early RA, treatment begins with education, a balance of rest and exercise, and referral to community agencies for support 2 ) Medical management begins with therapeutic doses of NSAIDs.

11. CONT…. 3 ) Several COX-2 inhibitors, another class of NSAIDs, have been approved for treatment of RA. 4 ) biologic response modifiers that are currently available infliximab (Remicade). These agents inhibit the function of tumor necrosis factor-alpha, a key cytokine known to play a role in the disease process in RA.

12. CONT….  MODERATE, EROSIVE RA : For moderate, erosive RA, a formal program with occupational and physical therapy is prescribed to educate the patient about principles of joint protection, pacing activities, work simplification, range of motion, and muscle-strengthening exercises. The patient is encouraged to participate actively in the management program.

13. CONT….  PERSISTENT, EROSIVE RA : 1 ) Reconstructive surgery is indicated when pain cannot be relieved by conservative measures. 2 ) Systemic corticosteroids are used when the patient has unremitting Inflammation.

14. CONT….  ADVANCED, UNREMITTING RA : 1 ) Advanced, Unremitting RA : For advanced, unremitting RA, immunosuppressive agents are prescribed.  These include high-dose methotrexate (Rheumatrex), cyclophosphamide (Cytoxan), and azathioprine (Imuran). These medications, however, are highly toxic and can produce bone marrow suppression, anemia, gastrointestinal disturbances, and rashes.

15.  The device, a protein A Immunoadsorption column (Prosorba.  The Prosorba Column is a Plasma filtering device used to treat severe cases of Rheumatoid Arthritis  The effect of the Protein A is to remove circulating immune complexes

17. 1 ) Food selection should include the daily requirements from the basic food groups, with emphasis on foods high in vitamins, protein, and iron for tissue building and repair. 2 ) Some medications (ie, oral corticosteroids) used in RA treatment stimulate the appetite and, when combined with decreased activity, may lead to weight gain.

18. CONT… 3 ) The most common issues for the patient with RA include pain, sleep disturbance, fatigue. altered mood, and limited mobility. 4 ) The patient with newly diagnosed RA needs information about the disease to make daily self management decisions and to cope with having a chronic disease.