 What comes to nursing school explained in this video on rheumatoid arthritis? So let's take a look at the pathophysiology first so rheumatoid arthritis is a chronic systemic autoimmune and inflammatory disorder and so these four words actually right away can kind of tell you what's going on So it's chronic typically progressive. So we it's not an acute episode. It's something that gets worse over time systemic affecting the entire body Autoimmune meaning that there is some sort of an autoimmune response and then inflammatory So just think about signs and symptoms of inflammation that we're gonna see here, but we'll get into the details So rheumatoid arthritis affects the freely moving joints So that's anything that can freely move the hands the feet the wrists the elbows and the shoulders as well as the hips The knees the ankles and the feet. So think more about the appendicular skeleton rather than the axial skeleton And so because it is an autoimmune response we have some sort of an antigen that triggers the immune response and then the body triggers or or sends IgG Immunoglobulin to the Sights and they form antibodies and these antibodies are also referred to as rheumatoid factor and because of these immunoglobulins come into the site of The synovium the inner lining or the inner membrane of these joints of these freely moving joints We are having some synovial tissue damage And so now when that joint the synovium inside the joint gets inflamed and irritable Then we have some apparent movement and pain because of this inflammation So risk factors rheumatoid arthritis is hereditary. So if it runs in your family, you're have a higher likelihood of getting it also Men women are more affected than men typically onset occurs in the 30s to 50s and then we have certain triggers here certain Antigen triggers that cause the immune response. And so some of those includes smoking environmental factors as well as viruses and Bacteria that's why it's so important to stay in overall good health to avoid these because you never know when or if You're going to have an autoimmune response and that particularly applies to patients that fall into these risk factor carry categories So then signs and symptoms because of we have this inflammation of the synovium the inner lining of the joint We're going to have joint pain swelling redness maybe even warmth all those signs of inflammation The patient might be fatigued because we know that it's systemic There might be morning stiffness of the affected joints and that typically lasts greater than 30 minutes And that here this time frame distinguishes rheumatoid arthritis from osteoathritis where osteoathritis is typically less than 30 minutes Then the symptoms are usually symmetrical So left and right side are equally affected whatever joints the patient has the symptoms in and then Eventually over time and time again over prolonged periods of time with this synovial tissue damage There can be some joint damage to that synovium itself that results in disability and deformities And then certain deformities that we see in patients with rheumatoid arthritis are these four right here? And so that is ulnar deviation where the hand will deviate the wrist will deviate towards the ulnar side then we have butanair deformities, which is where the Proxima in the phalangeal joint is Been this way and then the the distal joint is kind of form Deformed up that way and the swan neck deformity is the opposite where the Proxima joint kind of goes down and then the other one is also deformed in a different way It's best to Google images of these deformities and then halux valgus is basically the same as the ulnar deviation of the wrist but it pertains to the joints of The foot so you have that halux that that big Deformity of the toe of the big toe joint that kind of moves out So ulnar deviation butanair swan neck and halux are the telltale signs or the telltale Deformities that we see in patients with prolonged or chronic rheumatoid arthritis Let's look at some Extraarticular symptoms so extra articular meaning outside of the joint because we know it's a Stemic inflammatory disorder so patients can get what are called rheumatoid nodules and they can form anywhere Underneath the skin and the subcutaneous tissue and they would be some nodules are kind of firm and and non movable And certainly the patient will have to get those checked out to make sure there's no other cause for these nodules the patient might also have osteopenia the precursor for osteoporosis and then it also has effects on Their eyes so it can lead to inflammation of the sclera scleritis all the way to cataracts It can lead to pleuritis inflammation of the pleura as well as pleura effusions and Inflammation of the pericardial sac in pericarditis So these are the things that we always want to watch out for because clearly when it affects the eyes The lungs and the heart we want to make sure that we educate the patient To prevent those or to detect them early in case they happen And then for diagnostic tests in addition to any kind of other regular testing There are three or four actually four specific tests that we can do to determine if the patient has rheumatoid arthritis Which is check the blood for rheumatoid factor that we discussed over here to check for these antibodies ESR and CRP are always good measures to double check for inflammatory disorders and then a and a which is the anti-nuclear antibody which also has to do with Kind of like systemic inflammatory disorders and to give you a better idea of which particular Inflammatory disorder the patient is having if they starting to present with some of these signs and symptoms and then certainly because the Synovium of the joint is in Affected we can also aspirate that synovial fluid send it off to the lab check it for CBC check see if there's infection And any kind of other labs that we want to run from there and then x-rays of these joints mostly to want it to Progression of the deformity and the joint space narrowing and the inflammation that happens of these joints Treatment so education first of all to avoid the risk factors if you can and then also to teach the patient about these symptoms and what to do about them and then also to Report any of these so if they start having vision trouble or maybe some trouble breathing or Some chest pain they should get checked out right away because we never know when some of these extra Articular symptoms might occur and joint mobility is key here because the joints get kind of stiff and inflamed But keep in the mobile will have the the synovium Kind of get lubricated and range of motion exercises in collaboration with PT and OT here are always helpful Certainly we want to make sure that the patient has good nutrition healthy nutrition and a healthy weight Because the joints can be affected and think mostly about the joints of the lower extremities that are weight-bearing So the more weight the body and these joints have to carry around the more affected the joints will be so ideal Weight is very important here in addition to healthy well-balanced diet to make sure to keep these inflammatory symptoms at bay and Then there are certain medications that we can use to treat patients with rheumatoid arthritis So number one step is always non-steroidal anti-inflammatories but always be aware that those can have side effects such as bleeding GI bleeding in particular and They can be renal toxic if taken in high doses steroids can be used for certain flare-up so when that synovium is Really inflamed steroids can help kind of lessen that and then analgesics such as Tylenol and any other over-the-counter products and Typically, we want to stay away from controlled substances narcotics here because this is a chronic condition So this is something that the patient will have to be on for a long time And we know that narcotics can be habit-forming so we want to be extra cautious with those and then there's a medication category called D-Mars which are disease modifying Anti-rheumatic drugs and so they alter this immune response That's the cause of all this so this immune response that is triggered by the antigen whatever that antigen was for that particular patient and a very commonly used medication here is methotrexate and it can be very useful in treating rheumatoid arthritis, but As any medication there are side effects and so methotrexate in particular can be hepatotoxic so we have to make sure check liver function tests and You know notify the patient to report any kind of right upper quadrant pain or yellowing up the skin and sclera and Because it in alters the immune system. It also suppresses the bone marrow So we have to be careful and make sure that the patients stay healthy again with healthy nutrition and weight management But also stay away from other people that are ill because just a normal upper respiratory infection Could cause a big problem for patients who are on these immunosuppressant drugs and then option number two our medication class called Biologics which are usually used in moderate to severe disease alone or in combination with the D-Mars or the NSAIDs and analgesics And those an example of those is humera that you might have heard as well And then for nursing care So education here is key because we know it's a chronic progressive disorder So keep the patient as healthy as we can for as long as we can so that they don't have these Articular symptoms and also to report those when when they occur like I previously mentioned and then check the labs specifically here if they are on NSAIDs or any of these immune altering drugs. We want to make sure we check their CBC Their white count their platelets maybe if they're on NSAIDs as well as of course the stool for any bleeding and give the patient all the education that's needed for this and Then of course check for complications and extraarticular symptoms like I already mentioned here Check the patient for signs of symptoms of infection Particularly if they are on one of those immune altering drugs like methotrexate Make sure the patient is up to date on vaccines because like I mentioned any virus and bacteria here can cause this response But then also if they're already immune or compromised or their immune system is altered any kind of minor infection that could be prevented by vaccinations could cause a big problem So staying up to date on vaccinations is important And then most definitely we want to provide emotional support for our patients because it is a disease that's chronic in nature and progressive and usually has kind of like flares and then also these Articular symptoms so you want to support the patient maybe send them to a support group So that they get the support that they need and actually have a healthy coping mechanisms Thank you for watching this video on rheumatoid arthritis Please also check out my other video on osteoarthritis to see the differences between the two Please give me a thumbs up if you've enjoyed the video and I'll see you soon right here on nursing school explain Thanks for watching