health assessment
Rheumatoid arthritis - Most common form of inflammation arthritis. Results from
complex interaction of genes and environment that leads to a breakdown of immune
tolerance and synovial inflammation in a characteristic symmetrical pattern.
Key characteristics of rheumatoid arthritis - -Boutonniere deformity of the thumb
-Ulnar deviation of metacarpophalangeal joints
-Swan neck deformity of fingers
Synovial joints - -Purpose: skeletal stability and mobility
-Highly vascular
-Synovial membrane lines joint capsule and secretes synovial fluid
-Cartilage lies between synovial membrane and bone
-Knees, hands, fingers, feet, wrists are targets for inflammation
Pathophysiology of RA - -unknown
-Suspected to be a combination of genetics, and immune triggering event, and
development of an autoimmunity against synovial cells
-Possible trigger: periodontal disease
-Risk factor: Smoking
-Trigger leads to inflammation (CD4+ helper T cells, release cytokines)
-Formation of antibodies in synovial membrane and cartilage
-Formation of immune complexes
-Excess production and release of inflammatory mediators (Vasodilation and capillary
permeability)
-Joint becomes, red, swollen, painful with decreased ROM
-Altered synovium with pannus formation in joint
-Tissue damage and collagen formation
-Fibrosis and ankylosis
-Muscle atrophy and spasms
Clinical manifestations for RA - -Rubor(redness), Dolor(pain), Tumor(swelling),
Calor(heat), Functio laesa(impaired function)
-Joint malformation
-Pain and stiffness especially in AM and after immobility
Systemic sx
-Fever, fatigue, anorexia, weight loss, weakness
-Isolation and depression
-Granulomas, vasculitis
Clinical manifestations for dx (RA) - -Morning stiffness for at least one hour and present
for at least six weeks
