Rheumatoid Arthritis: Causes, Symptoms, and Treatment, Essays (university) of Nursing

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RHEUMATOID ARTHRITIS

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Introduction

Running Head: RHEUMATOID ARTHRITIS 1

Rheumatoid arthritis is an autoimmune disease that leads that causes swelling of joints and pain to the person affected. An autoimmune is a disease that makes the immune system to mistakenly attack body cells. In the case of rheumatoid arthritis, joint lining is attacked by the body immune system which causes inflammation and damaging of the joints (Lindstrom,and Robinson, 2010).. Although doctors are yet to establish the real cause of this disease, there are both environment and genetic related factors that contribute to high risks of being infected. The genetic factor is the family history in terms of the disease infection; this means that one is more likely to get it if there is a history of the disease in his or her lineage. Some of the environmental factors are things such as obesity and smoking, the disease is very common amongst smokers and those who have obesity (Källberg, ..et..al..,2010). Rheumatoid arthritis affects people of different ages and it are both painful and debilitating since it does not only causes damage to the lining but also the cartilage and bone that surround the joint. In Australia, rheumatoid arthritis is very common of all the known autoimmune disease; in fact, around 2% of the country’s total population has been affected (Ahlstrand..et..al..,2012). Additionally, in Australia like in most countries globally, the number of women affected by the disease is higher as compared to that of men (Ahlstrand..et..al.. 2015).. This 2 percent translate into around 407,900 people in Australia with women forming the highest percentage of 1.7 percent (Cross..et..al..,2014). Rheumatoid Arthritis pathophysiology Synovial lining cells in the inflamed blood vessels in the body produce some prominent immunologic abnormalities such as immune complexes (Choy, 2012). Additionally, rheumatoid factor and anticyclic citrullinated peptide which are the antibodies generated by plasma cells have their contributions to the complexes; there is also a possibility of a destructive arthritis

occurring when they are absent (Cooles, & Isaacs, 2011). During the early stages of the disease, macrophages move to the synovium that is affected by the disease and together with the vessel inflammation, the lining cells that have been derived macrophages become prominent. CD4+ T are basically the cells in lymphocytes that infiltrate the synovial tissue. Production of inflammatory cytokines as well chemokine such as TNF- alpha, different ILS among others in the synovium occurs in both macrophages lymphocytes. Inflammatory mediators and different enzymes that are released in one way have contributions in the various ways through which rheumatic arthritis manifests itself in the systematic tissues and joints, a good example being in cartilage as well as bone damages. There is also evidence supporting the fact that for the case of seropositive rheumatic arthritis, anti-CCP antibodies seem to show up earlier than the appearance of inflammation signs. In the cases of joints that are chronically affected, synovium that is in normal instances thin, begins to proliferate, becomes thick and develops a number of villous folds (Shiozawa,..et..al..,

2011. Production of different materials such as collagenase as well as stromelysin by synovial lining cells plays a key role in destruction of cartilage (Snir, ..et..al..,2010).). Other materials produced include IL-1 and also TNF- alpha that act as stimulants in destruction of cartilage, inflammation of synovial, absorption of bone mediated osteoclast as well as prostaglandins. There are also inflammatory mediators released by hyperplastic synovial tissue which cause eroding of the ligaments, subchondral bone, the articular capsule as well as the cartilage (Sudoł- Szopińska, ..et..al..,2012). Development of rheumatoid nodules happens to very few rheumatoid arthritis patients, in fact, it happens in very rare instances that comprise of about 30% of all the cases reported. Clinical manifestation

Rheumatoid arthritis affects any joint within the human body but mostly in the wrist and knees, metacarpophalangeal joints, metatarsophalangeal joints. Although the clinical manifestation of rheumatoid arthritis is different depending on the patient, at the initial stages of pain with uniformed swelling of the small joints is seen in most cases. Rheumatoid arthritis at the onset can be acute or sub-acute in a few cases comprising of about 25% of the patients with the patterns including palindromic onset, monoarticular presentations which can be either in slow or acute form and lastly other general symptoms such as fever, loss of weight as well as fatigue (Mahajan,..et..al..,2010). Recurring episodes of oligoarthritis without any form of residual radiologic damage is a characteristic of palindromic onset (Aletaha, ..et..al.., 2010). Additionally, polymyalgia amongst old-aged patients is in a way is clinically difficult to differentiate from the polygalmic onset. In the morning, the clinical manifestations of synovitis are clearly seen. The stiffness that last for a period of one hour without any improvement in or around the joint is a very clear sign of rheumatoid arthritis. Nonetheless, it is good to explain to the patient pain and stiffness differences so that they are able to detect during the early stages of the disease. It is good for people to know that the morning stiffness duration is related to the action of the disease at those early hours.

Another clinical manifestation of rheumatoid arthritis is having a tender swelling on the palpation with early motion impairment that is severe but without any bone damage evidence e.g. radiologic (Tehlirian, and Bathon, 2010). Other clinical signs include fatigue that can be prolonged, loss of weight, they are signs closely linked with manifestation of extra-articular involvement including rheumatoid nodules. Linking

Regardless of the absence of test that can be done in the laboratories to to show that a patient has been diagnosed with rheumatoid arthritis, there are still abnormalities that are detected (Robinson,..et..al..,2015). One of the humoral characteristics of rheumatoid arthritis that is very typical are the abnormal values of the systemic inflammation of the evaluation such as the viscosity of plasma, acute phase protein and erythrocyte sedimentation rate (Nakken..et..al..,. 2011.). The perfect information on the acute phase response is provided by the C - reactive protein and also erythrocyte rate of sedimentation. However, there is a strict correlation between C- reactive protein and clinical assessments as well as radiographic change. The rate of anatomic change amongst patients with rheumatoid arthritis is assessed using a standardized investigation by use of plain film radiography (Visscher, ..et..al..,2012). Clear features that can be seen at the early stages of the disease through radiography include swelling of the soft tissues and also juxtaarticular osteoporosis is mild.

Treatment Treatment of rheumatoid arthritis varies depending on the doctors opinion as well as the patients preferences. However, finding the right treatment that is effective is very important. Doctors must follow certain strategies to meet goals such as preventing damages on joint and organ, stopping inflammation, reliving symptoms, reducing long term complications and lastly improving the patients’ physical functioning as well as body well-being. A patient can choose to be treated using either medicines or non-pharmacological approach which include fatigue management, doing regular exercise and stretching (Catrina …et..al., 2016). One with the help of a health person can also develop an individual health work plan that involves exercise like aerobics, strengthening and stretching of muscles exercise. There is also medication that is

commonly known as disease modifying anti-rheumatic drugs. These drugs are more effective when they are taken during the early stages of the disease since they help in controlling inflammation of joints. The drugs also help improvement of the body functioning and prevention of joint damage (Singh..et..al..,2016). Other drugs like paracetamol as well as anti-inflammatory medicines reduce pain and swelling of joints without slowing down the disease process (Shlotzhauer, 2014). Another treatment is surgery e.g replacing joint, it is mostly for the patients who have permanent damages which hinder them from effectively carrying out day to day activities, inhibits their mobility hence making the dependent on others. Linking treatment to pathophysiology After stimulation of the first immune response, antibodies and inflammatory cytoikenes are released by immune system cells, this creates a cascade of inflation that leads to pannus formation (Singh, 2012). This pannus formed attacks the cartilages and bones leading to their damage. This damage can be treated through a surgery which involves replacing the damaged joints with plastic or metallic ones. This acts as pain reliever and the functioning of the damaged body parts is restored (Smolen,..et..al..,2010). The physical exercise treatment helps to ensure the normal functioning of the joints is maintained. These functions of the joints are affected by the inflammatory mediators that are from the affected joints.

Conclusively, rheumatoid arthritis is a disease that affects all people regardless of their age and so there is a need to come up with not only effective treatment methods but also prevention measures.

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