Autoimmune primarily occurs in synovial tissue

Phagocytocis produces enzymes within the joint

The enzymes breakdown collagen, causing edema, proliferation of the synovial membrane, and ultimately pannus formation (hypertrophied synovium)

Pannus destroys cartilage and erodes the bone

The consequences are loss of articular surfaces and joint motion

Muscle fibers undergo degenerative changes, and tendon and ligament elasticity and contractile power are lost

Diffuse connective tissue diseases have unknown causes

But they are also thought to be the result of immunologic abnormalities

Autoimmune disorders

Age

Female Hormones (70% of people with RA are women, this occur becasue of the fluctuations of the female hormones)

Infectious agents (bacteria and viruses)

Hormonal dysregulation in synovial fluid

Wear and tear of a joint from overuse

Joint pain

Swollen joint

Edema over both lower limbs

Intermittent Fever

Lack of function due to pain

Acute Pain related to tissue damage by the accumulation of fluid as evidenced by reports of joint pain with intermittent fever, swollen joints and edema over both lower limbs.

Impaired Walking related to pain and discomfort as evidenced by reports of joint pain with intermittent fever, swollen joints and edema over both lower limbs.

Impaired phyiscal mobility related to pain on movement as evidenced by reports of joint pain associated with intermittent fever, swollen jkoints and edema over lower limbs.

Acute pain

Impaired Walking

Impaired Physical Mobility

Teach comfort measures (application of heat or cold; massage, position changes, rest, relaxation techniques, diversional activities)

Administer anti-inflammatory, analgesic, and slow-acting antirheumatic medications as prescribed

Individualize medication schedule to meet patient;s need for pain management.

Encourage verbalization of feelings about pain and chronicity of disease

Assist in identification of and assess for subjective changes in pain.

Facilitate development of appropriate activity/rest schedule

Encourage verbalization regarding limitations in mobility.

Assess need for occupational or physical therapy consultation

Emphasize range of motion of affected joints

Promote use of assistive ambulatory devices

Develop a plan based on the patient’s perceptions and priorities on how to establish and achieve goals to meet self-care needs, incorporating joint protection.

Encourage independence in mobility and assist as needed

Monitor closely for systemic and local infections, which often can be masked by high doses of corticosteroids.

Conduct patient education on how to protect and strenghten joints.

Encourage patients to perform light activities such as walking, stretching, swimming or water activities to relieve pain and joint stiffness.

Avoid doing strenous activies and avoid prolonged standing.

Eat variety of healthy and nutritious foods such as fruit and vegetables, low-fat dairy products, leans and fish.

If the symptoms are getting worse even with treatment, call or inform your doctor immediately.

Rest when need. Rest is imprtant if your joints are painful.

Use ice or heat to decrease pain and swelling of the affected body area.

Elevate your joint. This will reduce swelling and pain.

Go to physical therapy as directed as this will help to relieve pain and joint stiffness.

Blood Tests

Imaging Test (X-rays of involved joints)

Steroids (Corticosteroid such as prednisone to reduce inflammation and slow joint damage)

NSAIDS (to reduce pain)

Conventional DMARDS (slow the progression of RA)

low-dose antidepressants (such as amitriptyline, paroxetine, or sertraline) for chronic pain

Balance of rest and exercise plan

Biologic response modifiers

Occupational and physical therapy

Nutrition (Basic food groups)

History

Physical Examination