topic selection for the disease Pathophysiology . I chose to do The sickle cell Anemia Disease .

RHEUMATOID ARTHRITIS

Matilda A Nkwanta

Chamberlain University College of Nursing

NR-283 Pathophysiology

RHEUMATIOD ARTHRITIS

Rheumatoid Arthritis, or RA, is considered to be an autoimmune and inflammatory disease, in which the immune system destroys the healthy cells in our body which causes painful swelling that affect other parts of the body such as the wrist, hands, and knees. In the joint with Rheumatoid Arthritis, the connecting joint becomes swelled, which caused damage to the joint tissue that can cause chronic pain, lack of balance and deformity. Rheumatoid Arthritis can cause a lot of problems in the other organs throughout the body such as the lungs, heart, and eyes. According to the Center for Disease Control and Prevention (CDC), the cause of the Rheumatoid Arthritis is unknown but the body immune system attacks its healthy cells and some other factors that increase the risk of it is Age, Genetics/Inherited traits, Smoking, History of live birth, Early Life Exposure and obesity has the higher rate for developing Rheumatoid Arthritis. (CDC, 2014)

Etiology and Risk Factors

The cause of the Rheumatoid Arthritis is unknown but researchers have noticed that adults who are in their sixties have higher risks of developing the disease. Genetics/Inherited traits who are born with a specific gene also have a higher chance of developing Rheumatoid Arthritis. These genes are called Human leukocyte antigen (HLA) class II genotype which can make the disease worse and it can be severely worse these people are exposed to an environment with smoking. Also, researchers show that a lot of people who smoke cigarette has the higher rate of developing Rheumatoid Arthritis which can make the disease worse and can be very hard to use the affected part of the body to do anything in their daily living. Also, the research found out that most children that have been exposing to parents who smoke twice of cigarette are at risk of developing Rheumatoid Arthritis as an older adult. Obesity is also one of the major risks of developing Rheumatoid Arthritis due to lack of physical activity and poor nutrition can increase their chances of having the disease. 

Pathophysiology Process

The cause of Rheumatoid Arthritis is unknown but researches show that the disease mainly affects the synovitis and joint destruction, which the synovial membrane in the RA becomes hyperplastic. The reason why it becomes hyperplastic is that both the synovial cells combined with the immune and causes the cells to inflamed especially the macrophages, B- and T-lymphocytes, plasma cells and dendritic cells. The higher amount of cytokines plays an important role in the preservation of synovial inflammation. Also, researchers show that Genome-wide association reveals that hundreds of loci are part of the development of this disease. According to the article, patients who have antibodies in their immune system that fight against IgG and the pathogens of the disease that changes both genetic and environmental integrations. Recently, studies show that there is a current approach in researching about how the effects of the treatment and with microRNAs on Rheumatoid arthritis patients so that they will know what will be the best treatment for these patients. Some studies have confirmed that patients with Microbial alteration with/without the disease in salivary, oral, and GI show a different outcome to the treatment but it hasn’t still been clear (Raychaudhuri, 2010).

Clinical manifestations and complications

The symptoms of Rheumatoid Arthritis vary from person to person depending on the age and genetics inherited. Most of the patients develop slowly progressive symptoms called polyarthritis which is having pain in more than one joint place. In addition to this, the pain is non-specific and it is usually tenderness in that joint area with swelling in which patients are not able to grab or use their hands for a while due to the pain and inflammation. The biggest symptoms that last longer such us chronic morning stiffness, pain and swelling in the joint should seek medical diagnose and better treatment. Patients who seek medical attention are examined carefully at the joint where they are having more pain, swelling, and stiffness that cannot be relieved by any anti-inflammatory medication. Most patients with Rheumatoid Arthritis avoid handshake, grasping or something that requires squeezing, pulling or pushing when they have to use their fingers or hands. Also, most patients who have this disease sometimes get help for their daily activities and some family members also support their loved ones especially those who have severe chronic RA which they cannot do anything with their hands. Patients who do not seek medical attention for their RA will end up being in a severe condition whereby they will not be able to use their affected hands to do anything and when it is left is untreated, it can lead to a severe chronic issue (Alaql, A. S, 2018).

Diagnostic

The diagnoses of Rheumatoid Arthritis are based on specialty and evaluation according to patients' signs and symptoms to provide the specific test and screenings that will require the Doctor to get the final diagnosis of the disease. According to the Mayo Clinic, Rheumatoid Arthritis is very hard to diagnose when the symptoms are very early to detect. Doctors usually do a physical exam on a patient to see whether the patient can use their hand or feel any pain in their joints. People with RA usually have an elevated erythrocyte sedimentation rate (ESR or Sed rate) or sometimes C-reactive protein (CRP) which is done by doing a blood test. Sometimes, an imaging test such as X-rays, MRI or ultrasound tests is done to make sure that they can detect the actual diagnoses of the disease. Clinical studies have shown that there is no cure for rheumatoid arthritis but there is some treatment that can reduce the pain and the inflammation of the disease. Doctors usually prescribe medication for a patient who has rheumatoid arthritis such as Non-steroidal anti-inflammatory drugs (NSAIDs) which will reduce the pain and inflammation. Steroids such as prednisone can be prescribed for short term to reduce the joint damage and inflammation as well. Other medication such as Disease-modifying antirheumatic drugs(DMARDs) also helps with the cause of tissue damage in the joint. Patients are always get teaching and instructions about the side effects of these medications and also should seek medical attention if they are having an allergic reaction to these medications.

Sometimes doctors refer patients with RA to the physical and occupational therapist on what to do that can help with their joint. Also, the physical therapist suggests patients with this disease to use their forearms to pick up a small object to avoid increase damage to their affected joints. Surgery can also be done to remove an inflamed lining of the joints in their fingers, wrist, knees, hips and other joints. Tendon repair can be done to reduce the damage in the joint. Some patients also request joint fusion to reduce the pain and swelling and lastly, total joint replacement surgery is done to replace any parts of the damaged joint which they will insert prosthesis made of metal or plastic. Sometimes home remedies are advice to use to reduce the pain and swelling such as exercise regularly to strengthen the joints, apply heat or cold packs to reduce the pain and swelling and also trying to use a coping mechanism such as relaxing (Mayo Clinic, 2019).

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