Post on 03-Apr-2018
transcript
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RHEUMATOID ARTHRITIS
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What is RA?A Chronic,
systemic inflammatory disease,
characterised by symmetrical
joint involvement which is
typically erosive/destructive.
hallmark feature: persistentsymmetric polyarthritis (synovitis)
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Recap on the anatomy and physiology
Function of JOINTS:
To allow articulation between twoor more bones and
secondarily to permit movementby contraction of opposing
muscles.
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Unknown
Genetic
Auto immune
Etiology
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Pathophysiology
Antigen
Environmental agent, infectious agent
Activates CD4 helper
T cells and probably
B lymphocytes
T cells stimulatessynovial macrophage
and fibroblast
Activates
B lymphocytes
Genetic
Susceptibility
HLA-DR4HLA-DQ
HLA- DPCytokines
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Pathophysiology
Pannus formation
Joint destruction
Cartilage fibrosis
Ankylosis
Joint injury
RANKL
Activatesosteoclast
Formation of
rheumatoid
factor
Formation ofautoimmune complexes
and probable deposition
in the joint
Cytokines
Fibroblast
Chondrocytes
Synovial cells
Enzymes release
(collagenase, streptomelysin,
elactase, PGE2 and matrix
metalloproteinases, others)
T cells stimulates
synovial macrophage
and fibroblast
Activates B lymphocytes
Proliferation
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INTERLEUKIN 1
IL-1 is a potent stimulator of synoviocytes,
chondrocytes and osteoblasts (Figure 1).
IL-1 is a proinflammatory cytokine that amplifies
and perpetuates the disease process in RA
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1. arth rit is
Clinical Manifestations
Associated with
low fever
Fatigue
Morning stiffness
Joint soft, warm to
touch
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Clinical Manifestations
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2. extra-articu lar featu res
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3. Associated syndromes(possib le compl icat ion s)
Clinical Manifestations
(a) Sjgrens syndrome-salivary gland
inflammation and keratoconjunctivitis
(b) Feltys syndrome-profound neutropenia,
thrombocytopenia and splenomegaly
(C) Pulmonary involvement-(pleuritis, interstitial
pneumonitis, alveolitis and intrapulmonaryrheumatoid nodules)
(d) Cardiac involvement-pericarditis
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ns
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Diagnnostic criteria1. Morning stiffness lasting more than
1 hour
2. Arthritis of 3 or more joint areas.
3. Arthritis of the hand joints
4. Symetric arthritis
5. Rheumatoid nodules over extensor
surface or bony prominences.
6. Serum rheumatoid factor.7. Radiologic changes.
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o l igoart icu lar JIA
Polyart icu lar J IA
System ic J IA
Types of JIA
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1. Acute Pain r/t inflammation & swelling
2. Fatigue r/t increased metabolic rate
3. Impaired physical mobility r/t decreasedrange of motion
4. Disturbed body image r/t physical &
psychological changes
Nursing Diagnosis:
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