Rheumatoid Arthritis
Submitted by Catheryn Brewington, CHUC,
Learning Objectives:
1. Define Rheumatoid
Arthritis.
2. List 3 symptoms of
this disease.
3. Name the specific blood test that is
available for diagnosing RA and distinguishing it from other types of arthritis.
Rheumatoid arthritis (RA) is a long-term disease that leads
to inflammation of the joints and surrounding tissues. It can also affect other organs. The cause of
RA is unknown. It is considered an
autoimmune disease. The body’s immune
system normally fights off foreign substances, like viruses. But in an autoimmune disease, the immune
system confuses healthy tissue for foreign substances. As a result, the body attacks itself.
RA can occur at any age.
Women are affected more often than men.
RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are
the most commonly affected. The course
and the severity of the illness can vary considerably. Infection, genes, and hormones may contribute
to the disease.
There are physical symptoms which are common to rheumatoid
arthritis. A physical examination by a
rheumatologist (arthritis specialist) can detect certain signs and symptoms
consistent with rheumatoid arthritis.
Many RA symptoms are also seen in other illnesses: fatigue, loss of appetite, low fever, swollen
glands, and weakness. Eventually, joint
pain appears. Imaging studies and blood tests, along with the physical
examination, are used in combination to diagnose RA.
No two cases of rheumatoid arthritis are exactly alike and
the disease course is unpredictable.
Some patients experience a lot of pain, but their x-rays don’t reveal
evidence of severe joint damage. Some
patients have evidence of severe joint damage on x-rays but do not experience a
lot of pain. Differences between
patients make it necessary for rheumatologists to observe the entire clinical
picture such as medical history, physical exam, imaging, and blood tests in
order to formulate an accurate diagnosis.
There is a specific blood test that is available for
diagnosing RA and distinguishing it from other types of arthritis. It is called the anti-CCP antibody test. Other diagnostic tests that may be done
include: complete blood count, c-reactive protein, erythrocyte sedimentation
rate, joint ultrasound, MRI, and joint x-rays. Other tests include the rheumatoid
factor test which is positive in about 75% of people with RA symptoms and synovial
fluid analysis. Once diagnosed, regular
blood or urine tests should be done to determine how well the medications are
working and whether they are causing any side effects.
Often, joint damage occurs within the first two years
following the onset of rheumatoid arthritis.
The possibility of early joint damage makes early diagnosis and
treatment essential. It’s also important
for rheumatoid arthritis patients and their doctors to consider an aggressive
approach to treatment rather than a conservative approach. RA usually requires
lifelong treatment, including medications, physical therapy, exercise,
education, and possibly surgery. Early,
aggressive treatment for RA can delay joint destruction.
Disease modifying anti-rheumatic drugs (DMARDs) are the current standard of care for RA, in addition to rest, strengthening exercises, and anti-inflammatory drugs. Methotrexate is the most commonly used DMARD for rheumatoid arthritis. Arava may be substituted for methotrexate. These drugs may have serious side effects so one will need frequent blood tests when taking them. NSAIDs (anti-inflammatory medications) work well, but long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. Corticosteroids work very well to reduce joint swelling and inflammation. Because of their long term side effects, corticosteroids should be taken only for a short time and in low doses when possible. Biologic drugs (Orencia, Rituxan, Humira, Enbrel, Remicade, Dimponi, Cimzia) can be very helpful in treating rheumatoid arthritis. However, people taking these drugs must be watched very closely because of serious risk factors such as infections from bacteria, viruses, and fungi, leukemia, possible psoriasis. Most of these medications are given either under the skin (subcutaneously) or into a vein (intravenously). Occasionally, surgery is needed to correct severely affected joints and can relieve joint pain and deformities.
Physical limitations may become disabling. The disease may challenge your emotions. Finances may be stretched by an inability to
keep working, but with a positive attitude and correct medical intervention, one
can take action and find solutions. Rheumatoid arthritis patients can have a
good quality of life.
Sources:
http://www.arthritis.org/conditons/Fact_Sheets/RA_Factt_Sheets.asp
http://www.cdc.gov/arthritis/data_statistics/arthritis_related_statistics.htm
My own personal experience
with this disease.
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Instructions: After reading the article, circle the best answer to the following questions:
1. Methotrexate is an example of which type of medication?
A. DMARD
B. NSIAD
C. Biologic
D. Controlled
substance
2. When does joint damage most often occur?
A. Within 2 weeks
B. Within 2 years
C. Immediately
D. Never
3. What is the cause of RA?
A. Diet
B. Unknown
C. Hereditary
D. Exercise
4. What kind of
doctor treats a patient with rheumatoid arthritis?
A. Arthritislogist
B. Cardiologist
C. Rheumatologist
D. Endocrinologist
5. Which is not a symptom of RA?
A. Fatigue
B. Fever
C. Weakness
D. Hair loss
6. A drug given subcutaneously is given:
A. By mouth
B. In the muscle
C. In the vein
D. Under the skin
7. Which of the following statements regarding surgery is false?
A. It may correct
painful deformities.
B. It may relieve
joint pain.
C. It is probably
not the first resort of treatment.
D. It can cure the
disease.
8. Which risk factor is not
associated with taking a Biologic drug?
A. Nose bleed
B. Fungi
C. Leukemia
D. Bacteria
9. The usual
treatment for RA consists of
A. physical
therapy, education, medication, possible surgery
B. physical
therapy, education, medication, money
C. diet,
education, blood work, surgery
D. diet, blood
work, medication, time
10. What is a specific blood test available for diagnosing
RA and distinguishing it from other types of arthritis?
A. hepatic
function panel
B. blood culture
C. anti-CCP
antibody
D. HIV