RHEUMATOID ARTHRITIS

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 Case scenario:

                     Joy G. is a 48-year old married mother of 3 active boys, ages 12, 15, and 18. She enjoys attending her sons’ sporting events and providing “Mom-Taxi” services for her sons and their friends. She also loves her part-time job as a hairdresser at a popular salon.

Seven months ago, Joy began noticing stiffness in both hands in the morning that lasted longer and longer. Stiffness now lasted more than 1 hour every morning and included hands, wrists, and ankles. She also had increasing difficulty standing for long periods at work or at home due to foot and ankle pain. She began taking ibuprofen 800mg 3 times daily and found it helped her get through her day with less pain and stiffness.

Three months ago, Joy noticed pain in her right and left shoulders when she would cut or blow dry her client’s hair. She also began feeling extremely tired and short-tempered. She had no energy to do her usual activities. Ibuprofen was no longer very effective for her pain or stiffness. 

Introduction:

                       a chronic progressive disease-causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.

Epidemiology:

                        Rheumatoid arthritis (RA) is estimated to affect approximately 0.24 to 1 percent of the population and to be twice as common in women compared with men. A range of poor long-term outcomes can potentially occur, but these have been reduced to some degree with the use of more aggressive treatment strategies and more effective drug therapies. However, RA's financial burden on society remains substantial. (See 'Incidence and prevalence' below and 'Long-term outcomes' below and 'Economic burden' below.)

Incidence and prevalence — The worldwide prevalence of RA has been estimated as 0.24 percent based upon the Global Burden of Disease 2010 Study. Estimates of RA prevalence in the United States and northern European countries are typically higher, usually between 0.5 to 1 percent. The annual incidence of RA in the United States and northern European countries is estimated to be approximately 40 per 100,000 persons. Most epidemiologic studies of RA have been conducted in the United States or northern European populations. As a result, epidemiologic estimates of RA and identification of risk factors come largely from these populations. The incidence and prevalence of RA are much greater in some populations, such as in the Pima Native Americans, where rates are up to 10 times higher than those of most population groups. 

RA has a predilection to affect women, in whom incidence and prevalence rates of RA are twice as high as in men. The lifetime risk of developing RA is 3.6 percent in women and 1.7 percent in men.

Causes:

            Rheumatoid arthritis is an autoimmune condition, which means it's caused by the immune system attacking healthy body tissue. However, it's not yet known what triggers this. Your immune system normally makes antibodies that attack bacteria and viruses, helping to fight infection.

Symptoms:

  1. Pain or aching in more than one joint.
  2. Stiffness in more than one joint.
  3. Tenderness and swelling in more than one joint.
  4. Weight loss
  5. Fever
  6. Fatigue and tiredness
  7. Weakness

Complications:

  1. Osteoporosis
  2. Rheumatoid nodules 
  3. Dry nose and mouth
  4. Infections
  5. Abnormal body composition
  6. Carpal tunnel syndrome
  7. Heart problems 
  8. Lung disease

Transmission:

                    The inheritance pattern of rheumatoid arthritis is still unclear because many genetic and environmental factors seem to be involved. However, having a close relative with rheumatoid arthritis likely increases a person's risk of developing the condition.

Danger signs:

                     When rheumatoid arthritis causes scar tissue to form in your lungs, you might notice chronic cough, Shortness of breath, and weakness. Rheumatoid arthritis may inflame the tissue that lines the lungs. That can read to shortness of breath or pain or discomfort when you breathe.

Diagnosis:

               Rheumatoid arthritis can be hard to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases but there is no one blood test or physical finding that can confirm the diagnosis.

During the physical team, your doctor might check your joints for swelling, redness, and warmth. The doctor may also check your reflexes and muscle strength.

                    Blood tests:

                                     People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate(ESR) or C-reactive protein level, which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide antibodies.

                    Imaging tests:

                                         Your doctor may ask for X-rays to track the progression of the disease in your joints over time. MRI and ultrasound scans can help your doctor track the severity of the disease over time.   

Management:   

                     Optimal care of patients with rheumatoid arthritis Consists of an integrated approach of pharmacological and non-pharmacological treatment therapies. Many non-pharmacologic treatments are available for this disease, including exercise, diet, counseling, stress reduction, physical therapy, and surgery.

Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids to relieve any pain.

References and citations:

  1. The case scenario is written by Karen Duclon(MSN, ARNP), from the Association of rheumatology professionals and the interprofessional division of the American college of rheumatology. The URL of the document is 

    Rheumatoid Arthritis Case Study - American College of ...

  2. The introduction is from IBD relief . The URL of the document is                                   https://www.ibdrelief.com/learn/complications-of-ibd/associated-conditions/arthritis-introduction/rheumatoid-arthritis-introduction#:~:text=Rheumatoid%20arthritis%20is%20an%20autoimmune,the%20cartilage%20and%20nearby%20bone. 
  3. The Epidemiology is from Pubmed, NCBI and the URL is https://pubmed.ncbi.nlm.nih.gov/11396092/#:~:text=Studies%20of%20the%20descriptive%20epidemiology,%2Fethnicity%2C%20and%20calendar%20year. 
  4.  The causes are from NHS UK and the URL is https://www.nhs.uk/conditions/rheumatoid-arthritis/causes/#:~:text=Rheumatoid%20arthritis%20is%20an%20autoimmune,viruses%2C%20helping%20to%20fight%20infection.
  5.  The symptoms are from CDC official website and the URL is https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html
  6. Th Complications are from mayoclinic and the URL is https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
  7. The transmission is from Medlineplus and the URL is https://medlineplus.gov/genetics/condition/rheumatoid-arthritis/#:~:text=The%20inheritance%20pattern%20of%20rheumatoid,risk%20of%20developing%20the%20condition.
  8. The danger signs are from WebMD and the article was reviewed by Brunilda Nazario, MD and the URL is https://www.webmd.com/rheumatoid-arthritis/cm/dont-ignore-ra-symptoms#:~:text=When%20RA%20inflammation%20causes%20scar,or%20discomfort%20when%20you%20breathe.  
  9. The Diagnosis is from Mayoclinic and the URL is https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653
  10. The Management is from Medscape, which was written by Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD and more(The non pharmacologic one) and the NHS UK(The pharmacological one) and the URL is https://emedicine.medscape.com/article/331715-treatment. The URL for NHS UK is https://www.nhs.uk/conditions/rheumatoid-arthritis/treatment/                                           

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