RA is an autoimmune disease where the immune system mistakenly targets and attacks the joint linings causing uncontrolled inflammation of the synovium. Joints on both sides of the body (bilateral) are affected, primarily the hands, wrists and knees. RA is characterized by bone erosion and joint deformity. As the disease progresses other joints may be affected symmetrically. Chronic inflammation and degenerative changes are the hallmark aspects of RA.
Doctors are still unsure as to what triggers RA, but it appears to be at least partially genetic in nature. This genetic predisposition makes the patient more susceptible to environmental factors like viruses and bacteria that may trigger the initial inflammation. Once the inflammation begins, the synovial fluid thickens and the tendons and ligaments weaken and stretch, resulting in the joint losing its shape and alignment.
While there is no cure, the goal of treatment is to manage the symptoms and slow disease progression. Medication, physical or occupational therapy and possibly surgery may be necessary.
The primary complaint of patients with RA is the intense pain and stiffness of the joints. Manage chronic pain and breakthrough pain as necessary.
As the disease progresses, it may be difficult for patients to perform ADLs such as feeding themselves or combing their hair; provide tools such as eating utensils or toothbrushes with larger grips to encourage patients to remain independent.
Fatigue is a common symptom of RA. Cluster care and promote rest as necessary
Patients with joint deformities may experience a negative body image
Patients fatigue easily, but daily exercise can help loosen joints. Encourage activity as tolerated.
When patients are in pain, they often want to turn to comfort foods. Help patients make healthy diet choices, avoiding alcohol and smoking.
Patients can also consult with a nutritionist regarding an anti-inflammatory diet.
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