Understanding Rheumatoid Arthritis: A Nurse’s Perspective When Treating Patients
By Candy Finley, RN,IgCN, Clinical Nurse Educator II - July 17, 2024
As a nurse, I have had the privilege of caring for patients with a variety of challenging diseases. One of the most challenging and complex diseases I have encountered is rheumatoid arthritis (RA). RA is an autoimmune disease that causes chronic inflammation of the joints, leading to pain, swelling, and potential joint damage. It’s not just a physical condition; it may also affect the emotional and psychological well-being of the patient. In this blog, I aim to share insights into RA from a nurse’s perspective, providing information on the disease, its management, and the importance of a holistic care approach.
Understanding, Rheumatoid Arthritis:
RA is a systemic disease, meaning it can affect the whole body, not just the joints. In some patients, the condition can damage a wide variety of systems, including the skin, eyes, lungs, heart and blood vessels. In RA, the immune system does not function properly, attacking the body’s own tissues, leading to inflammation that can result in joint damage and deformity if not effectively managed. The cause of RA is not fully understood, but it is believed to involve a combination of genetic and environmental factors.
The immune system can become active long before symptoms manifest. Initially, autoimmune processes might occur elsewhere in the body, but their effects typically concentrate in the joints. In these cases, immune cells trigger inflammation in the inner joint lining, known as the synovium. This inflammation becomes persistent, causing the synovium to thicken due to increased cell presence, protein production, and other factors within the joint. Consequently, symptoms such as pain, redness, and warmth may arise.
With the progression of RA, the thickened and inflamed synovium can extend deeper into the joint, leading to the destruction of cartilage and bone. As the joint capsule expands, structural changes within the joint occur. Over time, the surrounding muscles, ligaments, and tendons that provide support and stability to the joint weaken, impairing their function. This deterioration often exacerbates pain, increases joint damage, and restricts the joint's functionality.
Symptoms and Diagnosis:
There is no test for RA. Doctors diagnose the disease by: Taking your medical history, giving you an exam and ordering lab tests, x-rays or other tests. The symptoms of RA can vary from person to person, but often include joint pain, stiffness, and swelling, particularly in the hands and feet. Fatigue, fever, and a general feeling of malaise are also common. Because RA can mimic other conditions, diagnosis can be challenging and often requires a combination of blood tests, imaging, and a thorough clinical evaluation.
Management and Treatment:
There is no cure for RA, but there are treatments which help manage symptoms and slow the progression of the disease. Treatments includes medication management, physical and occupational therapy, and sometimes surgical intervention. Treatment may change over time based on symptoms and disease severity. Overall goals are to help relieve pain; decrease inflammation and swelling; prevent, slow, or stop joint and organ damage; and allow participation in daily activities. Medications to reduce inflammation and modify the immune response include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDS) which include biological agents such as infliximab and golimumab, which can be administered intravenously or subcutaneously.
DMARDS: Conventional
- Apremilast
- Azathioprine
- Ciclosporin
- Cyclophosphamide
- Hydroxychloroquine
- Leflunomide
- Methotrexate
- Mycophenolate
- Sulfasalazine
Biological Therapies:
- Infliximab
- Golimumab
- Abatacept
- Belimumab
- Ixekizumab
- Rituximab
- Sarilumab
- Secukinumab
- Tocilizumab
- Ustekinumab
JAK Inhibitors:
The Role of Nurses in RA Care:
Nurses play a crucial role in the care of patients with RA, working with the rheumatologist and pharmacist to ensure patients receive comprehensive care. We provide education on the disease, treatment options, and self-management strategies. We also monitor patients for side effects of medications and adjust care plans accordingly. Pain management is a significant aspect of our role, and we work to ensure patients have access to effective pain relief without the risk of addiction or other complications.
Lifestyle and Support:
Lifestyle modifications are essential for managing RA. As a nurse, we encourage patients to adopt a healthy diet, maintain a moderate level of physical activity, and get adequate rest. Support groups and counseling may also be beneficial for managing the emotional impact of living with a chronic illness.
In Conclusion:
RA is a complex and challenging disease requiring a multidisciplinary approach to care. As nurses, our commitment is to provide compassionate evidence-based care that addresses the physical and emotional needs of patient. By working together with patients, their families and other healthcare professionals we can help improve the quality of life for those affected by this condition.
