Rheumatoid Arthritis Practice Questions with Answers and NCLEX® Review

Rheumatoid Arthritis Pathophysiology

Rheumatoid arthritis (RA) is an autoimmune disorder that causes joint inflammation. It can also cause inflammation and damage to other tissues, including blood vessels and nerves.

The immune system normally protects the body from infection, but with RA, it attacks the lining of the joints and other tissues.

As a result, white blood cells enter the joint space and release enzymes that break down tissue and cartilage. Inflammation causes pain, swelling, stiffness, and loss of movement in joints. 

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Osteoarthritis vs Rheumatoid Arthritis

There are several different types of arthritis, with two of the most common being osteoarthritis and rheumatoid arthritis.

Osteoarthritis and rheumatoid arthritis differ in that osteoarthritis is caused by mechanical wear and tear on joints, whereas rheumatoid arthritis is caused by an autoimmune disorder.

It’s a progressive degeneration of the protective cartilage cushion on the end of the bones resulting in bone-on-bone rubbing, causing massive pain. 

Osteoarthritis is the most common type of arthritis, and typically begins in an isolated joint.

RA is a disease in which the immune system attacks the body, instead of defending it against intruders. As a result, it attacks the synovial membrane that encases and protects joints.

RA targets multiple joints at once, and affects about one-tenth as many people as osteoarthritis.

Pannus Formation in Rheumatoid Arthritis

Pannus (or synovial tissue proliferation) is a type of extra growth that can cause pain, swelling, and damage to the bones, cartilage, and other tissue.

RA causes extra tissue growth in your joints, known as pannus. But serious, if rare, pannus formations develop only if you don’t get treatment for RA or if your doctor can’t find an effective treatment for you.

Pannus is a sign of more serious RA, so health care providers may start clients on these prescription meds: 

• Disease-modifying antirheumatic drugs (DMARDs)
• Corticosteroids
• Biologics

Rheumatoid Arthritis Symptoms

• Fatigue
• Weight loss
• Morning joint stiffness
• Symmetrical pain and swelling in the small joints of the hands
• Pain, aching, or stiffness in more than one joint

Rheumatoid Arthritis Labs

• Synovial fluid aspiration
• Arthroscopy
• Blood tests:
  • Rheumatoid factor (RF)
  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)

Rheumatoid Arthritis Pharmacology

The goal of pharmacotherapy in RA is to alleviate symptoms, reduce inflammation, and slow down joint damage. In addition to pharmacotherapy, physical therapy, and exercise can also be beneficial for RA clients to improve joint function and reduce pain.

RA drugs include:

• NSAIDs
• Steroids “-sone”
  • Prednisone
• Disease-modifying antirheumatic drugs (DMARD)
  • Methotrexate

Methotrexate for Rheumatoid Arthritis

For clients with RA, as well as psoriatic arthritis (PsA) and juvenile idiopathic arthritis (JIA), many rheumatologists use methotrexate as first-line therapy.

Methotrexate is a drug that relaxes the immune system, and stops them from attacking cells. This helps reduce the inflammation that causes swollen and stiff joints in RA.

It’s important to note that Methotrexate is not a painkiller.

Methotrexate Mechanism of Action

Folate antagonists inhibit the enzyme DHFR, causing a deficiency in cellular pools of thymidylate and purines, which inhibits DNA synthesis. As a result, methotrexate interferes with DNA synthesis, repair, and cellular replication.

Methotrexate Side Effects

• Unusual bleeding or bruising
• Black, tarry stools
• Stomach pain
• Bleeding gums
• Red spots on the skin
• Blood in the urine, stools, or vomit
• Increased heartbeat
• Diarrhea
• Nausea
• Sores in the mouth or lips
• Swelling of the eyelids, face, lips, hands, feet, or lower legs
• Yellow eyes or skin

Rheumatoid Arthritis Nursing Interventions

• Provide pain relief interventions, including administering analgesics and teaching clients about pain-relieving methods.
• Educate your clients about RA including disease progression, symptoms, medications, and self-management strategies such as exercise, diet, and stress reduction.
• Assess pain, joint mobility, and functional status to identify any side effects that medication may cause.
• Promote mobility by exercising the body, including: range of motion exercises, strength training, and cardiovascular exercise.
• Manage clients’ medications by ensuring they take them as prescribed and providing education about possible side effects, drug interactions, and the importance of regular follow-up with their healthcare providers.

Rheumatoid Arthritis Patient Education

• Pain control – Assess pain levels
• Do NOT elevate the knees with pillows at night
• Exercise (low impact)
  • Swimming
• Heat & Cold to affected joints
  • Warm shower or bath before bed

Sources

https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=aa19377 

https://www.uofmhealth.org/conditions-treatments/cmc/difference-between-osteoarthritis-and-rheumatoid-arthritis 

https://www.elsevier.es/en-revista-revista-colombiana-reumatologia-english-edition–474-articulo-pannus-rheumatoid-arthritis-historic-pathophysiological-S2444440519300743 

https://www.cdc.gov/arthritis/rheumatoid-arthritis/index.html

https://www.arthritis.org/drug-guide/medication-topics/understanding-methotrexate