Rheumatoid Arthritis (RA) is a chronic systemic and progressive autoimmune disease of the body's connective tissue causing inflammation in the joints and eventually destroys them. Connective tissue supports, ensheathes and binds body tissue together. The exact cause of rheumatoid arthritis (RA) is unknown, however infectious agents are suspected to be the culprit. These infectious agents may be bacteria, virus, or fungus. RA may be genetically inherited.
Rheumatoid Arthritis is more prominent in women than in men. The disease onset of symptoms are between age twenty-five to fifty-five years. Symptoms include fatigue, lack of energy, decrease in appetite, low-grade fever, muscle aches, joint aches, and generalized stiffness. Remissions can occur that last weeks, months or even years.
To be diagnosed with rheumatoid arthritis there needs to be atleast four of the following criteria present for a six week period or longer.
- Morning stiffness that lasts for atleast one hour after waking.
- Arthritis in atleast three joint areas.
- Subcutaneous nodules.
- Rheumatoid factor present in blood lab work.
- Radiographic erosion in the hand or the wrist.
Once a diagnosis of rheumatoid arthritis has been made forming a pain management plan is essential for coping with the rheumatoid flare ups. The following is a pain management option:
- Medical care by a rheumatologist. A rheumatologist is a physician who specializes in the medical treatment and management of rheumatoid arthritis.
- Medication management of pain. Medications given for rheumatoid flare ups and/or prevention are Salicylates (aspirin), Non-steroidal anti-inflammatory drugs (NSAIDS), Antirheumatic drugs and Corticosteroids.
- Self care encluding the use of a cold pack and warm moist heating pack; warm showers; whirlpool bath; exercise; relaxation techniques; weight control; stress avoidance; use of a firm mattress; elevated toilet seat of three to four inches; assistive devices, music therapy; pet therapy; massage therapy and an adequate amount of sleep of ten to twelve hours per day.
- Physical therapy to maintain muscle strength, range of motion, and maintain mobility.
- Surgery. Synovectomy is a surgical procedure by which inflamed synovial lining is removed from the joint. Arthroscopy is the surgical removal of debris from the joint. Arthrodesis is the surgical fusion of the joint. Osteotomy is the surgical removal of bone from the joint. Implant arthroplasty is surgical joint replacement.
Tips to avoid a rheumatoid arthritis flare-up are:
- Avoid lifting heavy items.
- Avoid being in the same body position for a long period of time.
- Avoid carrying a handbag/purse or any item that pulls on one side of the body.
- Take frequent breaks while completing job tasks.
- Treat pain at first onset with medication and rest.
- Avoid stressful situations.
- Get adequate sleep daily.
- Avoid crossing legs when in a sitting position.
- Avoid low or soft chairs.
Halverson PB: Orthrop Nurs 14 (4): 47, 1995.
Maher AB, Salmond SW, Pellino TA, eds: Orthopaedic Nursing, Philadelphia, 1994, WB Saunders.