PHINMA University of Pangasinan

College of Nursing
College of Allied Health Sciences
Arellano St., Dagupan City

RHEUMATOID ARTHRITIS

In Partial Fulfillment of the Requirement of the Subject

NUR 151: Care of the Older Adults

Presented by:
Buenaobra, Ronaldino D.
Cachero, Danna Kate C.
Cerame, Clarisse B.
Corpuz, Lorelyn S.
Cuña, Audrey T.

Level III, BSN-13

Group 1
A.Y. 2022-2023

Presented to:
Prof. Carol Joy Paragas, RN, MAN
 CONTENTS

I. INTRODUCTION

Case Scenario

Brief discussion of the disease

II. ANATOMY AND PHYSIOLOGY

III. NURSING CARE PLAN

NCP 1: Acute Pain

NCP 2: Impaired Physical Mobility

IV. CONCLUSION

V. RECOMMENDATION
 INTRODUCTION

Case Scenario

Patient N.M., 66-year-old, white female, married, college graduate. She is

overweight with a relatively sedentary lifestyle and is diagnosed with rheumatoid arthritis
and came in for a hospital consult due to symptoms interfering with her daily activities.
The patient feels increasingly troubled by the pain and stiffness of her hands and feet
where she feels significant discomfort after performing simple activities such as
buttoning up her clothes. The pain and stiffness are felt particularly during the morning
as verbalized by patient N.M. She rated the pain 6/10. She also verbalized that the pain
was like a sprain or a broken bone but she doesn’t remember any activity that made her
feel this pain.

Her previous occupation is an office desk job as a secretary; it involves minimal

physical activity with repetitive hand movements (e.g., when typing on keyboard or
writing).

Upon arrival at the Emergency Room, her vital signs are as follows: BP=130/80
mmHg, HR= 86bpm, RR=22 cpm, T=37.8°C (100°F). On examination, her hands are
not grossly deformed but show mild ulnar deviation and swelling. It may be due to
excess joint fluid, thickening of the synovial lining, inflammation of surrounding soft
tissues, such as bursae and tendons, or bony enlargement. When palpated, the
patient’s hands and feet are tender, but no mass found on her joints. However, the fluid
is palpated as “boggy.” This can also be shown by her swelling hands and feet. She
appears restless, exhibiting guarded behavior. She reported a pain scale of 6/10.

She also reports constant fatigue and an intermittent low-grade fever. Her current
medications include: Naproxen (Aleve) 220 mg twice daily to relieve her symptoms. She
does not drink alcohol and has never smoked.
Brief Discussion of the Disease

Rheumatoid arthritis is a systemic autoimmune disease characterized by

inflammatory arthritis and extra-articular involvement. It typically starts in the small
peripheral joints, is often symmetric, and progresses to involve proximal joints if left
untreated. Joint inflammation over time leads to joint destruction with cartilage and bone
erosion.
Rheumatoid arthritis is an autoimmune disease. Normally, the immune system
helps protect the body from infection and disease. In rheumatoid arthritis, the immune
system attacks healthy tissue in the joints. It can also cause medical problems with your
heart, lungs, nerves, eyes, and skin.
This condition has no pathognomonic laboratory test, which makes its diagnosis
challenging. A comprehensive clinical approach is needed to make the diagnosis and
prevent debilitating damage to the joints.
Signs and symptoms of rheumatoid arthritis may include tender, warm, swollen
joints; joint stiffness that is usually worse in the mornings and after inactivity; fatigue,
fever, and loss of appetite. Early rheumatoid arthritis tends to affect the smaller joints
first — particularly the joints that are attached to the fingers to the hands and the toes to
the feet. As the disease progresses, symptoms often spread to the wrists, knees,
ankles, elbows, hips, and shoulders.
Pain is often a constant and daily feature of the disease. The pain may be
localized to the back, neck, hip, knee, or feet. The pain from arthritis occurs due to
inflammation that occurs around the joint, damage to the joint from disease, daily
wear and tear of the joint, muscles strains caused by forceful movements against
stiff, painful joints and fatigue. It is important that rheumatoid arthritis is identified and
diagnosed at the onset.
In most cases, symptoms occur in the same joints on both sides of the body.
About 40% of people who have rheumatoid arthritis also experience signs and
symptoms that don't involve the joints. Areas that may be affected include skin, eyes
lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow, and blood vessels
 Rheumatoid arthritis signs and symptoms may vary in severity and may even
come and go. Periods of increased disease activity, called flares, alternate with periods
of relative remission — when the swelling and pain fade or disappear. Over time,
rheumatoid arthritis can cause joints to deform and shift out of place.

How is Rheumatoid Arthritis diagnosed?

RA is diagnosed by reviewing symptoms, conducting a physical examination, and
doing X-rays and lab tests. It’s best to diagnose RA early—within 6 months of the onset
of symptoms—so that people with the disease can begin treatment to slow or stop
disease progression (for example, damage to joints). Diagnosis and effective
treatments, particularly treatment to suppress or control inflammation, can help reduce
the damaging effects of RA.
➔ Antinuclear antibody (ANA) titer: Screening test for rheumatic disorders,
elevated in 25%–30% of RA patients. Follow-up tests are needed for the specific
rheumatic disorders, e.g., anti-RNP is used for differential diagnosis of systemic
rheumatic disease.
➔ Rheumatoid factor (RF): Positive in more than 80% of cases (Rose-Waaler test).
➔ Latex fixation: Positive in 75% of typical cases.
➔ Agglutination reactions: Positive in more than 50% of typical cases.
➔ Serum complement: C3 and C4 increased in acute onset (inflammatory
response). Immune disorder/exhaustion results in depressed total complement
levels.
➔ Erythrocyte sedimentation rate (ESR): Usually greatly increased (80–100
mm/hr). May return to normal as symptoms improve.
➔ CBC: Usually reveals moderate anemia. WBC is elevated when inflammatory
processes are present.
➔ Immunoglobulin (Ig) (IgM and IgG): Elevation strongly suggests autoimmune
process as cause for RA.
➔ X-rays of involved joints: Reveals soft-tissue swelling, erosion of joints, and
osteoporosis of adjacent bone (early changes) progressing to bone-cyst
 formation, narrowing of joint space, and subluxation. Concurrent osteoarthritic
changes may be noted.
➔ Radionuclide scans: Identify inflamed synovium.
➔ Direct arthroscopy: Visualization of area reveals bone irregularities/degeneration
of joint.
➔ Synovial/fluid aspirate: May reveal volume greater than normal; opaque, cloudy,
yellow appearance (inflammatory response, bleeding, degenerative waste
products); elevated levels of WBCs and leukocytes; decreased viscosity and
complement (C3 and C4).
➔ Synovial membrane biopsy: Reveals inflammatory changes and development of
pannus (inflamed synovial granulation tissue).

How is Rheumatoid Arthritis can be treated or managed?

RA can be effectively treated and managed with medication(s) and
self-management strategies. Treatment for RA usually includes medications that slow
disease and prevent joint deformity, called disease-modifying antirheumatic drugs
(DMARDs); biological response modifiers (biologicals) are effective second-line
medications treatment. In addition to medications, people can manage their RA with
self-management strategies proven to reduce pain and disability, allowing them to
pursue the activities important to them.

Medical Management
Medical management is aligned with each phase of rheumatoid arthritis.
● Rest and exercise. There should be a balance of rest and exercise planned for a
patient with RA.
● Referral to community agencies such as the Arthritis Foundation could help the
patient gain more support.
● Biologic response modifiers. An alternative treatment approach for RA, biologic
response modifiers, has emerged, wherein a group of agents that consist of
molecules produced by cells of the immune system participate in the inflammatory
reactions.
● Therapy. A formal program with occupational and physical therapy is prescribed
to educate the patient about the principles of joint protection, pacing activities,
work simplification, range of motion, and muscle-strengthening exercises.
 ● Nutrition. Food selection should include the daily requirements from the basic
food groups, with emphasis on foods high in vitamins, protein, and iron for tissue
building and repair.

Pharmacologic Therapy
The drugs used in each phase of rheumatoid arthritis include:
Early Rheumatoid Arthritis
● NSAIDs. COX-2 medications block the enzyme involved in inflammation
while leaving intact the enzyme involved in protecting the stomach lining.
● Methotrexate. Methotrexate is currently the standard treatment of RA
because of its success in preventing both joint destruction and long-term
disability.
● Analgesics. Additional analgesia may be prescribed for periods of
extreme pain.
Moderate, Erosive Rheumatoid Arthritis
● Cyclosporine. Neoral, an immunosuppressant is added to enhance the
disease modifying effect of methotrexate.
Persistent, Erosive Rheumatoid Arthritis
● Corticosteroids. Systemic corticosteroids are used when the patient has
unremitting inflammation and pain or needs a “bridging” medication while
waiting for slower DMARDs to begin taking effect.
Advanced, Unremitting Rheumatoid Arthritis
● Immunosuppressants. Immunosuppressive agents are prescribed
because of their ability to affect the production of antibodies at the cellular
level.
● Antidepressants. For most patients with RA, depression and sleep
deprivation may require the short-term use of low-dose antidepressants
such as amitriptyline, paroxetine, or sertraline, to reestablish an
adequate sleep pattern and to manage chronic pain.

Surgical Management
For persistent, erosive RA, reconstructive surgery is often used.
● Reconstructive surgery. Reconstructive surgery is indicated when pain cannot
be relieved by conservative measures and the threat of loss of independence is
eminent.
● Synovectomy. Synovectomy is the excision of the synovial membrane.
● Tenorrhaphy. Tenorrhaphy is the suturing of a tendon.
● Arthrodesis. Arthrodesis is the surgical fusion of the joint.
● Arthroplasty. Arthroplasty is the surgical repair and replacement of the joint.
 ANATOMY AND PHYSIOLOGY

Microvascular injury and an increase in the number of synovial cells is the

earliest pathology in rheumatoid synovitis. The rheumatoid synovium is characterized by
the presence of a number of secreted products of activated lymphocytes, macrophages,
and fibroblasts. Many pathological and clinical symptoms of rheumatoid arthritis appear
to be mediated by the local production of these cytokines and chemokines.

The skeletal system is your body’s central framework. It consists of bones and
connective tissue, including cartilage, tendons, and ligaments. It’s also called the
musculoskeletal system.
Besides contributing to body shape and form, our bones perform several important body
functions.
1. Support. Bones, the “steel girders” and “reinforced concrete” of the body, form
the internal framework that supports the body and cradle its soft organs; the
bones of the legs act as pillars to support the body trunk when we stand, and the
rib cage supports the thoracic wall.
2. Protection. Bones protect soft body organs; for example, the fused bones of the
skull provide a snug enclosure for the brain, the vertebrae surround the spinal
cord, and the rib cage helps protect the vital organs of the thorax.
3. Movement. Skeletal muscles, attached to bones by tendons, use the bones as
levers to move the body and its parts.
4. Storage. Fat is stored in the internal cavities of bones; bone itself serves as a
storehouse for minerals, the most important of which are calcium and phosphorus;
because most of the body’s calcium is deposited in the bones as calcium salts,
the bones are a convenient place to get more calcium ions for the blood as they
are used up.
5. Blood cell formation. Blood cell formation, or hematopoiesis, occurs within the
marrow cavities of certain bones.
Anatomy and physiology of the affected part: Hands and Feet
Hand
The skeleton of the hand consists of carpals, the metacarpals, and the phalanges.
➔ Carpal bones. The eight carpal bones, arranged in two irregular rows of four
bones each, form the part of the hand called carpus, or, more commonly, the
wrist; the carpals are bound together by ligaments that restrict movements
between them.
➔ Metacarpals. The metacarpals are numbered 1 to 5 from the thumb side of the
hand to the little finger; when the fist is clenched, the heads of the metacarpals
become obvious as the “knuckles“.
➔ Phalanges. The phalanges are the bones of the fingers; each hand contains 14
phalanges; there are three in each finger (proximal, middle, and distal), except in
the thumb, which has only two proximal and distal.

Foot
The foot, composed of the tarsals, metatarsals, and phalanges, has two important
functions.; it supports our body weight and serves as a lever that allows us to propel our
bodies forward when we walk and run.
➔ Tarsus. the tarsus, forming the posterior half of the foot, is composed of seven
tarsal bones.
➔ Calcaneus and Talus. Body weight is carried mostly by the two largest tarsals,
the calcaneus, or heel bone, and the talus (ankle), which lies between the tibia
and the calcaneus.
 ➔ Metatarsals. Five metatarsals form the sole.
➔ Phalanges. 14 phalanges form the toes; each toe has three phalanges, except
the great toe, which has two.
➔ Arches. The bones in the foot are arranged to form three strong arches: two
longitudinal (medial and lateral) and one transverse.

Synovial Joints
Synovial joints are joints in which the articulating bone ends are separated by a joint
cavity containing a synovial fluid; they account for all joints of the limbs.
➔ Articular cartilage. Articular cartilage covers the ends of the bones forming the
joints.
➔ Fibrous articular capsule. The joint surfaces are enclosed by a sleeve or a
capsule of fibrous connective tissue, and their capsule is lined with a smooth
synovial membrane (the reason these joints are called synovial joints).
➔ Joint cavity. The articular capsule encloses a cavity, called the joint cavity, which
contains lubricating synovial fluid.
➔ Reinforcing ligaments. The fibrous capsule is usually reinforced with ligaments.
➔ Bursae. Bursae are flattened fibrous sacs lined with synovial membrane and
containing a thin film of synovial fluid; they are common where ligaments,
muscles, skin, tendons, or bones rub together.
➔ Tendon sheath. A tendon sheath is essentially an elongated bursa that wraps
completely around a tendon subjected to friction, like a bun around a hotdog.
Pathophysiology

The synovitis, swelling, and joint damage that characterize active RA are the end
results of complex autoimmune and inflammatory processes that involve components of
both the innate and adaptive immune systems. In a susceptible individual, the
interaction of environment and genes results in a loss of tolerance of self-proteins that
contain a citrulline residue. These proteins are generated via post-translational
modification of arginine residues to citrulline residues by the enzyme peptidyl arginine
deiminase.

Immune complexes produced by synovial lining cells and in inflamed blood

vessels are prominent immunologic abnormalities. Plasma cells produce antibodies
(e.g., rheumatoid factor) that contribute to these complexes, but in their absence,
destructive arthritis can occur. In early disease, macrophages migrate to the diseased
synovium, where they are joined by increased macrophage-derived lining cells and
vessel inflammation. CD4+ T cells (helper T cells) are the most common lymphocytes
infiltrating synovial tissue.

In the synovium, macrophages and lymphocytes produce pro-inflammatory

cytokines and chemokines. Released inflammatory mediators and a number of
enzymes are involved in the systemic and joint manifestations of rheumatoid arthritis,
including the destruction of cartilage and bone.
 NCP 1: ACUTE PAIN

ASSESSMENT EXPLANATION OF PLANNING INTERVENTIONS RATIONALE EVALUATION

THE PROBLEM

SUBJECTIVE Rheumatoid arthritis Short-Term Goals INDEPENDENT INDEPENDENT After 3 hours of

DATA: is a systemic 1. Monitor the vital 1. To set a baseline nursing
“My hands and feet autoimmune disease After 3 hours of signs of the patient. of observation for the interventions, the
feel painful and stiff. I which is nursing Determine the patient and to patient was able to
even feel discomfort characterized by interventions, the specifics of pain: determine verbalize that pain
in my fingers after I inflammatory arthritis patient will be able to intensity, location, appropriate pain was relieved with a
do simple tasks like as well as verbalize onset, and duration. management. pain scale of 3/10.
buttoning up my extra-articular relieved/controlled of Take note of the
clothes,” as involvement. It is a pain. verbal and/or ● Patient was able
verbalized by the chronic inflammatory nonverbal pain cues to appear
patient. disorder with an of the patient. relaxed, able to
● Patient will
unknown cause that sleep/rest and
appear relaxed,
Verbal report of joint primarily affects the 2. Determine factors 2. Pain may be participate in
able to sleep/rest
pain and discomfort synovial joints. If left or activities that caused by specific activities
and participate in
during activities of untreated, it typically appear to trigger movements, appropriately.
activities
daily living. begins in small acute episodes or particularly repetitive
appropriately. ● Patient followed
peripheral joints, is aggravate a chronic movement of the
Verbal report of often symmetric, and condition. involved joints. the prescribed
● Patient will follow
constant fatigue. progresses to involve pharmacological
the prescribed
proximal joints. 3. Assess the 3. To set a baseline regimen.
pharmacological
Verbal report of regimen. activities of daily for activity levels and
● Patient
intermittent It is a chronic living and perceived mental status related
incorporated
low-grade fever. disease that causes ● Patient will limitations to physical to activity intolerance
relaxation skills
joint pain, stiffness, incorporate activity of the patient. and pain.
and diversional
Reported a pain level swelling and relaxation skills
activities into the
of 6/10. decreased and diversional 4. Provide gentle 4. To promote
pain control
movement of the activities into the massage at the relaxation and
OBJECTIVE DATA: joints. Joint pain control involved joints. reduce muscle program.
V/S TAKEN AS inflammation leads to program. tension.
FOLLOWS: joint destruction with
● BP: 130/80 cartilage and bone 5. Ask the patient to 5. To assess the
During the whole
mmHg erosion over time. rate their pain again effectiveness of the
Long-Term Goals period of
after 30 minutes to 1 pain treatment.
● HR: 86 bpm hospitalization, the
During the whole hour after
patient will maintain
period of administering the
● RR: 22 cpm optimal functioning of
hospitalization, the analgesic.
well-being.
● T: 37.8°C patient will maintain
(100°F) optimal functioning of 6. Advise that the 6. To limit pain or
● Patient
well-being. patient assumes a injury to the affected
verbalized
● Mild ulnar drift comfortable position joints. Total bedrest
increased
and puffiness in ● Patient will in bed or while sitting may be necessary
confidence in the
hands verbalize in a chair. Encourage when disease is
ability to deal
increased bed rest as severe or
● Restlessness with illness,
confidence in the indicated. exacerbated until
changes in
● Guarded ability to deal subjective and
lifestyle, and
behavior with illness, objective
possible
changes in improvements are
limitations.
● Wearing a copper lifestyle, and observed.
bracelet. possible ● Patient
limitations. 7. Apply a hot or cold 7. Heat reduces pain formulated
pack on affected as it improves blood realistic
NURSING ● Patient will joints for 20 to 30 flow to the area and goals/plans for
DIAGNOSIS formulate minutes per hour. through the reduction the future.
realistic of pain reflexes. Cold
Acute pain goals/plans for can relieve pain and ● Patient
associated with the future. inflammation. performed
stiffness and self-care
● Patient will 8. Provide the patient 8. Copper bracelets activities at a
deterioration of joints
perform self-care with health education or magnet wrist level consistent
as evidenced by
activities at a about straps have no real with individual
patient reports pain level consistent non-evidence-based effect on pain, capabilities.
level of 6/10, with individual treatments for swelling, or disease
discomfort during capabilities. rheumatoid arthritis progression in
activities of daily (i.e., copper rheumatoid arthritis.
living, and constant bracelets).
fatigue.

DEPENDENT DEPENDENT
9. Begin 9. Methotrexate is a
methotrexate chemotherapeutic
(Rheumatrex) agent that is used as
therapy as ordered. a disease-modifying
antirheumatic drug
(DMARD) because it
has an
anti-inflammatory
effect, which reduces
symptoms in days to
weeks.

INTERDEPENDENT INTERDEPENDENT
/COLLABORATIVE /COLLABORATIVE
10. Assess the 10. Methotrexate can
patient’s periodic cause bone marrow
laboratory monitoring suppression and
(CBC, BUN, and liver hepatotoxicity.
panel).

11. Offer the patient 11. To assist in

adaptive equipment ambulation and
(such as cane, reduce stress on
walker), as indicated. joints.
 NCP 2: IMPAIRED PHYSICAL MOBILITY

ASSESSMENT EXPLANATION OF PLANNING INTERVENTIONS RATIONALE EVALUATION

THE PROBLEM

SUBJECTIVE DATA: Rheumatoid Arthritis Short-term Goals INDEPENDENT INDEPENDENT

“My hands and feet is a common form of After 8 hours of Assess and The activity and After 8 hours of
feel painful and stiff. I inflammatory rendering appropriate continuously monitor exercise level rendering appropriate
even feel discomfort polyarthritis that nursing interventions, the degree of joint depends on the nursing interventions,
in my fingers after I usually leads to joint the patient will be inflammation and inflammatory the patient was able
do simple tasks like destruction and loss able to: pain. process's to:
buttoning up my of function. It can progression and
clothes,” as affect almost any ● Demonstrate resolution. ● Demonstrated
verbalized by the joint in the body. The increasing Maintain bedrest or increased function
patient. first signs and function of the chair rest when Systemic rest is of the extremities,
symptoms usually extremities, indicated. Schedule mandatory during particularly the
Verbal report of joint show up in the wrists, particularly the activities providing acute exacerbations hands.
pain and discomfort knuckles, balls of the hands. frequent rest periods and important
during activities of feet, and knees. and uninterrupted throughout all phases ● Verbalized relief
daily living. ● Verbalize relief nighttime sleep. of disease to reduce and reduction of
and reduction of fatigue, and improve pain. It was
Verbal report of Swelling of the small pain to be strength. successfully
constant fatigue. joints, especially in maintained below Assist with active and maintained below
the hands and feet, is 3 out of 10 rating passive ROM and Maintains and 3 out of 10 rating
Verbal report of the hallmark of the on the numeric resistive exercises improves joint on the numeric
intermittent low-grade disease. In addition pain rating scale. and isometrics when function, muscle pain rating scale.
fever. to causing painful able. strength, and general
joint swelling and ● Increase stamina. Note: ● Showed an
Reported pain level stiffness, rheumatoid tolerance for any Inadequate exercise increased
of 6/10. arthritis can also form of physical leads to joint tolerance for any
cause fever and activity. stiffening, whereas
OBJECTIVE DATA: fatigue which usually excessive activity can form of physical
V/S TAKEN AS leads to impaired Long-term Goals damage joints. activity.
FOLLOWS: physical mobility. During the whole Encourage patient to Maximizes joint
● BP: 130/80 period of maintain upright and function, maintains
mmHg hospitalization, the erect posture when mobility. Long-term Goals
patient will maintain sitting, standing, and During the whole
● HR: 86 bpm optimal functioning ofwalking. period of
well-being. hospitalization, the
● RR: 22 cpm
Urge the patient to ADLs that can be patient will maintain
● T: 37.8°C ● Patient will perform activities of done should be optimal functioning of
(100°F) perform self-care daily living (ADLs), encouraged to well-being.
activities at a such as practicing maximize function.
● Mild ulnar drift level consistent good hygiene, ● Patient
and puffiness in with individual dressing and feeding performed
hands capabilities. himself. self-care
activities at a
● Restlessness ● Patient will Provide safety needs Helps prevent level consistent
demonstrate such as raised chairs accidental injuries with individual
● Guarded behavior techniques/lifesty and toilet seat, use of and falls. capabilities.
● Wearing a copper le changes to handrails in the tub,
bracelet. meet self-care shower and toilet, ● Patient
needs. proper use of mobility demonstrated
aids and wheelchair techniques/lifesty
● Patient will le changes to
safety.
identify meet self-care
Relieves pressure on
personal/commu needs.
Reposition frequently tissues and promotes
NURSING nity resources
using adequate circulation. Facilitates
DIAGNOSIS that can provide ● Patient identified
personnel. self-care and
needed personal/commu
Demonstrate and patient’s
Impaired physical assistance. nity resources
assist with transfer independence.
mobility related to that can provide
techniques and use Proper transfer
activity intolerance as of mobility aids such techniques prevent
evidenced by
decreased as a walker, cane, shearing abrasions of needed
endurance and trapeze. the skin. assistance.
control.
Promotes joint
Position with pillows, stability (reducing risk
sandbags, trochanter of injury) and
roll. Provide joint maintains proper joint
support with splints, position and body
braces. alignment, minimizing
contractures.
Suggest using a
small or thin pillow Prevents flexion of
under the neck. the neck.

Provide foam or
alternating pressure Decreases pressure
mattress. on fragile tissues to
reduce risks of
immobility and
development of
decubitus.

DEPENDENT DEPENDENT
Begin methotrexate Methotrexate is a
(Rheumatrex) chemotherapeutic
therapy as ordered agent that is used as
a disease-modifying
antirheumatic drug
(DMARD) because it
has an
anti-inflammatory
effect, which reduces
 symptoms in days to
weeks.

INTERDEPENDENT/ INTERDEPENDENT/
COLLABORATIVE/ COLLABORATIVE/
DISCHARGE DISCHARGE
TEACHING TEACHING
Discuss with the Helps prevent
family about the accidental injuries
safety needs such as and falls.
raised chairs and
toilet seat, use of
handrails in the tub,
shower and toilet,
proper use of mobility
aids and wheelchair
safety.

Collaborate with This helps to develop

physical medicine individual exercise
specialists and and mobility devices
occupational or and to limit or reduce
physical therapists in the effects and
providing complications of
range-of-motion immobility.
exercises (active or
passive), isotonic
muscle contractions
(e.g. flexion of
ankles, push-and-pull
exercises), assistive
devices, and
activities (e.g. early
ambulation, transfers,
stairs).

Involve patient and May need referral for

significant others in support and
care, assisting them community services
to learn ways of to provide care,
managing problems supervision,
of immobility. companionship,
respite services,
nutritional and ADL
assistance, adaptive
devices or changes
to living environment,
financial assistance,
etc.

Discuss safe ways Multiple options

that patient can provide client choices
exercise or stay a and variety (e.g.,
little mobile. walking around the
block with companion
or in a mall during
bad air days,
participating in a
water aerobics class,
and attending regular
rehabilitation
sessions).
Demonstrate use of Promotes safety and
standing aids and independence and
mobility devices (e.g., enhances the quality
walkers, strollers, of life.
scooters, braces, and
prosthetics) and have
patient/care provider
demonstrate
knowledge about,
and safe use of the
device. Identify
appropriate
resources for
obtaining and
maintaining
appliances and
equipment.

Consult with Helpful in

rehabilitation determining assistive
specialists devices to meet
(occupational individual needs
therapist). (buttonhook, a
long-handled
shoehorn, reacher,
hand-held shower
head).
 CONCLUSION

Rheumatoid arthritis is a chronic, systemic autoimmune that leads to synovial

inflammation and destruction of joints. The clinical manifestations of rheumatoid arthritis
vary depending on the severity of the disease. Characteristic signs and symptoms
include pain and edema in the affected joints along with warmth, erythema, stiffness and
loss of joint function or limited mobility; its progressive and debilitating signs and
symptoms can negatively affect a person’s quality of life. Fever may also be a symptom
as it can occur due to joint inflammation. Deformities of the hand and feet are common,
including the partial dislocation (subluxation) of the joints where one bone moves over
another bone (i.e., ulnar drift).

RECOMMENDATIONS

Patients with rheumatoid arthritis need information about the disease in order to
be able to make self-management decisions and to cope with having a chronic
condition. It is essential for a patient to: identify particular areas of life affected by
disease; be educated on basic disease management and required lifestyle changes; be
capable of identifying elements of control over the disease symptoms and treatment.