Discussing a Problem Statement for Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a chronic, deforming, and debilitating disease that does not discriminate and attacks women, men, and children at any age. “An estimated 1.3 million people in the United States have RA – that’s almost 1 percent of the nation’s adult population” (Arthritis Foundation, 2011, para. 1).

RA is an autoimmune disease of unknown etiology and is characterized for attacking the joints in the entire body. RA is such a chronic deforming disease that eventually, without the proper treatment, can disable anyone. RA is most commonly diagnosed/present in middle age women with family history of RA, but sometimes there is no apparent reason. Currently, there is not enough research that can tell us the causes, way to prevent, or support any lifestyle changes that can improve a patient’s way of life. Therefore, more and more people are facing the reality of this diagnosis with the uncertainty of what is going to happen with their health and their bodies in the future.

RA is an autoimmune disease that is growing worldwide and it does not respect gender, ethnicity, age, or social status. Day after day people around the world are being diagnosed with this debilitating disease facing a diagnosis in which there is not enough research. RA attacks the lining of the joints symmetrically by producing acute/chronic inflammation in both sides of the body. Some of the joints that are most commonly affected are the hands, wrists, fingers, elbows, shoulders, neck, back, hips, knees, ankles, and toes. Pain/tenderness to the joints, stiffness that is more prominent in the morning, inflammation, decreased movement, extreme fatigue, and warm joints are some of the most commons symptoms present with this disease.

Currently, there are a variety of medical treatments that are used to treat RA. Some of the anti-inflammatory medications used are naproxen and ibuprofen that unfortunately, over time, can cause stomach discomfort, some bleeding, and even ulcers. There are also other types of medications called Disease Modifying Anti Rheumatoid Drugs (DMARDS) such as methotrexate and the newest types of treatments are the biological medications such as Enbrel and Humira (Finckh, Bansback, Marra, Anis, Michaud, & Liang, 2009). DMARDS and biological medications have dramatically improved the quality of life in patients suffering from RA but still their symptoms do not completely disappear (Finckh et al., 2009). The patients are still in pain, fatigued, and have problems performing their regular activities.

Since RA symptoms can be so strong and debilitating, patients are forced to change their lifestyle. They start losing the mobility and strength in their affected joints and are forced to seek help for the simplest activities that once were so easy to perform such as getting up, walking, toileting, and eating. The symptoms become so difficult and painful that the patient requires assistance for the most basic needs. Patients start losing their independence and become dependent on someone else. For example, a very active individual who once worked and was very socially active becomes a dependent person by needing assistance to get up from bed each morning. Many patients have to quit their jobs, school, social life, or even doing the activities they enjoy because they cannot accomplish them by themselves anymore. Some of these patients become so depressed that they reach to a suicidal stage by just thinking that this way of living will be the rest of their lives.

On a daily basis in the emergency room (ER), we see all sorts of patients but the patients with RA are especially heartbreaking. When a patient arrives in the ER suffering from a flare or because their medication to control their symptoms does not work usually means that the patient is in extreme pain. Getting them from the ambulance stretcher into the hospital bed involves a great deal of pain and effort on their part. Most of these patients are middle aged women that have become disabled due to the extreme joint pain and inflammation. Regularly in the ER, they are only prescribed pain and anti-inflammatory medications in forms of shots and are discharged. Doctors and nurses do not explain to the patients any methods to help control their RA symptoms such as changing their diet (vegetarian diet). Vegetarian diet alone will not relieve their symptoms but along with their medications will improve their signs and symptoms significantly or even get them into remission. Doctors and nurses are not familiar with this kind of information and that is one of the reasons that more research is needed so they can become knowledgeable about this disease and distribute the information to their patients. For example, it is commonly known that for some reason red meat can worsen RA symptoms for some patients causing them to experience more pain, inflammation, stiffness, fatigue, and in general to feel worse. There is so little research regarding the effect of vegetarian diet on the signs and symptoms of RA patients but there have been studies that state that diet modification can improve RA symptoms in these patients. Therefore, I have developed the following PICOT questions regarding vegetarian diet as a mean to help improve symptoms in patients suffering from RA:

For middle age adults, how does the modification of their diet plus taking medication for RA compare to taking medication for RA alone influence the decrease of symptoms related to RA for the rest of their life after being diagnosed with rheumatoid arthritis?

According to Orem’s self care framework the client/patient is responsible and accountable for their own health and the health of their family/dependents (Simmons, 2009). As patient advocates, nurses need to educate and inform their patients in order to give them the tools to improve their health conditions or to improve the health status of their loved ones. Nurses who educate their patients regarding diet modifications such as vegetarian diets along their RA medications can drastically improve their quality of life. If the patient’s are educated regarding their condition, their medications, and their diet, they will be capable of taking decisions and modify their treatment to improve their symptoms and regain control of their life. In addition, family members need to be constantly educated regarding the disease, treatments, and diet modifications as tools to be able to improve the health status of their loved ones.

This research topic is very important for me, not only professionally but a personal level as well. Having a close family member with this condition has showed us the little research and information there is out there regarding the disease, treatments, and diet modifications. We have experienced the frustration of not getting information from doctors or nurses and discovered the latest information by performing our own research.

RA is a disease that is under researched for the quantity of existing patients. It is a harsh and life changing disease that causes social, emotional, and physical lifestyle changes to the patients affected. Spreading the word on information regarding this disease can help patients and their families be more empathetic and encouraged to seek answers or at least share common knowledge of comfort techniques or treatments available. Medical staff should step up to the challenge and self educate and share the knowledge to their current and new patients because the simplest information, like diet modification, can make a world of difference.