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Rheumatoid arthritis is an autoimmune disorder that affects about 1% of the population (Hubert & VanMeter, 2018). It results in a chronic inflammatory condition, primary in older women. An autoimmune disease means that the body is attacking itself. Rheumatoid arthritis (RA) typically affects the joints, making them distorted and aching. However, it can cause discomfort in other bodily systems as well.
The initial encounter with RA causes inflammation in small joints, like finger and toes. Other joints can be attacked, like the knee and pelvic joints. Inflammation to the joints cause increased permeability, vasodilation, and exudate formation. The subsequent occurrences of the disease show signs of cell proliferation (synovitis) and Pannus formulation. Pannus is granulated tissue that activates inflammatory mediators in the cartilage (Hubert & VanMeter, 2018).
Synovitis occurs when too many leukocytes are present due to activation of endothelial cells and adhesion molecules (Aletaha & Smolen, 2018). The disorder will result in sore, swollen, red, and painful joints. The inflammation in the synovial joint will cause Pannus-filled erosion in the joints. This will cause deformed joints and bones. A person with RA will have Rheumatoid factor (RF) in the blood and synovial fluid. RF increases the inflammation activation, along with other factors. Autoantibodies can formulate 10 years before signs and symptoms occur (Aletaha & Smolen, 2018). There is no known reason why people get RA, but the environment and genetics play a large role.
Etiology and risk factors
Rheumatoid arthritis can happen to anyone since there are no exact causes. However, certain factors put a person more at risk than others. For instance, women are more prone to this disease than males. About 70% of RA cases are women (Belleza, 2017). Some research find that women get RA and other autoimmune diseases at higher incidences than males due to their increase in hormone levels. RA can happen at any age, but it tends to develop in middle-aged adults. People exposed to asbestos and other harmful chemicals are at an increased risk due to poor environment. Being overweight also puts someone at a higher risk of developing RA (Mayo Clinic, 2019). Cigarette smoke and air pollution are other contributions in getting RA. Genetics are a consideration because people with the “HLA shared epitope have an increased chance of developing RA.” (Belleza, 2017).
Clinical Manifestations and Complications
The most common physical sign of rheumatoid arthritis is having swollen, red, warm, and painful joints. Upon palpation, the joints would feel spongy and bouncy. Joints would also be difficult to move. In response to inflammation, the joints may have deformities. This is another reason for the difficulty in mobility of the joints and bones. Other signs and symptoms include: fatigue, edema, morning stiffness, eye sensitivity, and mouth dryness. Rheumatoid nodules are another sign and a complication. This nodule can even occur in the lung and can further complicate the bodily systems. Many medications people with RA take cause complications like: osteoporosis, anemia, bone marrow suppression, and gastrointestinal disturbances. If left untreated permanent damage can occur to the joints. Cardiovascular, lung, and eye function can also be at stake. RA can increase the risk of having blocked arteries and inflammation of the pericardium. In addition, it usually puts a person at risk for Sjogren’s syndrome (Mayo Clinic, 2019). This syndrome decreases the moisture in the mucus membranes inside the mouth and in the eyes.
The autoimmune responses to the cells cause inflammation in the joints. This causes Pannus build up around the joints. Adhesive cells and endothelial cells are activated and leukocytes respond. The WBC’s accumulate in the surrounded area causing edema and pain. This can be aggravated by certain things, such as an increase in pressure to the joint, smoking, and stress. Inflammation from the leukocyte’s reaction will make signs and symptoms appear and in different severity levels.
There are quite a few ways to tell whether or not a person has rheumatoid arthritis. Although the signs and symptoms are quite profound and evident, certain diagnostic tests can confirm that the person has RA. One test is called the antinuclear antibody titer, which appears elevated in RA patients. However, this test typically has to be repeated to specify which rheumatoid issue it is. The Rose-Waaler test is used to check the rheumatoid factor, which is positive in 80% of RA patients. CBC’s are usually low, resulting in anemia. On the other hand, the WBC tends to be high during the inflammatory process or an acute episode. The ESR, C3 and C4 levels will also be increased during an acute episode. Most of the tests are non-evasive, but there are tests, like the synovial-membrane biopsy. This just checks the changes in fluids and leukocytes (Belleza, 2017).
To finalize, rheumatoid arthritis has no known cause. There are factors that may trigger it, as well as pathophysiological trends to follow. Common signs and symptoms that are present are joint pain, swelling, redness, and edema. This disease can affect other systems, as well. Since RA is an autoimmune disease, there is an attack on the body. This can cause other complications, such as pulmonary and cardiovascular issues. Fortunately, there are plenty of non-evasive diagnostic tests to confirm rheumatoid arthritis. It is important to confirm this disorder as soon as possible so that it can be treated. Reoccurring events will only result in worsening of the symptoms and possibly permanent damage.
- Hubert, R. J., & VanMeter, K.C. (2018). Gould’s Pathophysiology for the Health Professionals.(6th ed.). St. Louis, MO: Elsevier
- Aletaha, D., & Smolen, J. S. (2018). Diagnosis and Management of Rheumatoid Arthritis: A Review. Journal of the American Medical Association, 320(13), 1360-1369. doi:10.1001/jama.2018.13103
- Belleza, M. (2017). Rheumatoid Arthritis. Retrieved from https://nurseslabs.com/rheumatoid-arthritis/#Complications
- Mayo Clinic. (2019). Rheumatoid Arthritis. Retrieved fromhttps://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
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