The Musculoskeletal System
Lesson 1: Disease and Disorders of the Musculoskeletal System
Section III: Specific Musculoskeletal Diseases
1-7
Section III. SPECIFIC MUSCULOSKELETAL DISEASES
1-7. RHEUMATOID ARTHRITIS (RA)
Rheumatoid arthritis is a chronic, systemic, inflammatory disease that attacks outer body joints and the surrounding muscles, tendons, ligaments, and blood vessels. RA is characterized by recurrent inflammation involving the synovial joints or the lining of those joints. If untreated, fibrous tissue in the joints calcifies, and the patient is unable to move the affected joints. The cause of RA is unknown; however, one theory is that infectious, genetic, and endocrine factors help determine whether a person will develop rheumatoid arthritis.
a. Stages of Rheumatoid Arthritis. If RA is untreated, the inflammatory process in the joints progresses in four stages.
(1) Stage 1. Congestion and edema of the synovial membrane and joint capsule cause synovitis (inflammation of the membranes lining a joint).
(2) Stage 2. Pannus (thickened layers of granulated tissue) forms, covers, and invades cartilage, and finally destroys the joint capsule and bone.
(3) Stage 3. Fibrous ankylosis (abnormal immobility and fixation of a joint caused by the presence of fibrous bands between the bones forming the joint) takes place closing the joint and causing the joint to be immovable. It is in this stage that visible deformities can be seen.
(4) Stage 4. Fibrous tissue calcifies in this stage, and the affected joint becomes totally immovable.
b. Signs/Symptoms of Rheumatoid Arthritis. Included are the following:
(1) Easily fatigued and general feeling of being unwell.
(2) Persistent low-grade fever.
(3) Weight loss and general weakness. Anemia.
(4) Painful joint swelling.
(5) Subcutaneous nodules over bony prominences such as knuckles of the hand.
(6) Enlarged lymph nodes.
c. Treatment of Rheumatoid Arthritis. Initially, the patient must understand that this is a chronic disease necessitating a major change in life-style. The patient will need to learn how to perform daily activities without putting undue stress on arthritic joints. Follow this treatment:
(1) Instruct the patient to rest at specific periods of the day on a regular basis to control fatigue.
(2) Apply splints carefully to provide rest for painful joints.
(3) Refer the patient to a physical therapist--who can, among other things, teach the patient how to function without putting undue stress on his joints.
(4) Control the patient's pain by these methods.
(a) ASA--high dosage can be given. Salicylates reduce inflammation and relieve joint pain. Stop when the patient hears ringing in his ears. Most adults can tolerate 4-6 g daily.
(b) Nonsteroid anti-inflammatory medication can be given; for example, indomethacin (Indocin®)
(c) Gold compounds. These are effective against active joint inflammation only. Nonanalgesics can produce remission. Water soluble gold compounds can be given intramuscularly weekly.
(d) Moist heat. Hot soaks, paraffin baths, and whirlpool therapy are usually effective for patients with chronic arthritis.
