243 Nursing Assessment, Management and Treatment of Autoimmune Diseases
● Infectious agents : Various infectious pathogens have been suggested to be possible causes of RA. These include the rubella virus and the Epstein-Barr virus (EBV). The proposal that infectious pathogens can be a cause of RA is supported by the following: ○ Reports of flulike illnesses before the start of RA. ○ The ability to produce RA in experimental animals using various bacteria. ○ The presence of bacterial products in patients’ joints ● Hormonal factors : Sex hormones may play a part in the development of RA. Evidence to support this includes the disproportionate number of females with RA, improvement of signs and symptoms during pregnancy, and their recurrence after giving birth. ● Lifestyle factors : The main lifestyle contributory possible cause is the use of tobacco. Risk of developing RA is significantly higher in people who use tobacco. | NURSING CONSIDERATION Patients and families should be aware that in former smokers, the risk for RA may not return to the level of non-smok- ers for up to 20 years after ceasing to smoke (Smith, 2021a). ● Immunologic factors : The autoimmune response possibly triggers the formation of immune factors that activate the inflammatory process to a significantly greater degree than is normal.
Risk factors A number of risk factors are associated with the development of RA. These in- clude the following (CDC, 2020a; Mayo Clinic, 2021b): ● Sex : New cases of RA are usually two to three times higher in women compared to men. ● Age : Although RA can begin at any age, occurrence increases with age. Onset of RA is highest among adults in their sixties. ● Inherited traits : People born with genes called human leukocyte antigen (HLA) class II genotypes are more likely to develop RA. These genes can also make RA worse. The risk may be highest when people with these genes are exposed to environmental factors such as tobacco use, or when the person is obese. ● Smoking : Tobacco use increases risk of developing RA and can also make the disease worse. ● History of live births : Women who have never given birth may be at greater risk for developing RA. ● Exposures early in life : Research suggests that some early life exposures may increase the risk of developing RA in adulthood. One study found that children whose mothers had smoked had twice the risk of developing RA as adults. Children of lower income parents also seem to be at increased risk of developing RA. ● Obesity : Research shows that the more overweight a person is, the greater the risk of developing RA.
Powered by FlippingBook