245 Nursing Assessment, Management and Treatment of Autoimmune Diseases
Medications Medications are prescribed based on the severity of the symptoms and how long the patient has had RA. Medications in - clude the following (Comerford & Durkin, 2021; Mayo Clinic, 2021b; Rebar et al., 2019): ● Nonsteroidal anti-inflammatory drugs (NSAIDs) : NSAIDs are administered to relieve pain and reduce inflammation. Over-the- counter options include ibuprofen (e.g., Advil) and naproxen sodium (Aleve). Stronger prescription NSAIDs such as celecoxib (Celebrex) may be given with caution. Side effects of prescription NSAIDs include stomach irritation, cardiac issues, and kidney damage. ● Steroids : Corticosteroids, such as prednisone, are taken to reduce inflammation and pain as well as to slow joint damage. Side effects of corticosteroids include osteoporosis, weight gain, and diabetes. Therefore, corticosteroids are typically given to quickly relieve symptoms and are gradually tapered off in an attempt to prevent or reduce side effects. ● Conventional DMARDs : DMARDs are taken to slow disease progression and to protect the joints and other body tissues from permanent damage. Examples of conventional DMARDs include methotrexate (Otexup), leflunomide (Arava), and hydroxychloroquine (Plaquenil). Side effects may include hepatic damage and severe respiratory infections. ● Biologic agents : Also known as biologic response modifiers, biologic agents are a new class of DMARDs. Examples include abatacept (Orencia), certolizumab (Cimzia), and rituximab (Rituxan).
tonniere deformation (the middle joint of the injured finger will not straighten, while the fingertip bends back), swan-neck de - formity (flexion of the base of the finger, extension of the middle joint, and flexion of the outermost joint), hammer toe de- formities (toe is bent at the middle joint, resembling a hammer), and, sometimes, joint ankylosis. Symptoms usually occur bilaterally and symmetrically, typically involving fingers, wrists, elbows, knees, and ankles (Rebar et al., 2019). Many patients have muscle atrophy secondary to joint inflammation (Smith, 2021a). Diagnostic tests No test specifically identifies RA. How - ever, the following tests may be useful in making a diagnosis (Rebar et al., 2019): ● X-rays may show bone demineralization and soft tissue swelling. ● A rheumatoid factor is often positive in patients with RA. A positive test is indicated by a value of less than 60 units/ml. ● Analysis of synovial fluid shows an increase in volume and turbidity but decreased viscosity and complement levels. WBC count is often greater than 10,000/mm3. ● Serum protein electrophoresis may show an elevation in serum globulin levels. ● Erythrocyte sedimentation rate (ESR) is elevated in many patients with RA. The ESR helps in the monitoring of patients’ response to therapy. Treatment There is no cure for RA. Research in- dicates that symptom remission is more likely when treatment begins early with disease-modifying antirheumatic drugs (DMARDs; Mayo Clinic, 2021b).
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