Rheumatoid Arthritis Case Study Essay

Skeeter Buck has had 4 years of joint pain with many real severe occasions. He complains of bad weather in his wrists, hands, knees, and feet. The stiffness seems to last anywhere from 30 minutes to 2 hours in the morning. When his joints are sore he is very unstable and feels as though he has no balance. The joint pain does not occur on a regular basis that when it does, he tends to lose his appetite. Medication Cortisone shot (every 3 months), Aleve, Tylenol Medical History 4 years of joint pain. Recently symptoms worsened. Family History grannie and mother have derelict arthritis and have had surgery.Grandma had a hip replacement and his mother had a knee replacement. Most of his family is overweight alone in that location is no history of diabetes or heart ailment. Social Lifestyle Married with 2 children and wife is pregnant with their third. Lives in North Bay where he is the bus at a bank. He walks with a cane when his flare ups are bad. Lifestyle History Enjoys playi ng with the kids. He is as active as he can be without being in pain. He helps coach the hockey team his oldest son plays on. Wife is a dietician and so he take healthy meals on a regular basis.Risk Factors He is a non-smoker, regular cholesterol levels, and normal blood glucose levels. Physical Examination General expression Looks healthy, comfortable and has great colour in face. Vital Signs Blood Pressure = 123/82 mmHg in both arms, Pulse = 72 beats per minute, Respiration= 17 breaths per minute, Mass= 82 kg, Height = 70 in. (175 cm), BMI= 27, Waist Circumference = 34in. Cardiovascular No carotid bruits, no jugular venous distension, clear lungs, normal plosive of impulse, regular rate and rhythm, no extra heart sounds, no edema, normal peripheral vascular exam.Skin no rashes, a bit red, swollen and unassailable some knuckles on hands and feet. Musculoskeletal walks slow due to pain, joints on the hands and feet are a bit swollen, does not have a full range of motion in his joints. Neurologic Normal cranial nerves, loss of fine motor skills in hand, normal sensory exam. Resting Electrocardiogram in front Exercise Test Sinus rhythm, rate= 72 beats per minute, no Q waves, ST or T wave abnormalities. Computer interpretation is normal electrocardiogram. Diagnosis rheumatoid arthritis in wrists, hands, knees, and feet causing stiffness in the morning and pain throughout the day especially after more than normal use of the joints. This causes put to mould bigotry and fatigue. Plan Complete a standard cycle ergometer test and initiate a training program focussing on increasing exercise tolerance, muscle strength, and range of motion. ** Please refer to following pages for pre-screen and informed consent forms ** PATHOPHYSIOLOGY woebegone Arthritis Rheumatoid arthritis is a type of inflammatory arthritis and an autoimmune disease.An autoimmune disease is one where the bodys immune system becomes confused and begins to attack its own body. In rheumatoid ar thritis the target of the immune attack is the lining of the joints (synovial) and sometimes other internal organs. This causes swelling, pain, inflammation, and joint destruction. Inflammatory cells release enzymes that can digest bone and cartilage causing limited bone motion. This inflammation of joints usually occurs in a symmetrical and bilateral pattern (what happens on one side of the body, happens on the other).Rheumatoid arthritis is also characterized by aggravations and remissions ( degrees of time with intensified symptoms followed by period of time with reduced symptoms). Rheumatoid arthritis usually begins slowly, starting with only a few joints and spreading to others over a period of a few weeks to a few months. People with rheumatoid arthritis have impaired exercise tolerance. The disease affects flexibility, biomechanical efficiency, muscle strength, selection, and speed, which contributes to functional limitations.There are three levels of classifying rheumatoid arthritis disease stages 1. shrewd reversible signs and symptoms in the joint related to synovitis 2. degenerative stable but irreversible structural persecute brought on by the disease process 3. Chronic with acute exacerbation of joint symptoms change magnitude pain and decreased range of motion and function often related to overuse or superimposed injury. (3) determine(12) Signs and Symptoms of Concern (13)You should see your doctor if you pick up any of the following symptoms for more than two weeks Feel unusual pain and stiffness in your jointsPain and stiffness in the morning lasting more than 30-60 minutes before you feel any relief Feel more fatigued than normal Lack of hungriness leading to weight loss Importance of Exercise for Rheumatoid Arthritis Patients Although people with rheumatoid arthritis may be hesitant to exercise due to pain they experience within their joints, on-line(prenominal) evidence suggests that a significant amount of disability related to the condition occurs from lack of fitness. By not exercising, muscle strength and endurance begins to deteriorate.This weakens the joint and contributes to accelerating the speed or arthritis. By not exercising you are also putting yourself at risk for other chronic diseases such as coronary heart disease, diabetes mellitus, and osteoporosis. The American College of Sport Medicine outlines three goals for exercise and arthritis. The goals are 1) preserve or restore range of motion and flexibility around the affected joints 2) increase muscle strength and endurance to build joint stability 3) increase aerobic capability in order to enhance psychological state and decrease the risk of cardiovascular disease.(8) Although long term cause of dynamic weight bearing exercise on those with rheumatoid arthritis remains unclear, current data suggests that vigorous exercise may be used to improve joint mobility, muscle strength, and aerobic capacity without causing joint damage (except when at that place is an acute joint inflammation or uncontrolled systemic disease)(8). Those with rheumatoid arthritis should remember that post exercise discomfort should be expected, but activities causing increased joint pain enduring for greater than two hours post-exercise should be discontinued.As previously mentioned, people with rheumatoid arthritis often have little aerobic capacity due to inactivity, but it has been shown to be a safe and beneficial form of treatment for those who are not experiencing acute symptoms. The American College of Sports Medicine suggests that people with rheumatoid arthritis should participate in large muscle activities such as walk of life, cycling, rowing, swimming, and dance at 60-80% of their peak heart rate or 40-60% VO2max, a rate of perceive exertion (RPE) rating of 11-16, 3-5 days per week for five minute sessions building up to thirty minutes.When working with people with rheumatoid arthritis, it is important to emphasis date is more impor tant than intensity with goals of increasing VO2max, peak work, and endurance within 4-6 months. It is also important to have at least fifteen minutes of prolusion and cool-down. (8) MEDICATION Although there is no specific cure for rheumatoid arthritis at the present, there are a range of medications available to manage the symptoms to improve the condition. Rheumatoid medications can be classified into different classes such as NSAIDs, Corticosteroids, DMARDs, Biological Agents, Salicylates, and Pain Relief Medications.Your doctor will most likely use a combination of these drugs to alleviate pain and prevent further damage to the joints. NSAIDs NSAIDs or Non-steroidal Anti-inflammatory Drugs are effective in pain relief and inflammation reduction, but do not serve to protect the joints from further damage. NSAIDs prevent your body from producing a substance called prostaglandins, which is primarily responsible for inflammation and pain. When taken in extreme point dosages for a long time, these drugs can produce severe side effects, such as stomach bleeding, gastric ulcers, as well as potential damage to the kidneys and liver.Corticosteroids Corticosteroids suppress the immune system, thus managing inflammation. Although these may be very effective in treating rheumatoid arthritis, they have been said to trigger adverse side effects if used in prolonged periods. Examples of these side effects include easy bruising, glaucoma, cataracts, diabetes, excessive weight gain, and thinning of the bones. DMARDs DMARDS or Disease Modifying Anti-Rheumatic Drugs are groups of medications that serve to keep down the immune system from damaging the joints, thus slowing further joint damage.Rheumatoid arthritis causes permanent joint damage in the early stages and so it is very important to start these medications right away. The risks for severe side effects are high with these medications. Taking DMARDs for a long time may result in bone marrow and liver toxicity, vuln erability to infections, skin allergies, and autoimmunity. Biological Agents Biological agents or biological drugs function to alleviate inflammation via various methods. An example of how they work is by inhibiting tumour necrosis factors.They also can treat inflammation through eradicating Beta cells. Salicylates Salicylates reduce the bodys production of prostaglandins. The use of salicylates has been replaced with NSAIDs, in the first place due to the fact that they caused adverse side effects. Pain Relief Medications While anti-pain drugs neither decrease inflammation nor suppress further joint damage, these medications allow the undivided become more comfortable and eventually function better. (2) PHYSICAL ASSESSMENT PROTOCOLTo determine baseline levels and the areas exercise is in need of improvement, exercise examen can be used to evaluate the different exercise parameters. Those with rheumatoid arthritis tolerate sub-maximal and subjective symptom-limited treadmill tests that require less than 3 miles per hour walking speed. Early-onset muscle fatigue may limit receiving accurate information. Since people with rheumatoid arthritis may have troubles performing maximal treadmill test, sub-maximal bicycle tests may allow for more accurate information without over-stressing joints.