Rheumatoid Arthritis Case Study Essay

Skeeter Buck has had 4 years of sum pang with some very severe occasions. He complains of abrasiveness in his wrists, hands, knees, and feet. The severeness seems to last anywhere from 30 minutes to 2 hours in the morning. When his fits are sore he is very unstable and encounters as though he has no balance. The joint pain does not betide on a fixing basis scarce when it does, he tends to stand his appetite. Medication Cortis wiz shot (every 3 months), Aleve, Tylenol Medical fib 4 years of joint pain. Recently symptoms worsened. Family History Grand fix and mother remove arthritic arthritis and harbor had surgery.Grandma had a hip reversal and his mother had a knee replacement. Most of his family is overweight but there is no history of diabetes or bosom disease. Social Lifestyle get hitched with with 2 children and wife is pregnant with their third. Lives in North Bay where he is the manager at a bank. He walks with a enduree when his glistening ups are bad. Lif estyle History Enjoys playing with the kids. He is as sprightly as he offer be without being in pain. He helps coach the hockey team his oldest son plays on. Wife is a dietician and so he eats healthy meals on a symmetric basis.Risk Factors He is a non-smoker, regular cholesterol levels, and normal blood glucose levels. Physical Examination General Appearance Looks healthy, comfortable and has great colouring material in face. Vital Signs Blood Pressure = 123/82 mmHg in twain 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 point of impulse, regular rate and rhythm, no extra heart sounds, no edema, normal skirting(prenominal) vascular exam.Skin no rashes, a bit red, swollen and crank around knuckles on hands and feet. Musculoskeletal walks slow collectable to pain, joints on the hands and feet are a bit swollen, does not need a full locate of motion in his joints. Neurologic popular cranial nerves, loss of fine motor skills in hand, normal arresting exam. Resting Electrocardiogram before Exercise Test Sinus rhythm, rate= 72 beats per minute, no Q waves, ST or T wave abnormalities. Computer interpreting is normal electrocardiogram. Diagnosis decrepit arthritis in wrists, hands, knees, and feet causing stiffness in the morning and pain throughout the day especially after to a greater extent than than normal use of the joints. This causes exercise intolerance and fatigue. Plan Complete a standard cycle ergometer test and initiate a fostering 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 creaky Arthritis Rheumatoid arthritis is a type of inflammatory arthritis and an autoresistant disease.An autoimmune disease is unity where the clays immune system becomes confuse and begins to attack its proclaim body. In derelict arthritis the target of the immune attack is the lining of the joints (synovial) and sometimes other internal organs. This causes swelling, pain, discharge, and joint destruction. Inflammatory cells release enzymes that can can bone and cartilage causing limited bone motion. This dismission of joints commonly occurs in a symmetrical and bilateral pattern (what happens on one side of the body, happens on the other).Rheumatoid arthritis is as well characterized by aggravations and remissions ( heads of time with meliorater symptoms followed by period of time with reduced symptoms). Rheumatoid arthritis usually begins slowly, get-go 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, endurance, and speed, which contributes to sectional limitations.There are three levels of classifying rheumatoid arthritis disease stages 1. Acute reversible signs and symptoms in the joint related to synovitis 2. Chronic stable but irreversible structural ruin brought on by the disease process 3. Chronic with cutting provocation of joint symptoms increased pain and decreased range of motion and function often related to overuse or superimposed injury. (3) Figure(12) Signs and Symptoms of foreboding (13)You should see your doctor if you experience any of the following symptoms for more than than devil 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 pretermit of hunger leading to weight loss Importance of Exercise for Rheumatoid Arthritis Patients Although people with rheumatoid arthritis may be hesitant to exercise collectible to pain they experience within their joi nts, accepted evidence suggests that a real 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 accele judge the speed or arthritis. By not exercising you are likewise putting yourself at danger 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 capacity in order to enhance psychological assert and decrease the risk of cardiovascular disease.(8) Although long term cause of high-octane weight bearing exercise on those with rheumatoid arthritis remains unclear, current data suggests that vigorous exercise may be used to remediate joi nt mobility, muscle strength, and aerobic capacity without causing joint ill-treat (except when there is an acute joint inflammation or uncontrolled general 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 deuce 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 banging muscle activities such as move, cycling, rowing, swimming, and dance at 60-80% of their peak heart rate or 40-60% VO2max, a rate of perceived exertion (RPE) rating of 11-16, 3-5 days per week for five minute sessions building up to cardinal minutes.When wor king with people with rheumatoid arthritis, it is important to emphasis duration is more important 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 make relaxed 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 gain ground 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 cherish the joints from further damage. NSAIDs prevent your body from producing a substance called prostaglandin s, which is primarily responsible for inflammation and pain. When taken in extreme 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 indecent side effects if used in prolonged periods. Examples of these side effects include easy bruising, glaucoma, cataracts, diabetes, profligate weight gain, and thinning of the bones. DMARDs DMARDS or Disease Modifying Anti-Rheumatic Drugs are groups of medications that serve to curtail 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 wit h these medications. Taking DMARDs for a long time may result in bone marrow and liver toxicity, vulnerability to infections, scrape 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, mainly 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 individual become more comfortable and eventually function better. (2) PHYSICAL ASSESSMENT PROTOCOLTo repair baseline levels and the areas exercise is in need of improvement, exercise testing can be used to evaluate the different exercise parameters. Those with rheumatoid arthritis hold up 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 provide more accurate information without over-stressing joints.