Homework Diagnosis Rheumatoid Arthritis (RA): After revieing the labs and results we can determine a diagnoses of RA. Having a higher level of RA factor

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Homework Diagnosis

Rheumatoid Arthritis (RA): After revieing the labs and results we can determine a diagnoses of RA. Having a higher level of RA factor might point to RA, but this alone does not confirm it, but a positive CYCLIC CITRULLINATED PEPTIDE Ab IgG together with a positive RA factor and the signs and symptoms can help us give a confirmation of RA (Mil, 2020, p. 110).


1. DMARDs: Work by blocking the effects of the chemicals released when your immune system attacks your joints, which could otherwise cause further damage to nearby bones, tendons, ligaments, and cartilage (Coumbe et al., 2020, p. 458).
2. NSAIDS: Help reduce pain and inflammation (Coumbe et al., 2020, p. 460).
3. Topical agents: creams, gels or stick-on patches can ease the pain in a joint or muscle (Coumbe et al., 2020, p. 458).


Patient should be referred to RA specialty as soon as possible.


RA patient should be educated on maintaining a healthy weight by maintaining a healthy balanced diet. Educations should also focus on rest and activity to help improve the symptoms associated with RA and reduce joint inflammation and joint pain. Rest reduce inflammation, and fatigue. Movement or mild exercise reduce stiffness in joint, the use of heat and cold treatment should be incorporated to help heat helps loosen joints and cold helps reduce pain and inflammation.


If left untreated RA can cause severe disability, which in response will cause a decrease in quality of life. The patient will start to develop comorbidities and premature mortality. Some comorbidities can include cardiovascular disease, cancer, infection, depression, and GI disorders. Resent studies reflect that RA patient have four-fold increased risk for CV compared to the general population. A Cardiovascular risk score was used to evaluate the study and number show an increase in the score with patient with RA. These studies also revealed that the mortality of patient with RA and CV has widened within the last years and remain at an increased number. Standardized mortality ratio suggests that mortality from CV events is 1.5-fold higher among RA patients than among the general population (Handa et al., 2016, p.445). Literature Review or treatment for RA Include a comparison of therapies, including triple therapy with methotrexate [MTX], sulfasalazine [SSZ], hydroxychloroquine [HCQ]. The addition of therapy with corticosteroids with csDMARDs, tsDMARDs, TNF biologic DMARDs, and non-TNF biologic DMARDs. Studies for corticosteroids and csDMARDs show that corticosteroids in combinations with MTX can lead to higher remission rates than MTX alone in patients with moderate to severe disease. This gives the patient a higher quality of life and gives them a higher functional capacity. The corticosteroids used were heterogeneous and included varying doses of prednisone (PRED), prednisolone, and methylprednisolone regimens (Donahue et al., 2016).

Recent trials provide evidence that the available population, will benefit from the use corticosteroids and csDMARDs and it does not differ significantly in serious adverse events or discontinuation rates attributable to adverse events. Long-term studies of up to 10 years have shown that the use of a combination csDMARDs or csDMARD plus TNF biologics ultimately showed no differences in serious adverse events between immediate combination and step-up therapies (low SOE). Further trial compared IFX plus MTX with high-dose methyl-PNL and MTX. And the overall showed that SOE was insufficient for discontinuations because of adverse events and serious adverse events. The investigators reported no appreciable differences in overall discontinuation and discontinuation attributable to adverse events (Donahueet al.,2016).


Identifying patients that are at high risk for complications of RA at an early stage, will help us identify patients that are at risk for poor outcomes and allow us to intervene in a timely manner. This is an area that will need further research to help prevent worsening of the disease and limiting joint damage. The prognosis of RA is appearing to be the RF factor positivity, which will be most important at predicting joint damage, and functional disability. It is known that IgA RF is the most predictive. WE are far from the cure of RA, but have several treatments at our disposal, used in single doses or in combination therapy to help. The goal of therapy for RA should be to control symptoms and hopefully control the symptoms of inflammation, and joint pain. Helping the patient alter the course of the disease will help improve the prognosis of joint damage. The goal of the NP should include the control of symptoms such as joint pain, inflammation and minimize loss of the joint (Albrecht & Zink, 2017).

Albrecht, K., & Zink, A. (2017). Poor prognostic factors guiding treatment decisions in rheumatoid arthritis patients: A review of data from randomized clinical trials and cohort studies. Arthritis Research & Therapy, 19(1). https://doi.org/10.1186/s13075-017-1266-4

Coumbe, B. G., Nikiphorou, E., & Sokka-Isler, T. (2020). Combination therapy in rheumatoid arthritis. Oxford Textbook of Rheumatoid Arthritis, 457-462. https://doi.org/10.1093/med/9780198831433.003.0037

Donahue, K. E., Gartlehner, G., & Schulman. (2016). 094 A systematic review of the impact of intensive therapy on remission in rheumatoid arthritis. Rheumatology. https://doi.org/10.1093/rheumatology/kew144.021

Handa, R., Rao, U., Lewis, J. F., Rambhad, G., Shiff, S., & Ghia, C. J. (2016). Literature review of rheumatoid arthritis in India. International Journal of Rheumatic Diseases, 19(5), 440-451. https://doi.org/10.1111/1756-185x.12621

Mil, A. V. (2020). Clinical features of rheumatoid arthritis. Oxford Textbook of Rheumatoid Arthritis, 109-120. https://doi.org/10.1093/med/9780198831433.003.0011

Peterfy, C., Conaghan, P. G., & Østergaard, M. (2020). Radiography in rheumatoid arthritis. Oxford Textbook of Rheumatoid Arthritis, 177-194. https://doi.org/10.1093/med/9780198831433.003.0017

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