Rheumatoid Arthritis Case Study Essay

Skeeter Buck has had 4 old age of joint troubleful sensation with some very austere occasions. He complains of ungracefulness in his wrists, give, knees, and feet. The stiffness seems to last anywhere from 30 minutes to 2 hours in the daybreak. 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 but 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 Grandmother and mother fork out woebegone arthritis and cave in had surgery.Grandma had a hip replacement and his mother had a knee replacement. Most of his family is overweight but in that location is no memorial of diabetes or heart disease. Social life style Married 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 atomic number 50e when his flare ups are bad. Lifestyle History Enjoys playing with the kids. He is as active as he can be without being in pain. He helps coach the field hockey team his oldest son plays on. Wife is a dietician and so he eats healthy meals on a regular basis.Risk Factors He is a non-smoker, regular cholesterol levels, and normal blood glucose levels. Physical testing General Appearance Looks healthy, comfortable and has great colour in face. indispensable 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 vein venous distension, clear lungs, normal point of impulse, regular rate and rhythm, no extra heart sounds, no edema, normal peripheral vascular exam. hide no rashes, a bit red, swollen and warm around knuckle duster on hands and feet. Musculoskeletal walks slow due to pain, joints on the hands and feet are a bit swollen, does not have a expert depart of motion in his joints. Neurologic Normal cranial nerves, dismission of fine motor skills in hand, normal sensory exam. Resting Electrocardiogram originally Exercise Test Sinus rhythm, rate= 72 beats per minute, no Q waves, ST or T wave abnormalities. Computer interpretation is normal electrocardiogram. diagnosisRheumatoid arthritis in wrists, hands, knees, and feet causing stiffness in the morning and pain throughout the day especially after much than normal substance abuse of the joints. This causes model intolerance and have on. Plan Complete a standard hertz ergometer test and initiate a training program counsel on increasing workout tolerance, ponderousness faculty, and range of motion. ** Please confer to following pages for pre-screen and informed consent forms ** PATHOPHYSIOLOGY Rheumatoid Arthritis Rheumatoid arthritis is a vitrine of inflammatory arthritis and an autoimmune disease.An autoimmune dis ease is one where the bodys immune remains becomes conf utilize and begins to attack its own body. In derelict arthritis the target of the immune attack is the lining of the joints (synovial) and sometimes other ingrained organs. This causes s substantiallying, pain, turmoil, and joint destruction. Inflammatory cells release enzymes that can digest bone and gristle 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 ( stoppages of time with intensified symptoms followed by period of time with reduced symptoms). Rheumatoid arthritis usually begins slowly, starting with only a a couple of(prenominal) joints and spreading to others over a period of a few hebdomads to a few months. People with unhealthy arthritis have impaired exercise tolerance. The disease affects flexibility, biomechanic al efficiency, muscle long suit, endurance, and speed, which contributes to functional limitations.There are three levels of classifying screaky arthritis disease stages 1. Acute reversible signs and symptoms in the joint link to synovitis 2. continuing stable but irreversible structural damage brought on by the disease process 3. Chronic with smashing exacerbation of joint symptoms change magnitude pain and decreased range of motion and function often related to overuse or superimposed injury. (3) Figure(12) Signs and Symptoms of Concern (13)You should see your regenerate if you feature any of the following symptoms for more than two weeks Feel comical pain and stiffness in your joints suffering and stiffness in the morning lasting more than 30-60 minutes before you feel any relief pitcher Feel more fatigued than normal Lack of hunger pencil lead to weight loss Importance of Exercise for Rheumatoid Arthritis Patients Although masses with rheumatoid arthritis may be hesi tant to exercise due to pain they experience within their joints, current evidence suggests that a significant amount of stultification related to the condition occurs from lack of fitness. By not recitation, 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 jeopardize for other degenerative diseases much(prenominal) as coronary heart disease, diabetes mellitus, and osteoporosis. The American College of Sport care for 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 oxidative efficacy in order to enhance psychological state and decrease the risk of cardiovascular disease.(8) Although long term effects of dynamic weight pushchair exercise on those with rheumatoid arthritis remains unclear, current data suggests that lively exercise may be used to improve joint mobility, muscle strength, and aerobic capacity without causing joint damage (except when there is an acute joint inflammation or uncontrolled systemic disease)(8). Those with rheumatoid arthritis should look on that post exercise discomfort should be expected, but activities causing change magnitude 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 proficient form of comprehendment for those who are not experiencing acute symptoms. The American College of Sports medicament suggests that people with rheumatoid arthritis should participate in large muscle activities such as walking, cycling, rowing, swimming, and dance at 60-80% of their peak heart rate or 40-60% VO2max, a rate of perceived exertion (RPE) rati ng 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 serious to emphasis duration is more important than zeal with goals of increasing VO2max, peak work, and endurance within 4-6 months. It is also important to have at least fifteen minutes of warm-up 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, biologic Agents, Salicylates, and inconvenience oneself Relief Medications.Your doctor will most likely use a combination of these drugs to alleviate pain and save nurture 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 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 express to trigger adverse side effects if used in extensive periods. Examples of these side effects include easy bruising, glaucoma, cataracts, diabetes, excessive weight gain, and newspaper clipping of the bones. DMARDs DMARDS or Disease Modifying Anti-Rheumatic Drugs are groups of medications that serve to inhibit the immune system from damaging the joints, thus slowing further joint damage.Rheumatoid arthritis causes long-lived joint damage in the early stages and so i t is very important to start these medications right away. The risks for severe side effects are gritty with these medications. Taking DMARDs for a long time may result in bone marrow and liver toxicity, vulnerability to infections, skin allergies, and autoimmunity. Biological Agents Biological agents or biological drugs function to alleviate inflammation via various methods. An lawsuit of how they work is by inhibiting tumour necrosis factors.They also can treat inflammation through eradicating Beta cells. Salicylates Salicylates reduce the bodys end product 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 in the end function better. (2) PHYSICAL ASSESSMENT PROTOCOLTo determine 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 tolerate sub-maximal and subjective symptom-limited tread-wheel 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.