rheumatoid arthritis

rheumatoid arthritis


Mrs. Pam is a lone resident who was diagnosed with rheumatoid arthritis. She is under medication of 15 mg of oral methotrexate which she takes on every Mondays, 5mg of Folic acid which she takes on every Friday, and 1.5 g of Sulfasalazine which she takes twice each day, 400 mg of Hydroxychloroquine which she takes daily. She also takes 200 mg of ibuprofen, 200mg of Omeprazole and 1g of paracetamol. She also receives 40 mg of Humira injection which is supplied by Homecare Company. She also has an acute prescription of 200 mg of trimethoprim which is to be taken twice each day for seven days. This is to cater for a certain infection in the urine.  It is therefore important to have a professional approach toward ensuring that the patient is well taken care of while ensuring that principles of optimization of medicines are adhered to.

Rheumatoid arthritis is a condition of chronic inflammation whose characteristic is lack of control in the proliferation of the Synovial tissue (Kim 167). It is also characterized by wide range of Comorbidities in the multisystem. The disease prevalence is a percentage of 0.8 % in the world. Women are at a higher chance of developing the condition when put in the same comparison with men. Upon being untreated, a percentage ranging between 20 and 30 of people affected by the condition end up being work disabled two to three years after being diagnosed.

Major factors contributing to the pathogenesis are environmental and genetic (Klein 254). As much as testing in the laboratory and studies of imaging may of great assistance in confirming the diagnosis and looking into the progress of the disease, the disease, there is not a single test from the lab which is diagnostic. Complications accompanying the disease may start to come up several months after the disease is presented. It is therefore important to make consultations early enough so that treatment is started. There are several drugs which have been availed in the market. Some of them are inflammatory drugs which are not steroidal, corticosteroids, and modalities which are not pharmacologic. Patients who may not be responsive to a single drug mostly result in combination therapy.

Rheumatoid arthritis is a disease which lasts in the life of a patient, but patients can have remission. Doctors should be in a position of being aware of common Comorbidities. The rate of the disease progress is monitored depending on the change in certain symptoms and findings of the laboratory (Kourilovitch 302). Very bad outcomes in the first stages of the disease are characterized by a functional score which is low, a poor socioeconomic status, too many joints being involved when it’s early, too much sedimentation of erythrocyte, the presence of rheumatoid factor and changes in radiology when it is early.

Rheumatoid arthritis has a characteristic of persistent inflammation of the joint synovial tissue. With time, bones are eroded, cartilage destroyed and loss of integrity in joints is a possible occurrence (Bryun 265). At long last, most of the systems of organs may become affected. The disease is the very common inflammatory arthritis. The onset of the condition may come up at the ages of 30 to 50.  In the United States, 25 people in 100,000 men and 54 people in 100,000 women are estimated to have contracted the disease.  More than 250000 people are hospitalized under visits of physicians amounting to 9 million.


Rheumatoid arthritis is viewed as a clinical diagnosis. It is observed that patients experience the presence of pain and stiffness in several joints. However, a third of those experiencing the sickness may feel the symptoms in scattered locations within their body. Most of the patients have the symptoms come up from weeks to months. It begins with a single joint, and in most cases, it is accompanied by anorexia symptoms which are prodromal (Sorensen 189). In more than 15 percent of patients, the signs start off days after having an event of illness.

Commonly affected joints are those with a large ratio of synovium cartilage when compared to articular cartilage. Wrists, interphalangeal and metacarpophalagenal joints have a high chance of being involved. Interphalagenal and sacroiliac joints are mostly not affected. Joints of a rheumatoid patient are often tender when touched, boggy and have a sense of warmth (Singh 167). There are patients who make complaints of puffiness in their hands. The weakness of the patient is not in the same proportion as the pain experienced. There is stiffness experienced in the morning when the patient begins moving. People affected by the disease hold their muscles while flexing to ensure that they reduce the pain in capsules which are joined.  Once the patient visits a doctor at the beginning, they should be told to explain the extent to which they feel pain, how long stiffness and fatigue lasts and what the disease limits them from doing.

Tests for Diagnosis

There is no existence of a single test that can confirm the diagnosis of the disease. There are however many tests which can provide data which is objective to increase the certainty of the diagnosis and ensure that the progression of the disease is followed. According to American College of Rheumatology Subcommittee on Rheumatoid Arthritis, basic evaluations of the lab involve and are inclusive of a complete count of blood cells which contain a differential factor of rheumatoid factor and sedimentation rate of erythrocyte (Sun 236). It also involves baseline evaluation of the function of renal and hepatic functions. These assist in coming up with appropriate medical choices.

Optimizing Care for Patient Using Four Principles of Medicine Optimization

Patient Experience

Patients are often faced with the worry of having to take medicines which are toxic their entire life. Most of them dislike injections not to mention self-injections. At the same time, they are faced with the need to have the courage to face pain. As a result, they end up telling the nurses, caregivers, and doctors that they feel much better than they do. At the point when the disease is in remission, he patients may end up not taking their medication because they feel like they are cured. The patients face the need of being helped to live a life which is normal. They also need to be in a position to manage flares on their own when they come up.

It is therefore important to remind the patient that as much as the cure for rheumatoid arthritis, the disease is easy to manage as long as the patients observe medication (Lionta 212). The patient should also be assured that the medication is only toxic to the condition and not the person. The patient should be informed that the medicines have been proven to be safe for use. It is also important to advise the patient on acquiring the best means to relieve themselves of pain.

Evidence If the Medicine Is Appropriate

Rheumatoid arthritis is a disease which can be easily managed. Combination of early treatment helps reduce signs and damage on joints which is caused by the disease. Methotrexate has been proven to provide a boost to other medications and can offer protection to the heart. As a health practitioner, it is important to assure the patient that feeling the effect of medicine may take the duration of up to six months. One should also put into emphasis that the patient should adhere to medication. If a patient is experiencing other infections, they should avoid taking DMARD’s and biological until they are fully recovered.

Safe and Effective

Medicines which are prescribed for the disease are often effective as long as one takes them as per the prescription. Patients should be in a position of monitoring their progress on assessing how the joints feel, the look of their joints and the level of relief of pain they are in need of.  Taking responsibility is part of ensuring that they manage their condition. As a health practitioner, I should ensure that I have access to medication record of the patient. It is also important to ensure that patients make use of their doses for relief and encourages them on the importance of being aware of their DAS28 and what it informs them concerning the disease.

Medicine Optimization as Part of Routine Practice

Being in a position where one is aware of the patient is helpful. It is important for one to familiarize with the life of the patient and their needs. It is important to practice skills of consultation since the patient is bound to come for advice. Upon doing this, the patient will be in a position where they understand the reason behind taking medicine. It is also important to look if patients acquire the desired effect from the medicine they take. It is also important to signpost in the groups and websites of the patient as a means of offering assistance with various aspect of the disease.


The European League against Rheumatism (EULAR) has guidelines whose aim is to ensure that patients suffering from the disease are not over treated. One of their recommendations is that patients suffering from the disease should undergo an every three months monitoring process. An adjustment of the treatment should be done if no improvement is experienced within six months. Also, Methotrexate should be used as the first line of therapy and can be substituted by leflunomide if any contradictions for Methotrexate exist (Smolen, 226). The recommendations also state that Tumor necrosis factor inhibitors are not the only existing biologics which are recommended for patients, who do not quite respond to methotrexate. Any other biologic is equally functional and also affects. Lastly, biologics should be taken in combination with disease-modifying antirheumatic drugs, also known as DMARD’s.

Works cited

Bruyn, George AW, et al. “Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of an OMERACT consensus-based ultrasound score focussing on the diagnostic reliability.” Annals of the rheumatic diseases (2014): annrheumdis-2013.

Kourilovitch, Maria, Claudio Galarza-Maldonado, and Esteban Ortiz-Prado. “Diagnosis and classification of rheumatoid arthritis.” Journal of Autoimmunity 48 (2014): 26-30.

Lionta, Evanthia, et al. “Structure-based virtual screening for drug discovery: principles, applications, and recent advances.” Current topics in medicinal chemistry 14.16 (2014): 1923-1938.

Smolen, Josef, et al. “EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 Update.” Rheumatology 28.1 (2014): 1-25.

Sørensen, Jan, and Merete Lund Hetland. “Diagnosis in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: results from the Danish nationwide DANBIO registry.” Annals of the rheumatic diseases (2014): annrheumdis-2013.

Singh, Jasvinder A., et al. “2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis.” Arthritis & rheumatology 68.1 (2016): 1-26.

Kim, Sooah, et al. “Global metabolite profiling of synovial fluid for the specific diagnosis of rheumatoid arthritis from other inflammatory arthritis.” PLoS One 9.6 (2014): e97501.

Sun, J., et al. “Diagnostic accuracy of combined tests of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis: a meta-analysis.” Clinical and experimental rheumatology 32.1 (2014): 11-21.

Klein, Kerstin, and Steffen Gay. “Epigenetics in rheumatoid arthritis.” Current Opinion in Rheumatology 27.1 (2015): 76-82.

Lee, Eun Bong, et al. “Tofacitinib versus methotrexate in rheumatoid arthritis.” New England Journal of Medicine 370.25 (2014): 2377-2

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