case report of a patient with rheumatoid arthritis undergoing shoulder surgery

Case Description:The patient was a 60-year-old female elementary school teacher with functional class III adult-onset rheumatoid arthritis, who came to physical therapy 2 weeks after undergoing a hemiarthroplasty for RCTA of the right shoulder.

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What is a case study of rheumatoid arthritis?

Below is a case study of rheumatoid arthritis patient. The patient is 69 years old, woman, and a mother. She has been diagnosed with seropositive rheumatoid arthritis. She complains of increasing pain and stiffness in her hands and knees.

What is rheumatoid arthritis (RA)?

Robert George Lahita defines rheumatoid arthritis as a “chronic inflammatory disorder of the movable joints”. Lahita explained that rheumatic arthritis is different from osteoarthritis as “it is not caused by wear and tear”.

What are the symptoms of seropositive rheumatoid arthritis?

Thus a person suffering from rheumatoid arthritis complains primarily of pain from those mention body parts. Below is a case study of rheumatoid arthritis patient. The patient is 69 years old, woman, and a mother. She has been diagnosed with seropositive rheumatoid arthritis. She complains of increasing pain and stiffness in her hands and knees.

What is the nursing role in the management of rheumatoid arthritis?

In many hospitals, there is observance of nursing involvement in the management of Rheumatoid Arthritis. According to Margaret Alexander, Josephine Fawcett and Phyllis Runciman, the aim of care is “to maintain independence as long as possible and provide comfort and support”.

Can you have surgery if you have rheumatoid arthritis?

Drugs for rheumatoid arthritis, or RA, can slow it down. But if you already have joint damage, surgery may be your best option. The main reasons to choose surgery for rheumatoid arthritis are to get relief from pain and to help you move better.

Do you need surgery if you have rheumatoid arthritis?

Most people with RA never have surgery but—like people with osteoarthritis—people with rheumatoid arthritis may elect to have surgery to reduce joint pain and improve everyday function. The most common surgeries are joint replacement, arthrodesis and synovectomy.

Can shoulders be affected by rheumatoid arthritis?

RA commonly involves the shoulders and is manifested by tenderness, nocturnal pain, and limited motion. Initially, swelling occurs anteriorly, but it may be difficult to detect and is present on examination in a minority of patients at any point in time.

Can you have surgery for arthritis in shoulder?

Advanced arthritis of the glenohumeral joint can be treated with shoulder replacement surgery. In this procedure, damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. Replacement surgery options include: Hemiarthroplasty.

Is rheumatoid arthritis a Covid risk?

Patients With RA Have Higher Risk for COVID-19 and Related Death, Hospitalization. A study has found that patients with rheumatoid arthritis (RA) may have a higher risk for developing COVID-19 and experiencing COVID-19-related hospitalization or death compared with people without RA.

What is the most common treatment for rheumatoid arthritis?

Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids (corticosteroids) to relieve any pain....The DMARDs that may be used include:methotrexate.leflunomide.hydroxychloroquine.sulfasalazine.

How do you treat rheumatoid arthritis in the shoulder?

NON-SURGICAL TREATMENTSRest.Physical therapy to improve range of motion and strength.Nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin, Advil/Motrin (ibuprofen) or Avele (naproxen) to help reduce pain and swelling.Corticosteroid injections in the shoulder to reduce pain and swelling.Moist heat.More items...

What is rheumatoid arthritis in the shoulder?

Rheumatoid Arthritis of the Shoulder Rheumatoid arthritis is an autoimmune disorder, which means your body attacks your own healthy cells, which may include the lining of the joint. This inflammatory arthritis can be present in both shoulders at the same time.

What is the best treatment for arthritis in the shoulder?

These treatments include:Resting the shoulder joint. ... Taking over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin. ... Performing physical therapy as assigned by the doctor.Performing range-of-motion exercises. ... Applying moist heat.Applying ice to the shoulder.More items...•

How successful is shoulder surgery arthritis?

The majority of all shoulder surgeries are successful. However, complications can occur even when surgeries are done properly and go smoothly. A doctor and patient can talk about the existing wear-and-tear on the shoulder as well as the patient's lifestyle, hopes and expectations, and potential surgical risks.

How long does it take to recover from shoulder surgery for arthritis?

Six Weeks After Surgery Patients will also begin strengthening exercises at this time. Many times, it takes from three to six months for the shoulder to heal. Regaining full strength and range of motion can take up to a year.

How long is recovery from shoulder surgery?

During your recovery period, you will work with your physical therapist to regain motion and strengthen the area. The rotator cuff surgery recovery timeline can vary case by case, but a full recovery typically takes four to six months. It may take longer than that to return to heavy lifting.

What is pseudoseptic arthritis?

Pseudoseptic arthritis is an inflammatory monoarthritis with negative Gram stain and cultures.

How long does it take to recover from pseudoseptic arthritis?

The majority of cases in the literature recover in days to weeks following an acute episode of pseudoseptic arthritis.1–35914Occasionally, rehabilitation therapy is used for residual joint pain.212There are no cases reported that identified joint damage or destruction necessitating joint replacement as a consequence of pseudoseptic arthritis. There is evidence that the condition can recur following initial resolution.9131417Our patient appeared to have a chronic aspect to his condition rather than any further acute attacks.

Is pseudoseptic arthritis a clinical condition?

Pseudoseptic arthritis is becoming an increasingly recognised entity.1–6The condition cannot be differentiated from septic arthritis clinically or on laboratory markers, so is often initially treated as septic arthritis. Diagnosis requires sterile synovial Gram stain and culture, and can only be confirmed when other causes of inflammatory arthritis have been excluded.57–10Clinicians should have a high index of suspicion for pseudoseptic arthritis when managing a patient with a persistently culture-negative inflammatory monoarthritis.

Is pseudoseptic arthritis a inflammatory disease?

Pseudoseptic arthritis is an increasingly recognised entity. It is an inflammatory arthritis that mimics septic arthritis; however, Gram stain and cultures are persistently negative. It is a diagnosis of exclusion. We present the first case, to date, in which pseudoseptic arthritis led to such severe joint degeneration that joint replacement surgery was required. A 54-year-old truck driver with rheumatoid arthritis, on immunosuppressive therapy, presented with acute onset severe left hip pain. He was given a clinical diagnosis of septic arthritis and treated with two prolonged courses of antibiotics despite persistently negative synovial fluid cultures. He experienced progressive joint destruction necessitating a two-stage total hip replacement. A retrospective diagnosis of pseudoseptic arthritis was made. This case demonstrates the difficulties inherent in differentiating between septic and pseudoseptic arthritis. This case also highlights the importance of accurate diagnosis and treatment for pseudoseptic arthritis to avoid accelerated joint destruction.

Is pseudoseptic arthritis a recurrent aetiology?

Previous authors have identified a single case of recurrent pseudoseptic arthritis in a patient with rheumatoid arthritis receiving an anti-TNF-α blocker.13The anti-TNF-α blocker was implicated as the cause, however, this is an unlikely aetiology in our patient as there was no correlation between withdrawal of the drug and resolution of symptoms.

Can culture negative arthritis be treated with steroids?

There are no management guidelines currently for this condition; however, the published literature advocates the use of steroids, either orally or intra-articularly, and the use of other anti-inflammatory drugs.159

Is pseudoseptic arthritis fatal?

Pseudoseptic arthritis is an acute inflammatory monarthritis with a sterile synovial Gram stain and culture.610It is a diagnosis of exclusion, and in the first instance septic arthritis should be ruled out as this is more severe and potentially fatal. 14–691012Pseudoseptic arthritis has been previously described in a number of patients, many of whom have chronic diseases. These include rheumatoid arthritis,161011Behçet's disease,1516pseudogout,17gout,110relapsing polychondritis112and prosthetic joints,1following immunosuppressive therapy113and after intra-articular injection.23712It has also been suggested that there is a link between pseudoseptic arthritis and subsequent development of rheumatic disease.18Despite pseudoseptic arthritis gaining recognition, there is little published literature on the topic.

What is radiographic evidence of osteoporosis?

Radiographic evidence of cartilage and bone destruction in addition to osteoporosis; joint deformity, such as subluxation, ulnar deviation, or hyperextension, without fibrous or bony ankylosis; extensive muscle atrophy; possible presence of extra-articular soft-tissue lesions (e.g., nodules, tenosynovitis)

How often should you change your position in a pulmonary incision?

The client’s position should be changed every 1 to 2 hours to allow full chest expansion and increase perfusion of both lungs. Ambulation, not just sitting in a chair, should be aggressively carried out as soon as physician approval is given. Adequate and regular analgesic medication should be provided because incisional pain often is the greatest deterrent to client participation in effective ventilation and ambulation. The client should also be reassured that these activities will not cause the incision to separate. Adequate hydration, either parenteral or oral, is essential to maintain the integrity of mucous membranes and to keep secretions thin and loose for easy expectoration.

What is S.P. surgery?

S.P. is taken to surgery for a total hip replacement. Because of the intracapsular location of the fracture, the surgeon chooses to perform an arthroplasty rather than internal fixation. The postoperative orders include:

What is S.P.'s medical history?

S.P. is admitted to the orthopedic ward. She has fallen at home and has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: *She is a *75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5 feet 3 inches; weight is 118 pounds. She has a *50-pack-year smoking history and denies alcohol use. She has severe rheumatoid arthritis (RA), with evidence of cartilage and bone destruction, along with joint deformities. She had an upper gastrointestinal bleed in 1993, and had coronary artery disease with a coronary artery bypass graft 9 months ago. Since that time she has engaged in* “very mild exercises at home.” Vital signs (VS) are 128/60, 98, 14, 99° F (37.2° C), SaO2 94% on 2 L oxygen by nasal cannula. Her oral medications are *rabeprazole (Aciphex) 20 mg/day, *prednisone (Deltasone) 5 mg/day, and *methotrexate (Amethopterin) 2.5 mg/wk.

Does osteoporosis show on a radiograph?

No destructive changes on radiograph, possible radiographic evidence of osteoporosis

What causes rheumatoid arthritis?

What really causes rheumatoid arthritis? Robert Lahita explains that human body produces anti bodies that rid the body of foreign invaders called antigen. The immune system produces anti bodies to cells and tissues that make the body but it can also make other antibodies against its own body, which is called auto immune response. The resulting combination causes the existence of rheumatoid arthritis. Prime targets of arthritis in the human body according to Lahita are the musculoskeletal system or the structural support of the body. This system is composed of bones and muscles, tendons, ligaments; cartilage attached to the skeleton. Another is the joints, which is the point at which two or more bones connect. Thus a person suffering from rheumatoid arthritis complains primarily of pain from those mention body parts. Below is a case study of rheumatoid arthritis patient.

How many people have arthritis?

Hire a subject expert to help you with Case study of arthritis patient. Hire writer. Dr. Gary Null noted that more than forty million Americans suffer from arthritis and some 300,000 children have the disease, but this number is rapidly increasing.

Why do people with rheumatoid arthritis suffer from depression?

Haynes noted that people having rheumatoid arthritis generally experience major depression by 80 percent. Some reason for depression of patients with depression is due to lack of social support, decreased mobility, low income, and reduced self-esteem.

What are the prime targets of arthritis?

Prime targets of arthritis in the human body according to Lahita are the musculoskeletal system or the structural support of the body. This system is composed of bones and muscles, tendons, ligaments; cartilage attached to the skeleton. Another is the joints, which is the point at which two or more bones connect.

How much is arthritis relief?

Null further noted the estimates of drug companies, which suggest, “arthritis relief accounts for anywhere from one-third to one-half of the $900 million in annual aspirin sales” and arthritis medications are one of the pharmaceutical industry’s biggest and most lucrative product.

How to cope with arthritis?

Family and friends must be supportive of the patients so they can cope up with negativism on their own. The patient must honestly acknowledge the disease and be open to deal with it properly through the aid of medicine and people around him.

Does heat help arthritis?

They also added that in case of arthritic pain, devices such as “moist air cabinets and whirlpool” may use. Generally, heat can help reduce the tenacity of arthritis however, it has contradictions like inflammation and acute infection. Aside from heat, electrical devices may be used like TENS.